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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 Hull, 1968 M.A. University of British 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 dissertation 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 t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the requirements f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head o f my department o r by h i s o r her' r e p r e s e n t a t i v e s . I t i s understood t h a t copying or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department of d^QU^j^il ir^j P&\Zj (M-(j(OCj lj The U n i v e r s i t y of B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 Date lO < N ^ , l^jf A l l our actions take Their hues from the complexion of the heart As landscapes their variety from light W.T. Bacon Emotion is a transformation of the world. J.P. Satre ABSTRACT The present study compared the relative effectiveness of two interventions in the treatment of marital discord, a cognitive behavioral intervention, teaching problem solving s k i l l s , and an experiential intervention, focussing on emotional experiences underlying interaction patterns. Forty-five 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 in eight sessions by six 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 alliance between couples and therapist and general therapist effectiveness were equivalent across treatment groups, and that both treatment groups made significant gains over untreated controls on measures of goal attainment, marital adjustment, intimacy levels and target complaint reduction. Further, the effects of the experiential treatment were superior to those of the cognitive behavioral treatment on marital adjustment, intimacy, and target complaint level. At follow-up, marital adjustment scores in the experiential group were s t i l l significantly higher than in the cognitive behavioral group. - i i i -TABLE OF CONTENTS Page Dedication i Abstract i i Table of Contents i i i List of Tables v List of Appendices v i i List of Figures v i i i Acknowledgements • ix Chapter I INTRODUCTION 1 Background 1 Definition of Terms 7 Summary of Hypotheses ••• 9 II LITERATURE REVIEW 11 Outcome Research in Marital Therapy 11 Conceptual Models of Interpersonal Conflict and Marital Distress 14 The Role of Emotion in Therapy 33 Emotion in Marital Therapy 41 A Description of Interventions Used 48 III THE METHODOLOGY OF THE STUDY 57 Client Population 57 Therapists 59 Instruments • 61 - iv -Page Data Collection Procedures 72 Hypotheses • • 75 Data Analysis Procedures... 76 Limitations of the Study 78 IV 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 V DISCUSSION OF RESULTS 117 BIBLIOGRAPHY 132 APPENDICES 146 - v -LIST OF TABLES Table Page 1. DAS: Test Statistics 83 2. Pair Perceived: Test Statistics 85 3. Pair Expected: Test Statistics 86 4. Couples Therapy Alliance Scale: Test Statistics 87 5. Summary ANOVA: Couples Therapy Alliance Scale 90 6. Summary ANOVA: Pre-Test Couple Scores 93 7. Pre-Test Pair Perceived Couple Scores 95 8. Summary ANOVA: Post-Test DAS Total Scores 97 9. Multivariate Analysis of Variance: Treatment Outcome Variables 99 10. Summary Repeated Measures ANOVA: Total DAS Follow-Up Scores 108 11. Repeated Measures Analysis: Follow-Up Scores on Differentiating Variables 110 12. Percentages of Couples Improved on Total DAS 115 D-l DAS: Subtest Correlations 201 D-2 DAS Males: Test Statistics 202 D-3 DAS Females: Test Statistics 203 D-4 Pair Perceived: Subtest Correlations 204 D-5 Pair Perceived Individual Scores 205 D-6 Pair Expected: Subtest Correlations 206 D-7 Pair Expected Individual Scores . 207 E-l Summary of ANOVAS: Demographics 209 E-2 Test of Emotional Style: Analysis of Variance 210 E-3 Couples Therapy Alliance Scale Individual Scores 211 - v i -Page E-4 Summary ANOVA: Task Dimension of Alliance 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 219 E-12 Individual Post-Test Scores 220 E-13 Repeated Measures Analysis: Follow-Up Scores on Non-Differentiating Variables.. 221 E-14 Summary ANOVAS: Individual Total DAS Scores at Follow-Up.. 222 E-15 Individual Follow-Up Scores on Differentiating Variables... 223 E-16 Individual Follow-Up Scores on Non-Differentiating Variables 224 - v i i i -LIST OF FIGURES Page 1. Groups Means on Total DAS Scores at Pre-Test and Post-Test and Follow-Up Assessment 116a - v i i -LIST OF APPENDICES Page A. Treatment Manuals 146 B. Instruments Used in the Study 175 C. Forms: Consent and Follow-Up 195 D. Item Analysis 200 E. Data Analysis 208 - ix -ACKNOWLEDGEMENTS I would like to thank a l l members of the research committee and Mr. Bob Prosser for his invaluable assistance in s t a t i s t i c a l analysis. I would also especially like to acknowledge the particular 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 is dedicated to my mother, Winifred Dorothy Bell, who taught me how to strive. 1 CHAPTER I INTRODUCTION Background Interpersonal conflict 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 is that of educating i t s citizens to resolve interpersonal conflict without reference to solutions such as the law. One sub-set of such conflict which seems particularly disruptive in the everyday l i f e of people in North America is the conflict which arises between spouses. In Canada and the U.S.A. one marriage in three currently ends in divorce (U.S. Bureau of the Census, 1976, Adams & Nagnur, Statistics Canada, 1981). There is also evidence that marital disruption is a significant stressor with a greater incidence of psychiatric admission, motor vehicle accidents, physical illness and alcoholism occurring during or after marital separation (Bloom, Asher & White, 1978). The negative consequences of marital disruption for children is well documented (Wallerstein & Kelly, 1974), and Renne (1971) has suggested that in terms of physical health, marital distress can be as damaging as marital separation. On the other hand there is now evidence to suggest that positive close relationships seem to help innoculate those involved against the stresses of l i f e . Myers, Lindenthal, 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 increased psychiatric impairment. Lowenthall and Haven (1968) in their analysis of adaption 2 in the later 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 in 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 is a key correlate in a person's a b i l i t y to adapt over the lifespan; in fact Lowenthal and Weiss (1976) suggest that men and women find the motivation to live autonomous satisfying lives only through the presence of one or more mutually supportive and intimate dyadic relationships. The main vehicle for such intimacy in our society would appear to be through the institution of marriage. Given the significance of intimate dyadic relationships and the fact stated above that one in three marriages currently ends in divorce i t would seem to be no accident that marital therapy as a f i e l d has grown substantially in the last decade (Gurman & Kniskern, 1981). The growth of marital therapy may also be viewed as being part of a shift towards a concern with human transactions rather than just the behaviour of individuals. 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 in the present flowering of marital and family therapy approaches. Duke and Nowicki (1982) point out that effective treatment outcomes in a l l theoretical orientations are linked to changes in the client's customary ways of interacting with others, the attitudes he or she maintains towards others, and the beliefs he or she holds about him or herself. 3 Sullivan (1953) stressed that such beliefs about the self are, above a l l interpersonal in both their development and current evolving contents. This view is echoed by Kiesler (1982) who suggests that the self is social, interpersonal and transactional in i t s development and functioning throughout l i f e . Marital therapy has grown not only as a separate entity but as a component or general mode of intervention for a wide variety of problems traditionally treated by individual psychotherapy including affective disorders, alcoholism, sexual dysfunction, childhood behaviour problems and obsessive compulsive disorders such as agoraphobia. In fact in the last decade marital therapy may be viewed as having evolved into one of the most significant psychotherapeutic interventions in the mental health f i e l d (Gurman, 1978). Also as Lewis, Beavers, Gosset and Austin Phillips (1976) point out in their study of psychological health in family systems, interventions at the level of the marital relationship have considerable potential for creating change at other levels, and that i f only one level could be approached (individual, marital or family) the marital level would seem to have potentially the greatest impact upon both the individual and the total family. As the f i e l d of marital therapy has grown research into the effects of such therapy has also grown (Gurman & Kniskern, 1981). By 1978 Gurman and Kniskern (1981) were able to state that in general non-behavioural marital therapy appeared to produce beneficial effects in 65% of cases, which is essentially the same gross improvement rates noted for non-marital individual 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 efficacy 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 is then well recognized in the literature. The completion of such comparative studies has been hampered by the fact that considerable homogeneity of interventions exists across different theoretical models. This homogeneity of interventions is reflected for example by the fact that Sager, a psychodynamic practitioner (1981) and Weiss, a behavioral practitioner, (1978), both use operations such as behavioral contracting. Particular models have also become more encompassing. O'Leary and Turkewitz (1978) point out that even behavior therapy has tended to become ambiguous as a result of the cognitive trend in psychology. A comparison of different kinds of interventions from different models addressing specific problems would then address the need for an investigation into what kinds of interventions are most effective in the marital context. A specification of the target of change would also be a desirable refinement in any study comparing interventions taken from different models of therapy. In marital therapy one of the most logical targets would appear to be the conflict engaged in by distressed couples. There is agreement in the literature that effective conflict resolution interactions between spouses is crucial for the maintenance 5 of marital satisfaction (Glick & Gross, 1975), and that distressed couples have greater numbers of unresolved problems and conflict episodes than do non-distressed couples (Birchler & Webb, 1977). Since one of the main goals, i f not the sine qua non of marital therapy, is to f a c i l i t a t e the resolution of conflict between spouses, the effect of different kinds of interventions on marital conflict resolution would appear to be a f r u i t f u l area of investigation. Although i t is often d i f f i c u l t to distinguish different types of interventions encompassed within contrasting models, there does seem to be a clear distinction between the rational problem solving operations typically employed by cognitive behaviorists (Jacobson, 1981; Jacobson & Margolin, 1979; O'Leary & Turkewitz, 1981) and the emotional exploration operations of the more experiential and dynamic approaches (Feldman, 1982; Wile, 1981; Perls, 1973). Experientially oriented treatments have emphasized the importance of assisting clients to explore and experience previously disavowed emotional material in order to help resolve their problems, whereas approaches based upon classic 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 efficacy of two intervention modes currently operating in the f i e l d of marital therapy and would also add to the knowledge in the f i e l d in other ways. For example, considerable interest has been recently shown in the role of affect in behavior therapy (Rachman, 1981) and in marital therapy in particular (Margolin & Weinstein, 1983); however therapeutic 6 operations geared towards working with emotion have been associated with psychodynamic or humanistic formulations, which do not r e a d i l y lend themselves to empirical study. To s t i p u l a t e s p e c i f i c emotionally oriented operations and describe t h e i r effectiveness would then seem to be valuable i n i t s e l f . The r o l e of emotional experience i n the r e s o l u t i o n of interpersonal c o n f l i c t 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 r e s o l u t i o n or other changes i n therapy i s then a c o n t r o v e r s i a l issue requiring further exploration. Emotional experience has ranged from being considered i r r e l e v a n t , detrimental, or i n c i d e n t i a l to necessary and even c r u c i a l to therapeutic change. Recently therapists such as Epstein and Bishop (1981) have proposed that human emotions function as f a c i l i t a t i n g factors i n problem solving since d i f f e r e n t emotions tend to stimulate d i f f e r e n t solutions (for example anger f a c i l i t a t e s an aggressive/defensive s o l u t i o n ) , and t h e o r i s t s such as Zajonc (1980) have argued for the dominance and primacy of a f f e c t i n human experience. Mahoney (1980) has suggested that the r o l e of a f f e c t i n psychotherapy i s a key issue with t h e o r i s t s of d i f f e r e n t persuasions biased e i t h e r towards the control or expression of a f f e c t . As a consequence there has been a lack of studies which examine si t u a t i o n s i n which a f f e c t i v e expression may f a c i l i t a t e therapeutic change. The s t i p u l a t i o n and evaluation of interventions focussing upon and using emotion thus has general s i g n i f i c a n c e outside the context of marital therapy. In summary t h i s study i s concerned with the s p e c i f i c a t i o n of an a f f e c t i v e l y based treatment for marital discord followed by a preliminary evaluation of the e f f i c a c y of t h i s treatment when compared 7 with a wait l i s t control group and with a problem solving cognitive-behavioral treatment. As suggested above such a study would appear to have considerable current 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 relevance; addressing the need for the s p e c i f i c a t i o n and evaluation of approaches to marital therapy other than the well-documented behavioral approach and the more general question of the relevance of a f f e c t i v e experience 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 of Terms Operational d e f i n i t i o n s of the key concepts used i n t h i s study are as follows: M a r i t a l Therapy: Gurman (1978) defines marital therapy as therapy i n which the marital r e l a t i o n s h i p i s the patient. Gurman and Kniskern (1978) view marital therapy as a subtype of family therapy, and comment that some family therapists focus on and conceive of the spouse dyad as being the core family sub-system requiring change ( S a t i r , 1967). However, i n t h e i r a r t i c l e they evaluate marital and family therapy semi-independently since t h i s i s i n keeping with the current 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 involves the modification of an intimate r e l a t i o n s h i p between two partners, i n such a way as to reduce pain and discomfort and increase s a t i s f a c t i o n and a sense of well-being. Such modification may involve 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 acceptable basis or f a c i l i t a t i n g a separation of the spouses. The process may be viewed i n molecular terms as the creation of a more acceptable contract, i n the sense of behaviors 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 positions taken by each partner i n the r e l a t i o n s h i p . M a r i t a l C o n f l i c t : D i f f e r e n t extensive conceptualizations of t h i s phenomenon are summarized i n Chapter I I . Fink (1968) defines s o c i a l c o n f l i c t i n terms of antagonistic psychological r e l a t i o n s or antagonis-t i c i n t e r a c t i o n . Koren, Carlton and Shaw (1980) state that "Marital c o n f l i c t i s an adversary event within the context of an ongoing intimate r e l a t i o n s h i p . Thus i n the process of influencing each other toward opposing content spouses also a f f i r m or redefine the character of t h e i r marriage" (p. 461). This d e f i n i t i o n was employed i n this study. Altman and Taylor (1973) suggest that continued unresolved interpersonal c o n f l i c t acts to create "depenetration" or loss of intimacy and rewards i n a r e l a t i o n s h i p so that the process moves to "successively more s u p e r f i c i a l areas of the r e l a t i o n s h i p " (p. 173). Waller and H i l l (1951) distinguished between acute progressive and habituated c o n f l i c t i n marriage and suggest that the deeper the investment and ego-involvement 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 tends to be viewed as a threat to the s e l f . C o n f l i c t Resolution: Koren et a l . (1980) suggest that c o n f l i c t outcomes can be evaluated from two major perspectives, one that focuses on mutual s a t i s f a c t i o n and another that focuses on the attainment of objective r e s o l u t i o n s . This study w i l l attempt to address both viewpoints by assessing 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 well as an assessment of s p e c i f i c goal attainment. Problem Solving Treatment: This treatment i s defined as the problem solving interventions described i n Appendix A, which focus upon 9 the teaching of new s k i l l s and rules for resolving c o n f l i c t u a l i n t e r a c t i o n . Problem solving i s defined by Jacobson and Margolin (1979) as "a structured i n t e r a c t i o n between two people designed to resolve a p a r t i c u l a r dispute between them," concentrating upon "manifest observable complaints" (p. 117). Emotionally Focussed Treatment: The emotionally focussed treatment i n this study i s defined as the interventions described in Appendix A, which are designed to bring to awareness and develop rather than suppress or dispose of emotional experiences. The exploration of underlying emotional issues i s the focus of therapy. M a r i t a l D i s t r e s s : Distress i n this study was operationalized as at l e a s t one partner scoring below 100 on the Dyadic Adjustment Scale (Spanier, 1976). Couple scores were obtained by taking the mean of the i n d i v i d u a l scores for each couple. This study considers d i s t r e s s l e v e l on an i n d i v i d u a l basis rather than requiring both partners to score below 100, since one distressed partner i s adequate to constitute a distressed r e l a t i o n s h i p and i n fact i n couples who request therapy one partner usually presents as s i g n i f i c a n t l y more distressed than the other. The pre-treatment couple scores i n t h i s study ranged from 71 to 105, the mean being 92. The o v e r a l l mean DAS scores was 93.8 for husbands and 90.5 for wives. The following hypotheses are under i n v e s t i g a t i o n i n t h i s study: that both an a f f e c t i v e l y oriented treatment and a cognitive behavioral s k i l l oriented treatment w i l l be more e f f e c t i v e i n helping couples reach r e l a t i o n s h i p goals, reduce target complaints, increase marital adjustment and l e v e l s of Intimacy than a wait l i s t control condition, and that these two treatments w i l l have d i f f e r e n t i a l e f f e c t s on the above variables as measured at post assessment and at follow-up. 11 CHAPTER II LITERATURE REVIEW The following review w i l l focus on the outcome l i t e r a t u r e i n ma r i t a l therapy, conceptual models of interpersonal c o n f l i c t and marital d i s t r e s s , interventions i n marital therapy, and the role of emotion i n psychotherapy and i n marital therapy i n p a r t i c u l a r . A d e s c r i p t i o n of the treatments used i n t h i s study then follows. Outcome Research i n M a r i t a l Therapy In the l a s t decade the rate of growth of research i n the outcomes of marital and family therapy has been astounding. Recent extensive reviews of the family and marital therapy research have been completed by Gurman and Kniskern (1978, 1981), Jacobson (1978), and Williams and M i l l e r (1981). Gurman and Kniskern (1981) i n t h e i r review state that the evidence suggests that both behavioral and non-behavioral treatments are 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 that, i n the marital therapy reviewed 65% of cases improved. They note that conjoint treatment i s c l e a r l y the treatment of choice, since i n d i v i d u a l psychotherapy for the treatment of marital problems has a poor record when i t comes to p o s i t i v e outcomes and also a high rate of negative outcomes. Williams and M i l l e r (1981) state that, although there seems to have been l i t t l e change i n q u a l i t y , the quantity of outcome research i n t h i s area has recently t r i p l e d , and the question of general therapeutic effectiveness 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 effectiveness of the key approaches to m a r i t a l therapy does not seem to have been addressed. Comparative studies i n the marital area have been confined to a comparison of the treatment components within one model. Margolin and Weiss (1978) for example, compared behavioral communications s k i l l s t r a i n i n g with that t r a i n i n g plus a cognitive r e s t r u c t i n g component and a non-specific intervention ( f i n d i n g that the communication s k i l l s plus cognitive r e s t r u c t u r i n g component was the most e f f e c t i v e ) ; and O'Leary and Turkewitz (1981) conducted a comparative outcome study of "good f a i t h " contracting plus communication enhancement and communication s k i l l s t r a i n i n g involving 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 l i t e r a t u r e only one non-analogue study that compares behavioral interventions with a form of nonbehavioral m a r i t a l therapy, and that i s the study conducted by Liberman, Levine, Wheeler, Sanders and Wallace (1976) who compared communications s k i l l s t r a i n i n g plus contingency contracting group intervention with an approach co n s i s t i n g of the v e n t i l a t i o n and discussion of f e e l i n g s . Here couples i n both groups improved on s e l f - r e p o r t measures but only the behavioral group showed improvement on problem solving methods. Methodological problems such as the lack of a control group, non-random assignment and a small therapist sample q u a l i f y any conclusions based on these data. There are four analogue studies which compare behavioral and nonbehavioral approaches i n existence. The f i r s t of these studies i s by Fisher (1973), who compared behavioral group therapy with an Adlerian group format involving non-distressed couples and found that both 13 interventions increased perceptual congruence or agreement between husband and wife. The second study by Wieman (1973) which compared groups that taught behavior exchange s k i l l s to groups involved i n a conjugal 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 post-treatment differences on various 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 with a contingency contracting 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 differences between communication t r a i n i n g (Carkhuff, 1969) and a behavior exchange treatment on s e l f report measures of marital s a t i s f a c t i o n . This shortage of across-model comparative studies i s s u r p r i s i n g when one considers the large volume of l i t e r a t u r e (for example p r a c t i c a l l y the whole June 1978 issue of the journal Family Process) concerned with the r e l a t i v e merits of behavioral versus more dynamically oriented approaches. The shortage of such studies may be due not only to the homogeneity of treatment components across models but also to the lack of i d e n t i t y among the non-behavioral treatments (Williams & M i l l e r , 1981). This lack of i d e n t i t y i s r e f l e c t e d by the fact that i n reviews of outcome research such treatments have been categorized by a c h a r a c t e r i s t i c they lack, that i s by not being behavioral, rather than by an e a s i l y recognizable c h a r a c t e r i s t i c they share. In his review (1978) Jacobson states that "few would deny the popularity of either the psychoanalytic or the systems theory approaches to marital therapy. However neither perspective can claim even a single 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 studies 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 explained by the emphasis of these the o r i s t s on family as opposed to marital therapy" (p. 397). 14 The behaviorists, on the other hand, have been characterized by t h e i r rigorous methodological stance. He also stated that a most welcome research development would be a number of well controlled comparative outcome studies examining approaches that have not been emp i r i c a l l y v a l i d a t e d . The experiential/dynamic approach which has produced a great deal of theory and practice but l i t t l e research i s then one of the approaches that i s r e l a t i v e l y uninvestigated. I t would seem that the time i s ripe for a c o n t r o l l e d study comparing a behavioral and a more e x p e r i e n t i a l / dynamic approach to marital therapy. Since treatment operations tend to be homogeneous across models, i t i s necessary to specify d i f f e r e n t interventions taken from d i f f e r i n g t h e o r e t i c a l perspectives and examine t h e i r e f f i c a c y i n the treatment of dysfunctional marital c o n f l i c t . Despite the s i m i l a r i t y i n the interventions used by therapists of d i f f e r e n t schools, there does appear 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 operations t y p i c a l l y employed by behaviorists (Jacobson & Margolin, 1979; O'Leary & Turkewitz, 1981) to v / change the environment response r e l a t i o n s h i p s , and the emotional exploration operations of the more e x p e r i e n t i a l and dynamic approaches (Pe r l s , 1973; Feldman, 1982; S a t i r , 1973), to change perception and experience. A comparison of these two types of interventions i s then possible and pertinent. Conceptual Models of Interpersonal C o n f l i c t and M a r i t a l Distress In order to understand the process and goals of marital therapy i t i s necessary to consider the phenomenon of interpersonal c o n f l i c t , and 15 the various conceptual models underlying the p r a c t i c e of marital therapy. C o n f l i c t may be viewed as a process i n which incompatible demands or behaviors r e s u l t i n negative i n t e r a c t i o n (Deutsch, 1969). It i s an i n e v i t a b l e but not necessarily a destructive phenomena. C o n f l i c t for example may stimulate i n t e r e s t and c u r i o s i t y , provide an impetus for the v e n t i l a t i o n of problems or the generation of solutions and help to create new adaptive norms. However problems i n marital r e l a t i o n s are usually defined as the presence of dysfunctional c o n f l i c t and discord. Deutsch (1969) suggests that the process of dysfunctional c o n f l i c t i s one that leads to escalation and an expansion of issues rather than re s o l u t i o n and e f f e c t i v e problem solving, and usually involves components of threat and coercion, t a c t i c s which tend to e l i c i t r e c i p r o c a t i o n i n kind. A l l t h e o r i s t s seem to concur that destructive c o n f l i c t often arises when c o n f l i c t u a l issues are ignored and suppressed (Jacobson & Margolin, 1979; Rausch, Barry, Hertel & Swain, 1974), since "the e f f e c t s of unattended c o n f l i c t are i r r e p r e s s i b l e and s a t i s f a c t i o n w i l l be cumulatively impaired" (Jacobson & Margolin, 1979, p. 23). Rausch et a l . (1974) suggest that the suppression of interpersonal differences and of the f e e l i n g s attached to them r e s u l t s i n less of each person's s e l f being communicated and t h i s often leads to an erosion of t r u s t . C o n f l i c t u a l marital i n t e r a c t i o n may also be viewed as an exercise i n interpersonal control whereby spouses attempt to sway each other toward incompatible goals (Morton, Alexander & Altman, 1976); for example one spouse attempts to persuade the other to adopt a point of 16 view or problem solution while the other argues or r e s i s t s . Koren, Carlton and Shaw (1980) state that marital c o n f l i c t i s an adversary event within the context of an ongoing intimate r e l a t i o n s h i p taking place on a content l e v e l and also serving to a f f i r m or redefine the character of the relationshp. This viewpoint i s consistent with that of Watzlawick, Beavin and Jackson (1967), who view a l l communications as containing a content or d i g i t a l component and a r e l a t i o n s h i p d e f i n i n g or analogic component. Gurman (1978) also points out that while there are many ways to define c o n f l i c t , as a demand for immediate change, as the esca 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 solving, or as the f r u s t r a t i o n of inappropriate needs a l l models of dyadic c o n f l i c t see th i s phenomena as a r e s u l t of attempts to define the re l a t i o n s h i p between spouses i n a c e r t a i n way. E f f e c t i v e c o n f l i c t 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 consists of two f a c t o r s , mutual s a t i s f a c t i o n with outcomes and the attainment of objective r e s o l u t i o n s , would appear to be e s s e n t i a l for a marriage to remain v i a b l e and s a t i s f y i n g (Glick & Gross, 1975; B i r c h l e r , Weiss & Vincent, 1975; B i r c h l e r & Webb, 1977). Dysfunctional c o n f l i c t has also been associated with p a r t i c u l a r i n t e r a c t i o n a l patterns, such as the frequent occurrence of c r i t i c i s m and derogatory blaming (Koren et a l . , 1980, Bernal & Baker, 1979); more frequent negative a f f e c t r e c i p r o c i t y i n general; s p e c i f i c responses such as cross complaining (Gottman, 1979); high r e a c t i v i t y , that i s functioning on the basis of immediate contingencies (Jacobson, F o l l e t t e & Waggoner Mcdonald, 1982); and s e l e c t i v e focussing upon negative behavior (Robinson & P r i c e , 1980). These patterns tend 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 decline i n general marital s a t i s f a c -t i o n , the a l i e n a t i o n of the partners from each other and i n e f f e c t i v e problem solving. These kinds of behaviors are p a r t i c u l a r l y potent since negative behaviors account i n general for a larger proportion of the variance i n the spouses ratings of marital s a t i s f a c t i o n than do pleasing behaviors (Patterson, Hops & Weiss, 1975). The approaches towards marital c o n f l i c t and d i s t r e s s vary according 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 three major t h e o r e t i c a l approaches to marital therapy: the psychoanalytic, the behavioral and the systems approach. The Systems Approach: This approach emphasises the interconnected-ness of in t e r a c t i o n s and i s a perspective that, although focussing more on family rather than on s p e c i f i c a l l y marital i n t e r a c t i o n s , has influenced a l l other approaches to marital therapy. Dynamic therapists such as Wile (1981) and behaviorists such as Weiss (1980) both acknowledge t h e i r debt to the systems transactional model and have incorporated t h i s perspective into t h e i r approaches. The systems approach to marital c o n f l i c t i s one which stresses c i r c u l a r c a u s a l i t y (Bateson, 1971; Jackson, 1967), so that each partners behavior i s viewed as a reaction or adjustment to the behavior of the other. The i n d i v i d u a l s behavior i s caused then not by personal problems or "neurotic" reactions but by the present operating t r a n s a c t i o n a l system. Systems theory contains 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 psychoanalytic and monadic terms as a r i s i n g when i n d i v i d u a l s are poorly i n t e r n a l l y d i f f e r e n t i a t e d , to authors such as Haley, who focus on the partners 18 struggle for control within the interdependent web of interpersonal transactions which constitute a "system". Haley (1963) views the major " c o n f l i c t s i n a marriage as centering on the problem of who i s to t e l l whom what to do under what circumstances. Individual symptoms may then a r i s e as a means of gaining control i n a r e l a t i o n s h i p . The Palo Alto group (Watzlawick, Weakland & F i s h , 1974) who view themselves as " i n t e r a c t i o n a l " therapists also subscribe to the systems model. Both Haley and the Palo Alto group suggest that c o n f l i c t i s created by paradoxical communication when report or d i g i t a l and command or ana l o g i c / r e l a t i o n s h i p defining l e v e l s of communication are contra-d i c t o r y . Such paradoxical communication i s purposeful i n that i t avoids the open expression of ambivalence and the clear 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 from the anxiety attendent upon s e l f and r e l a t i o n s h i p d e f i n i t i o n . Watzlawick et a l . (1974) also focus on problematic cognitions. He states that often the solution to the problem becomes the problem, i n that what i s problematic i s the meaning att r i b u t e d to the s i t u a t i o n and therefore i t s consequences, rather than i t s concrete facts (Watzlawick, 1976). These theo r i s t s suggest that i t i s how i n d i v i d u a l s "punctuate" a communication sequence that i s of primary importance i n understanding c o n f l i c t s , that i s how a series of events i s grouped to produce cause and e f f e c t l a b e l s . Gurman (1978) has pointed out the s i m i l a r i t y between th i s approach and cognitive behavioral therapists such as Beck (1976), Meichenbaum (1977) and E l l i s (1973). In t h i s model habitual modes of operating are maintained, and c o n f l i c t r e s o l u t i o n opposed by an inherent homeostatic or balancing mechanism, which i s presumed to operate i n any 19 system to maintain s t a b i l i t y and equilibrium. This, by i m p l i c a t i o n , places the therapist i n a p o s i t i o n where i t i s necessary to s t r a t e g i c a l l y manipulate c l i e n t s often with paradoxical i n s t r u c t i o n s since d i r e c t intervention w i l l be r e s i s t e d . The major contribution of the systems theory o r i e n t a t i o n has been i t s emphasis on present couple i n t e r a c t i o n s , and on the c y c l i c a l 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 i n t e r a c t i o n s (Wile, 1981). However, t h i s perspective on the process and organization of communication i s maintained at the expense of a considering i n d i v i d u a l orientated motivational explanations for behavior. As Gurman (1978) suggests, t h i s approach seems to emphasise input and output or "between e f f e c t s " and to l a r g e l y ignore "within e f f e c t s " ; the problem i s i d e n t i f i e d as the patterns of i n t e r a c t i o n which constitute the r e l a t i o n s h i p rather than the i n d i v i d u a l partners. Systems t h e o r i s t s such as Haley (1976) l i k e the behavioural therapists tend to regard fee l i n g s and other i n t e r n a l experience as epiphenomena of overt behavior change. He suggests that main goal of therapy i s to get people to behave d i f f e r e n t l y and so to have d i f f e r e n t subjective experiences. The d i f f i c u l t y here i s that f e e l i n g s of well-being, p a r t i c u l a r l y c r u c i a l 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 high c o r r e l a t i o n with behavioral changes (Strupp & Hadley, 1977). Interventions used i n t h i s approach such as paradoxical d i r e c t i o n s teach the partners nothing about t h e i r r e l a t i o n s h i p so that they are l e f t with no tools to prevent future problems. Interventions s t i p u l a t e d by t h i s model, such as paradoxical i n s t r u c t i o n s are d i f f i c u l t to test 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 of int e r a c t i o n s and meanings. Comparative research i s also d i f f i c u l t since the systems perspective has become so incorporated into other approaches. The Psychoanalytic/Psychodynamic Approach: The psychodynamic t r a d i t i o n focuses on c o n f l i c t as an expression of intrapsychic needs, expectations and construals that a r i s e i n the context of an intimate r e l a t i o n s h i p . Barry (1970) states that " i n any interpersonal s i t u a t i o n behavior i s at least p a r t l y determined by the i n t e r n a l reference system (of each of the actors) of s e l f to others and others to s e l f , which i s the product of each ones experience with s i g n i f i c a n t others up to that point i n time" (p. 41). C o n f l i c t s then may be projected intrapersonal p o l a r i t i e s or 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 inappropriate needs (Dicks, 1967) or a change i n needs as a r e s u l t of developmental changes and c r i s e s . Object r e l a t i o n s theory (Dicks, 1967; Meissner, 1978) forms the foundation of t h i s approach. Meissner (1978) suggests that the success of the marital r e l a t i o n s h i p i s determined to a large extent by the "residues of i n t e r n a l i z e d objects and the organization of i n t r o j e c t s which form the core of the sense of s e l f " (p. 27). In t h i s model c o n f i c t i s generally viewed as the res u l t of n a r c i s s i s t i c needs or i n f a n t i l e dependence projected onto the partner, or as a r i s i n g from r i g i d 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 object r e l a t i o n s schemata (Rausch et a l . , 1974). Schemata r e f e r to the organized structures of images of the s e l f and others and the needs and a f f e c t s characterizing the re l a t i o n s h i p s between these images i n one or both partners which then constrain the ways interpersonal messages w i l l be perceived and 21 responded to. Rigid schemata then render the partners unable to change roles i n response to the others needs and t h i s loss of emotional f l e x i b i l i t y r e s u l t s i n marital c o n f l i c t and d i s t r e s s . In t h i s model mar i t a l d i f f i c u l t i e s are then often viewed as symptoms of unresolved childhood c o n f l i c t s (Meissner, 1978; Nadelson, 1978), or i n f a n t i l e impulses and f a i l u r e s i n the separation-individuation process (Abies & Brandsma, 1977). In the l a t t e r case, Mahler's (1968) notion of separation-individuation Is applied to the partners i n the m a r i t a l r e l a t i o n s h i p . F a i l u r e to separate from one's primary care-givers i s hypothesized to be the source of marital c o n f l i c t since dependency and v u l n e r a b i l i t y are increased by t h i s f a i l u r e and the undifferentiated partner or partners come to depend on the responses of the other to define his or her selfhood. . As Skynner (1976) states c o n f l i c t u a l couples "are usually attracted by shared developmental f a i l u r e s " (p. 43). Sager (1981), perhaps the most well known p r a c t i s i n g psychoanalytically orientated marital t he ra pi st , speaks of unexpressed and often unconscious expectations based upon i n t r o j e c t e d childhood influences that form the basis for dysfunctional marital contracts. M a r i t a l c o n f l i c t i n t h i s model i s related to the " i d e n t i t y adequate ego strength" (Dicks, 1967, p. 31) of the partners, that i s t h e i r r e l a t i v e freedom from neurosis or intrapsychic c o n f l i c t around such issues as fears of intimacy or abandonment (Feldman, 1979). The goal of t r a d i t i o n a l psychoanalytically oriented marital therapy i s to restructure those aspects of personality functioning i n both spouses that create d i s t r e s s and c o n f l i c t i n the marital r e l a t i o n s h i p 22 and f a c i l i t a t e each spouse's encountering his or her mate as a safe r e a l person. Gurman (1978) sugges.ts that the psychoanalytic approach o f f e r s a model that bridges the gap between private inner experience and public outer behavior, and thus allows an understanding of both the function and meaning of marital behavior. He stresses that t h i s model also focuses upon the adaptive p o t e n t i a l of marital c o n f l i c t , for as Rausch et a l . (1974) state "of a l l human rel a t i o n s h i p s marriage has the greatest p o t e n t i a l for r e i n t e g r a t i n g the schemata associated with anxieties of childhood,—schemata concerned with t r u s t , giving and receiving love, autonomy, expression 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, closeness and distance" (p. 47). This perspective on marital c o n f l i c t must confront two issues: 1) i t f a i l s to take account of the current patterns of i n t e r a c t i o n that maintain marital c o n f l i c t beyond any perceptual d i s t o r t i o n s engendered by phenomenon such as marital transference, and 2) there are no e x i s t i n g operational d e f i n i t i o n s of central constructs such as i n d i v i d u a t i o n . Gurman (1978) also suggests that while i t may have added to our understanding of the s u b t l e t i e s of the marital relationshp t h i s model has yielded few s i g n i f i c a n t t e c h n i c a l innovations i n the treatment of dysfunctional intimate r e l a t i o n s h i p s . This approach has also tended to l i m i t the therapist to a c t i v i t i e s designed to create insight as to the unconscious o r i g i n s of c o n f l i c t i n each partner (Taylor Segraves, 1982). One v a r i a t i o n of, or perhaps more accurately deviation from, the psychoanalytic perspective that i s s i g n i f i c a n t 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 humanistic existen-t i a l t r a d i t i o n . Whereas i n the psychoanalytic t r a d i t i o n problems are a t t r i b u t e d to uncontrollable impulses, i n the e x p e r i e n t i a l approach problems are a t t r i b u t e d to defenses that r e s u l t i n impulses being subdued and re-emerging i n d i s t o r t e d or exaggerated forms. C l i e n t s are assumed to have healthy fee l i n g s and needs, which w i l l emerge into awareness with the help of the therapist. C o n f l i c t , intrapsychic or interpersonal, i s viewed then as the r e s u l t of the disowning or denial of experience r e s u l t i n g i n d i s t o r t e d expression and a lack of need f u l f i l l m e n t . From the e x p e r i e n t i a l perspective (Rogers, 1951; P e r l s , H e f f e r l i n e & Goodman, 1951), people are regarded as active perceivers, who construct meanings and organize what they see or hear on the basis of t h e i r current emotional state and e x p e r i e n t i a l organization. Kaplan and Kaplan (1981) state that i n t e r n a l experience may be viewed as determined by intrapsychic factors and by context fa c t o r s , i n that r e l a t i o n s h i p rules and d e f i n i t i o n s as well as intrapsychic blocks or s p l i t s determine what people attend to i n themselves and t h e i r partner. The e x p e r i e n t i a l approach then d i f f e r s from the psychoanalytic t r a d i t i o n i n that present experience and i n t e r a c t i o n s with others are the focus of therapy rather than past experiences, and the impulses of the c l i e n t are viewed as healthy rather than signs of developmental f a i l u r e or neurosis. Insight, the usual goal of the psychodynamic therapy, i s not the aim of t h i s approach which regards new emotionally meaningful experience as necessary for the creation of change. S p e c i f i c applications of t h i s model to couple therapy has been l i m i t e d and no 24 outcome studies of an e x p e r i e n t i a l approach to therapy have been completed. The Behavioral Approach: The behavioral approach which i n t h i s f i e l d i s more accurately termed applied s o c i a l learning theory views c o n f l i c t as a demand for immediate change (Weiss & Margolin, 1977). This demand involves the i n i t i a t i o n of coercive i n t e r a c t i o n patterns where one partner seeks to gain p o s i t i v e reinforcement i n exchange for negative reinforcement r e s u l t i n g i n the e s c a l a t i o n of r e c i p r o c i a l aversiveness. More s p e c i f i c a l l y i t i s assumed that marital c o n f l i c t s r e s u l t from f a u l t y behavior change operations (Patterson & Hops, 1972). Thus Jacobson (1981) suggests that distressed couples control the behavior of the other through "the presentation of negative communica-ti o n and the withholding of p o s i t i v e communication" (p. 562). The l o g i c a l antidote to such behavior would seem to be to teach people how to be e f f e c t i v e behavior modifiers (Jacobson, 1978). On a more general l e v e l , Jacobson et a l . (1982) suggest that the basic s o c i a l learning hypothesis underlying t h i s model of marital therapy i s that marital d i s t r e s s i s associated with low rates of rewarding exchanges and high rates of punishing exchanges. Each spouse's behavior i s viewed as l a r g e l y a function of the consequences provided for that behavior by the partner. Thus i f a partner i s rewarded for coercive behavior by compliance from his spouse t h i s behavior w i l l tend to increase, often to the long-term detriment of the r e l a t i o n s h i p . The behavioral approach i s based on behavioral exchange theory (Thibaut & K e l l y , 1959) which suggests that a r e l a t i o n s h i p may be viewed as a market place i n which two people exchange a set of behaviors from 25 t h e i r repertoire and that these behaviors are exchanged with c e r t a i n rewards and costs to each of the partners. So c i a l behavior i s maintained by a high r a t i o of rewards to costs and by the perception 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 fewer rewards and more costs. When reinforcement i s not dispensed at an equitable rate or not judged to be adequate then the s i t u a t i o n fosters c o n f l i c t u a l i n t e r a c t i o n . Theorists such as Stuart (1969) suggest that a quid pro quo or a "something for something" arrangement underlies successful marriages and that distressed marriages are ones i n which there i s a s c a r c i t y of p o s i t i v e outcomes av a i l a b l e for each partner. According to exchange theory then partners 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 reinfo r c e each other at an equitable rate, with exchanges following a norm of r e c i p r o c i t y over time so that p a r i t y i s established. The issue of r e c i p r o c i t y i s an important one i n t h i s model since recent proponents point out that i t i s not only rates of behavior but the sequence that i s important i f behavior i s to be viewed l a r g e l y as a function of i t s consequences. Gottman, Markman and Notarius (1977, 1979), and Margolin and Wampold (1981) have tested t h i s notion of r e c i p r o c i t y and found that there i s a greater tendency towards negative r e c i p r o c i t y i n distressed marriages. Gottman (1979) found however that i n non-distressed couples p o s i t i v e responses were not contingent upon the spouses antecedent code whereas Margolin 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 that partners who were able to resolve 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 i n the structure of t h e i r i n t e r a c t i o n s and were able to "unlatch" (p. 122) at any stage i n an 26 i n t e r a c t i o n and so break negative chains with agreement or some kind of e d i t i n g process. Research on r e c i p r o c i t y seems to suggest then that exchange theory operates i n distressed r e l a t i o n s h i p s rather than i n non-distressed r e l a t i o n s h i p s . Jacobson and Margolin (1979) note that freedom from control by a partner's immediate consequences i s perhaps an operational d e f i n i t i o n of " t r u s t " . They point out that distressed couples seem r e l a t i v e l y dependent on immediate as opposed to delayed punishments and rewards, whereas day to day s a t i s f a c t i o n i n happily married 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 punishing behaviors (Jacobson et a l , 1982). The i n a b i l i t y to resolve c o n f l i c t i n t h i s model i s the re s u l t of negative habitual behaviors r e s u l t i n g from a d e f i c i t i n negotiation and problem solving s k i l l s . Weiss (1978) suggests that i n marriage s a t i s f a c t i o n i s an accomplishment and "accomplishment i s related to s k i l l f u l n e s s as well as e f f o r t " (p. 192), and that such s k i l l involves using rules rather than the s p e c i f i c responses of the partner to d i c t a t e ones own next response. The t r a d i t i o n a l behavioral model of a the o r i s t such as Stuart (1969), i s based on the assumption that the impression which each spouse forms of the other i s based on the behavior of the other. Thus when one changes behavior there are corresponding changes i n each partners impressions and perceptions of the other. This viewpoint gives r i s e to treatment based upon techniques such as contingency contracting. Stuart's approach contrasts somewhat with that of therapists such as Jacobson and Margolin (1979) whose approach includes the modification of cognitive constructs such as the way i n which spouses appraise the r e l a t i o n s h i p i n order to judge i t s adequacy. 27 Jacobson & Margolin then acknowledge the role of cognition i n the creation and maintenance of marital c o n f l i c t , and support the view of the o r i s t s such as Bernal and Baker (1979) who point out that distressed 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 partner (example: the problem i s that you are stupid) rather than viewing problems i n terms of shared r e s p o n s i b i l i t y . Jacobson et a l . (1982) i n t h e i r study on couples r e a c t i v i t y found that t h e i r data suggests that negative behaviors have "a d i f f e r e n t meaning for distressed couples than they do for non-distressed couples. These differences i n meaning seem to implicate cognitive and perceptual differences between distressed and non-distressed couples i n the way they process and i n t e r p r e t r e l a t i o n s h i p events" (p. 713). These behavioral therapists then follow i n the path of th e o r i s t s such as Bandura (1977) who argued that behavior i s mediated by cognitive symbolic mechanisms and set the stage for the evolution of the coping s k i l l s paradigm and the focus upon a t t r i b u t i o n a l theory (Mahoney & Arnkoff, 1978). The teaching of negotiation s k i l l s as put forward by Jacobson & Margolin (1979) has come to epitomize t h i s cognitive behavioral approach to ma r i t a l d i s t r e s s . Comparison of Approaches Gurman (1978) points out that each t h e o r e t i c a l perspective o f f e r s very d i f f e r e n t explanations of the forces operating 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 conceptuali-zations of dysfunctional c o n f l i c t / d i s t r e s s , would seem to imply a d i f f e r e n t basis f o r intervention. However there are many s i m i l a r i t i e s 28 across models i n terms of the therapeutic operations a c t u a l l y used. It i s possible to see 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. The behaviorists consider overt behavior and conscious contracts, with feelings and experience to a c e r t a i n extent being seen as epiphenomena, while the psychodynamic t h e o r i s t s are more concerned with the motives and intentions behind overt behavior and how intimate relationships r e f l e c t and help to construct the nature of the s e l f . Many ultimate goals, process goals, and therapeutic a c t i v i t i e s seem to be commonly found across a l l models of m a r i t a l therapy. Gurman (1978) suggests that a l l models seem to value increased role f l e x i -b i l i t y and a d a p t a b i l i t y , the r e s o l u t i o n of presenting problems and decreased symptomatology, a more equitable balance of power, open and clear communication and increased self-esteem. He points out a p a r t i c u l a r confluence between psychoanalytic and Bowenian goals, and between the systems based communicationists and behaviorists goals. The mediating goals which seem to be of major importance across 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 of each spouses' i n d i v i d u a l desires and needs i n the r e l a t i o n s h i p , (3) r e d e f i n -ing the nature of the couples' d i f f i c u l t i e s , (4) encouraging each partner's recognition of his/her mutual contribution to the marital discord, (5) the modification of communication patterns, (6) increasing p o s i t i v e r e c i p r o c i t y , and (7) decreasing the use of coercion and blame. A l l approaches also attach importance to four therapist a c t i v i t i e s : (1) d i r e c t i n g and structuring the flow of therapy sessions, and guiding the sequencing of treatment goals, (2) challenging assumptions about 29 marriage, and providing a l t e r n a t i v e world views, (3) c l a r i f y i n g the communication process and (4) assigning out-of-therapy homework of various s o r t s . A l l approaches, except the communications-oriented systems t h e o r i s t s , also believe that i t i s important for the therapist to provide an e x p l i c i t r a t i o n a l e for the couple's d i f f i c u l t i e s and the treatment proposed. Many approaches also advocate the teaching of concrete interpersonal s k i l l s , imparting expert knowledge and modelling new more adaptive behaviors. So how do the interventions based upon d i f f e r e n t conceptualizations of m a r i t a l d i s t r e s s / c o n f l i c t d i f f e r ? Some therapeutic goals w i l l d i f f e r , psychodynamic therapists being more oriented towards personal growth than the b e h a v i o r i s t s , who focus primarily upon s k i l l s . Techniques guided by d i f f e r e n t conceptualizations w i l l also be implemented with a d i f f e r i n g focus, i n t e n t , and within a d i f f e r e n t context. For example, Jacobson (1981) points out that i n the more behavioral approaches, communication s k i l l s are "problem" not "expres-sion" oriented. The view of the couple-therapist r e l a t i o n s h i p , and how i t i s used to achieve treatment goals, also d i f f e r s i n various models, technique being the key to success i n the behavioral models, and an intense therapeutic r e l a t i o n s h i p being seen as c r u c i a l i n the more psychodynamic approaches. The differences between the main t h e o r e t i c a l models may be c l a r i -f i e d by considering how each approaches the modification of communica-ti o n patterns i n marital therapy. The modification of communication patterns i s the most common key element found i n a l l marital therapies. Communication here i s the 30 i n t e r a c t i o n a l content and the means by which the r e l a t i o n s h i p i s defined; that 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 change, and a target for s p e c i f i c intervention i n i t s e l f . As Jacobson and Dallas (1981) point out communication i s "the primary vehicle for the exchange of rewards and punishments i n a r e l a t i o n s h i p " (p. 392). Koren et a l . (1980) found that low c r i t i c a l n e s s and high responsiveness predicted c o n f l i c t r e s o l u t i o n and s a t i s f a c t i o n with that r e s o l u t i o n . He suggests that couples use t h e i r communication behaviors to convey r e l a t i o n s h i p a t t i t u d e , whereas other t h e o r i s t s such as Gottman (1978) suggest that a lack of s k i l l r e s u l t i n g i n a contrast between the intended and received message i s the root of marital d i s s a t i s f a c t i o n . This would seem to be a key d i s t i n c t i o n . M a r i t a l therapists who are behaviorally oriented tend to concentrate on increasing communication s k i l l s e s p e c i a l l y the s k i l l s involved i n verbal expression. Jacobson and Margolin (1979) write that teaching couples communication "resembles i n s t r u c t i o n i n other kind of technical s k i l l s such as learning to operate an automobile" (p. 192). More psychodynamically oriented / therapists tend to focus upon intentions of the sender and the reception of a message as well as expression and to see communication patterns as a r e f l e c t i o n of the motivations and personal construals of the partners. Interventions w i l l r e f l e c t t h i s difference i n viewpoint; one therapist w i l l teach s k i l l s another w i l l explore needs and fears experienced by the spouse's. The behavioral therapist acts from the premise that i f one spouse's behavior changes then changes i n the others perceptions of, and reactions to, that partner w i l l follow. The psychodynamic therapist w i l l tend to t r y to reorient the spouse's 31 perceptions of each other so that behavior may be viewed d i f f e r e n t l y . Thus Jacobson (1981) suggests that behaviorists are l i k e l y to use "d e s c r i p t i v e " feedback when modifying couples communication whereas psychodynamic therapists would use i n t e r p r e t a t i o n . The approach of an ego-oriented dynamic therapist, such as Wile (1981), to the modification of communication patterns provides an e f f e c t i v e contrast to the more behavioral approach. Wile states that he helps couples to construct "the dialogue or conversation they might have had" i f they had been able to be open and t r u s t i n g and the e f f e c t i s " i n vivo communication t r a i n i n g ... without the rules and without the t r a i n i n g " (p. 157). Clear communication i s then the means by which such a therapist attempts to c l a r i f y partners' positions i n a r e l a t i o n s h i p and develop a shared perspective. In Wile's model, to state feelings f u l l y and have them validated rather than interrupted or d i s q u a l i f i e d enables partners to f e e l more i n contact with each other and i n greater control 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 are seen not as samples of inadequacies i n expertise or performance to be remedied by prac t i c e but as signs of deprivation and a l i e n a t i o n , often r e f l e c t i n g norms of minimal s e l f - d i s c l o s u r e and self-exposure. As the research of B i r c h l e r , Weiss and Vincent (1975) suggests distressed couples show normal communication s k i l l s l e v e l s when not involved i n an encounter with t h e i r spouse. The more dynamic models assume that ins i g h t into the motivations and needs of the s e l f and the other, which maintain the positions each partner takes i n i n t e r a c t i o n s , w i l l create change. In the case of the 32 e x p e r i e n t i a l therapies, i t i s assumed that new emotional experiences that c l a r i f y underlying fee l i n g s and needs w i l l create new and more p o s i t i v e patterns of communication. If communication patterns are a r e f l e c t i o n of inner experience then to change the ways the couple experience the r e l a t i o n s h i p w i l l change how they communicate. The behavioral approach attempts to f a c i l i t a t e the control of negative communication patterns and to substitute p o s i t i v e rule based pra c t i c e s ; the dynamic approach i s to explore such patterns i n terms of the experience of the r e l a t i o n s h i p which they r e f l e c t and to create new insi g h t or new experiences. Woolfolk (1976) states that, "By and large one finds that the kinds of techniques employed i n each approach to therapy are quite consistent with i t s theory of a f f e c t . S i m i l a r l y the technical narrowness of each school can be viewed as r e f l e c t i n g a corresponding l i m i t e d understanding of emotion" (P. 49). The d i f f e r i n g role of emotion i n therapy seems to best r e f l e c t the differences between the behavioral and e x p e r i e n t i a l models. In the behavioral interventions the expression of emotion i s relegated to c l a r i f i c a t i o n of the impact of one partner's behavior upon the other and i s taught as a s k i l l . In ego-oriented dynamic approaches such as Wile's (1981) or the e x p e r i e n t i a l treatment used i n t h i s study the exploration of emotion i s seen as a key method for a l t e r i n g the salience of private events and f a c i l i t a t i n g new learning. The time would seem to be r i g h t for the d e l i n e a t i o n of an emotionally focussed treatment taken from an 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 emotional experience i n the creation of change and a comparison of that treatment 33 with an already tested cognitive-behavioral intervention such as problem solving (Jacobson & Margolin, 1979). Whereas the coping s t i l l s paradigm and the teaching of problem solving has been s p e c i f i e d and tested e m p i r i c a l l y i n the area of m a r i t a l therapy (Jacobson, 1977, 1978b, 1979; Orvis, Kelley & Butler, 1976) the general area of emotion and therapeutic interventions centered upon the use of emotion are lacking i n corresponding c l a r i t y and d i r e c t i o n . It i s e s s e n t i a l at t h i s point to discuss the role of emotion i n therapy and i n marital therapy i n p a r t i c u l a r . The Role of Emotion i n Therapy Authors such as Mahoney (1980) and Fincham and O'Leary (1982) suggest that the role of a f f e c t i n therapeutic change i s the issue of the current decade, as the role of cognition tended to be the issue of the 70s. The role of a f f e c t i n change would seem to be p a r t i c u l a r l y important i n the context of a therapy that attempts to change r e l a t i o n -ships i n the d i r e c t i o n of increased s a t i s f a c t i o n and a sense of w e l l -being and even to encourage the creation of a f f e c t i o n and intimacy where possib l e . In the marital therapy l i t e r a t u r e , i n the psychotherapy l i t e r a t u r e and i n the psychology l i t e r a t u r e i n general the role of emotional experience i n human functioning has been unclear. At the turn of the decade Zajonc (1980) published a provocative p o s i t i o n paper e n t i t l e d "Thinking and Feeling: Preferences need no Inferences", arguing that a f f e c t i v e and cognitive systems are r e l a t i v e l y independent and that a f f e c t i v e responses a c t u a l l y precede cognitive responses and even stimulus recognition. This a r t i c l e has prompted 34 t h e o r i s t s , even the behaviorists to consider the place of a f f e c t i n therapy. Rachman (1981) has commented on the Zajonc a r t i c l e and has suggested that behaviorists should aim to expand behavior modification to include a f f e c t modification. The research of Fincham and O'Leary ( i n press) suggests that causal a t t r i b u t i o n s i n close r e l a t i o n s h i p s do not seem to a f f e c t behavioral responses to the extent that might be expected and 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 negative behavior. This r e s u l t might help to explain Williams (1979) fin d i n g that couples at the extremes of the happy-distressed continuum reported rewarding and punishing behaviors, r e s p e c t i v e l y i n response to the partners presence regardless of the behaviors emitted. Mahoney (1980) has commented on the need to review the role of factors such as unconscious processing and the experience of a f f e c t i n therapy rather than placing an excessive emphasis on the role of r a t i o n a l i t y i n adaptation. He also discusses various theories as to how the experience or expression of a f f e c t may f a c i l i t a t e therapeutic change. For example, he discusses the theory that human learning may be state dependent (Bower, 1981), that i s that an angry c l i e n t may be able to learn to deal more e f f e c t i v e l y with anger i f anger i s present. Greenberg and Safran (1982) state that: "therapists who construe a f f e c t as a dependent variable i n human functioning tend to regard emotion as disruptive to the therapeutic process, and t h i s leads 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 looking for ways to control c l i e n t ' s emotion. Although i t i s true that c e r t a i n emotional reactions such as angry outbursts and panic reactions or more chronic states are by 35 d e f i n i t i o n reactions 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 solving i n therapy t h i s i s not true of a l l emotion" (p. 2). Greenberg and Safran (1984) d i f f e r e n t i a t e between primary, reactive and instrumental a f f e c t ; primary a f f e c t being that which needs to be sought a f t e r and c l a r i f i e d i n therapy i n order to aid problem solving. Theorists such as Arnold (1960), Plutchik (1980), and Izard (1977) stress that emotions, not j u s t r a t i o n a l i t y and cognitive processes, function so as to enhance human adaption, providing a motivating force for adaptive behaviors. Epstein and Bishop (1981) i n t h e i r approach to family therapy also stress that emotions function as f a c i l i t a t i n g f actors i n problem solving. The role of a f f e c t i n therapy i s then recognized as an important issue i n current psychotherapy l i t e r a t u r e . Behaviorally orientated therapists now recognize that t h i s issue of i t must be addressed but generally see a f f e c t as a d i s r u p t i v e phenomena which should be modi-f i e d . Dynamic and e x p e r i e n t i a l therapists on the other hand view a f f e c t as a key variable i n therapy and as something which should be experien-ced by the c l i e n t and used i n the therapeutic process. It would seem appropriate at t h i s point to consider some of the t h e o r e t i c a l perspect-ives from which emotional experience has been considered and the implications of these perspectives for treatment. Strongman (1978) describes twenty theories of emotion. Emotion has been viewed as e s s e n t i a l l y a motivational concept (Arnold, 1960; Leeper, 1970), as p r i m a r i l y a state of p h y s i o l o g i c a l arousal (James, 1907), as an e s s e n t i a l l y cognitive phenomenon and a source of meaning and values (Solomon, 1977), as a response to cognition (Lazarus, 1982; Schatcher, 36 1971) as simply a learned conditioned response (Millenson, 1967) and as a form of psychic energy (Rapaport, 1970). Other authors have viewed emotion as a complex experience consisting of many elements. Lang (1977) for example views emotion as consisting of subjective, behavioral and p h y s i o l o g i c a l elements. Arnold's approach i s also a c t u a l l y a mixture of cognitive, p h y s i o l o g i c a l and motivational approaches since she views emotion as a response to an " i n t u i t i v e a p p r a i s a l " of a stimulus, and involving a f e l t tendency to action. In her model correct appraisals and appropriate actions require memories of sensory and motor events, memories of previous p o s i t i v e and negative attitudes and the rehearsal i n imagination of the appropriate actions. Zajonc (1980) views emotion as precognitive, and independent of cognitive processing and states that a f f e c t i v e reactions are "primary" and irrevocable, whereas Lazarus (1982) argues that Zajonc confuses cognition with conscious awareness, and that appraisal i s c r u c i a l to the emotional response, and can happen as automatic discrimination without awareness. However, both of these stances view experience i n terms of a l i n e a r causal model; the debate i s simply which element comes f i r s t , emotional response or cognition. Greenberg and Safran (1982) drawing on Leventhal's (1979) model suggest that emotion i s appropriately considered as an i n t e g r a t i o n of a number of d i f f e r e n t information processing components which operate simultaneously. They state, "information from the conceptual l e v e l , schematic l e v e l and the perceptual motor l e v e l may be thought of as constantly feeding into the emotion process simultaneously rather than being 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 related" (p. 14). As Greenberg and 37 Safron point out, Leventhal maintains that three d i s t i n c t mechanisms operate i n emotional processing. These are, a predominantly f a c i a l expressive motor mechanisms, a schematic or emotional memory and a conceptual system which stores rules and b e l i e f s about emotional experiences. In t h i s model schematic memory mechanisms d i r e c t attention i n the perceptual f i e l d and store automatic reactions. Schemas are representations of p r i o r emotional experience and can generate as well as be generated by expressive motor responses. The conceptual system i s concerned with conscious and v o l i t i o n a l processing and can analyze and evaluate concrete experience, storing the s i t u a t i o n a l antecedents and consequences of f e e l i n g s . Experienced emotion i s then a preattentive synthesis of perceptual motor information, i m p l i c i t motor schemas and conceptual cognition. In t h i s model Leventhal integrates a f f e c t , cognition, physiology and behavior into a comprehensive model of 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 theories of emotion have i n terms of therapeutic interventions? Rachman (1981) suggests that i f a f f e c t i s primary and independent then therapists should attempt to modify mood d i r e c t l y and focus upon that single dysfunctional system. Schachter's (1971) model of emotion, which i s that emotion b a s i c a l l y consists of the l a b e l l i n g or explanation of p h y s i o l o g i c a l arousal, implies that the therapist might help c l i e n t s r e - l a b e l such arousal or become desensitised to such arousal. Cognitive behaviorists such as Aaron Beck (1976) or Meichenbaum (1977) who view cognition as primary and emotional response as the product of cognition focus t h e i r therapeu-t i c interventions upon the modification of thoughts and b e l i e f struc-38 tures. Therapy consists then of a l t e r i n g b e l i e f s and dysfunctional cognitive processing s t y l e s . For the more t r a d i t i o n a l behaviorist emotion i s either a condi-tioned response to be deconditioned (Millenson, 1967) or modified by techniques such as the use of images (since a f f e c t i s associated with non-verbal channels) or music, as suggested by Rachman (1981). Other psychoanalytic the o r i s t s have viewed emotion i n therapy generally as a component of the "corrective emotional experience" (Applebaum, 1982) experienced by the c l i e n t i n r e l a t i o n to the therapist. Emotion has also been considered as being repressed and experienced i n the process of making the unconscious conscious, or as a signal that unconscious material i s about to emerge into awareness. Some the o r i s t s view emotion as a form of psychic energy, and so have focused upon v e n t i l a t i o n and catharsis i n the sense of purging as the primary way to use emotional experience to f a c i l i t a t e change. (Nichols & Zax, 1977) However, i f emotion i s viewed according to Leventhal's (1979) synthesis model then obscure concepts such as the release of psychic energy i n catharsis are not necessary to j u s t i f y the expression of intense emotion as a useful element i n therapy. Rather the expression of emotion i s understood as a complex aspect of informa-t i o n processing. It i s i n t e r e s t i n g to note that i n the Liberman et a l . comparative study (1976) the non-behavioral treatment seems to have as i t s base the v e n t i l a t i o n of emotion, that i s , i t was a catharsis based in t e r v e n t i o n . Berger and Luckmann (1966) suggest that language i s an ongoing o b j e c t i f i c a t i o n of experience which helps to c r y s t a l l i z e and s t a b i l i z e 39 subjective experience; i t i s thus possible to see a l i n k between emotional expression and emotional synthesis. I f as Leventhal (1979) suggests emotion i s an int e g r a t i o n of concepts, schemas and perceptual motor responses, i t would seem to be a r i c h source of information relevant for therapy. As Greenberg and Safran (1982) point out, accessing and acknowledging a f f e c t can help to motivate change, and also to access "hot" cognitions which themselves require change. These authors and c l i n i c i a n s such as Wile (1981) suggest that previously avoided or unacknowledged a f f e c t i v e experience forms the basis for new perspectives and meaning sets. Therapists such as Epstein and Bishop (1981) view the experience of emotion as adaptive since i t tends to stimulate d i f f e r e n t problem solutions. These authors teach t h e i r c l i e n t s to i d e n t i f y and use emotions that w i l l f a c i l i t a t e the r e s o l u t i o n of t h e i r presenting problems, for example teaching non-assertive c l i e n t s to access and use anger. What are the therapeutic implications of a model such as Leventhal's (1979)? This question has been addressed by Greenberg and Safran (1981), who suggest that " c l i n i c a l problems can r e s u l t both from the r e p e t i t i v e synthesis of maladaptive emotions and the absence of adaptive emotional synthesis" (p. 18). The focus of therapeutic work i s then modifying the synthesis of maladaptive emotions or f a c i l i t a t i n g the synthesis of new adaptive emotions. Synthesizing adaptive emotional experience can be f a c i l i t a t e d by helping people get i n touch with a f f e c t that i s not normally attended to, or encoding a f f e c t i v e information more accurately (Arnkoff, 1980; Davison, 1980; Gendlin, 1980; Wexler, 1974). 40 To achieve t h i s the therapist could 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 experiences are acceptable and d i r e c t attention to various perceptual motor cues. Greenberg and Safran suggest that "once the new information i s attended to the therapist asks the c l i e n t to verbalize his or her experience and explores emotional memories and images and discusses the rules and meanings surrounding the feeli n g s i n order to help synthesize new a f f e c t i v e experience ... Once new adaptive emotional experiences have been generated the therapist can help the c l i e n t learn to translate them into appropriate actions" (p. 21). Bower (1981) has suggested that many maladaptive cognitions can only be accessed i n the presence of the state i n which they were acquired, that i s i n states of a f f e c t i v e arousal. The experience and am p l i f i c a t i o n of emotion may then be a prerequisite to the modification of "hot cognitions" (Abelson, 1963), and to the creation'of the motiva-t i o n to deal more e f f e c t i v e l y with problem responses. Green and Murray (1975) did indeed f i n d that the expression of feelings f a c i l i t a t e d the attainment of i n s i g h t . Greenberg and Safran also suggest general i n t e r -ventions such as the use of v i v i d and metaphorical language, the r e f l e c -t i o n of f e e l i n g and heightening the awareness of non-verbal expression. Jacobson and Margolin (1979) present another view; they state that since change i s l a r g e l y a matter of e f f o r t and practice and there i s a c o r r e l a t i o n between feelings and behavior, the causal sequence i s i r r e l e v a n t . The decision regarding intervention can then be made on the basis of e f f i c i e n c y , and since the therapeutic technology for changing behavior i s considerably more developed than the technology f o r changing 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 intervention i s one which focuses on changing behavior. 41 A f f e c t i n M a r i t a l Therapy The f i e l d of marital therapy r e f l e c t s the general controversy concerning 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 behavioral approaches i n therapeutic interventions. As Mahoney ( i n press) suggests "our t a c i t notions about emotional processes exert a persuasive influence on how we approach and conduct therapy." Gurman and Knudson (1978) i n t h e i r c r i t i c a l review of the more behavioral approaches note the behavioral focus upon the " r a t i o n a l observing ego" and the assumed c l i e n t openness to reason and a b i l i t y to see that change i s i n t h e i r r a t i o n a l s e l f - i n t e r e s t . They c r i t i c i z e t h i s approach for a lack of focus upon "the power and salience of private events" (p. 128) and the assumption that i f behavior changes then changes i n feelings w i l l follow. In fact i n recent years cognitive private events have been included even i n models of behavioral marital therapy (Jacobson & Margolin, 1979), behaviorists tending to become cognitive-behaviorists. The private events which now appear to be at issue i n therapy, are emotional i n nature. In the more behavioral therapies couples are encouraged to separate problem solving from emotional expressiveness and learn to control the l a t t e r i n favor of problem solving. As Margolin and Weinstein (1983) state a s k i l l oriented stance places a "value on r a t i o n a l as opposed to emotional processes" (p. 334). However these authors now suggest that a f f e c t i v e experience and expression seem e s s e n t i a l to the aims of marital therapy, and that emotional expression may be conceptualized as a s k i l l , f o r example spouses can be taught "to assign labels to physio-l o g i c a l cues" (p. 349). The more dynamic e x p e r i e n t i a l therapies 42 focusing as they do more upon intrapsychic 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 behaviors but as a bargain about the d e f i n i t i o n of s e l f have tended to be more concerned with the exploration of emotional experience. As Solomon (1977) notes emotional 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 and concerned with s e l f -concept. Gurman, Knudson and Kniskern (1978) suggest that the expression of f e e l i n g serves to define r e l a t i o n s h i p s , and attempts to define r e l a t i o n s h i p s represent fundamental attempts to define one's s e l f . Gurman and Knudson (1978) go on to suggest 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 distressed marital partners disrupts the partners a b i l i t y to recognize, respond to or learn from new experiences. It i s also not possible to teach responses such as respect which may be key i n a r e l a t i o n s h i p and do not always follow from a spouse learning to behave i n a more pleasing fashion. Responses such as love, which for most people i s the sine qua non of marriage (Broderick, 1981), seem by t h e i r very nature d i f f i c u l t i f not impossible to bring under cognitive c o n t r o l . It may be that the more behavioral approaches a c t u a l l y encourage repression with t h e i r focus on compromise and pleasing behaviors (Gurman & Knudson, 1978). Jacobson and Weiss (1978) i n t h e i r reply to the above authors suggest that couples are "quite s k i l l f u l at expressing negative fee l i n g s that an encouragement of this practice would be counterproductive" (p. 151). They state that they encourage a focus upon the p o s i t i v e , and attempt to provide couples with a new armamentarium of s k i l l s with which to manage c o n f l i c t . Couples have then to become accomplished at tasks such as problem solving "over a wide range of resources, including love, 43 a f f e c t i o n and the use of finances" (p. 152), and are thus guided by the therapist i n the creation of a p o s i t i v e control system, and the r a t i o n a l r e s t r u c t u r i n g of contingencies i n the r e l a t i o n s h i p . Jacobson and Margolin (1979) suggest that the most d i f f i c u l t c l i e n t behavior to change i n marital therapy i s the tendency of the spouse to blame each other for marital problems. Most dynamic and e x p e r i e n t i a l t h e o r i s t s agree. However, where cognitive behaviorists would tend to attempt to replace such behavior with problem solving, following a set of rules rather than emotional cues, dynamic and e x p e r i e n t i a l therapists tend to explore the underlying anxiety occurring within the partners which acts as a stimulus for and response to defensive interpersonal behavior. In the more dynamic therapies i t i s not the s k i l l l e v e l but the context which i s considered the issue. Authors who consider emotional experience to be c r u c i a l i n the modification of r e l a t i o n s h i p s have then considered defensive behavior, motivated by emotional v u l n e r a b i l i t y , to be a block to new learning, problem solving, and p o s i t i v e intimacy experiences. The intrapsychic experience 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 i n that i t can f o s t e r emotional r e a c t i v i t y and defensiveness, or under p o s i t i v e circumstances, intimacy and bonding. The disclosure of emotional experience i s also generally viewed as intimacy enhancing, and thus related c l o s e l y to marital s a t i s f a c t i o n (Margolin & Weinstein, 1983). L'Abate (1977) focuses upon the necessity for the sharing of fee l i n g s such as v u l n e r a b i l i t y and hurt for the cr e a t i o n of intimacy and true c o n f l i c t r e s o l u t i o n . He suggests that to be aware of and express hurt i s a healing process i n i t s e l f . Knudson, 44 Sommers and Golding (1980) found i n fact that couples who resolved c o n f l i c t by 'engagement' rather than avoidance had greater access to one another's interpersonal perceptions and construals of r e a l i t y , suggest-ing greater intimacy. However authors who believe i n the importance of the exploration of a f f e c t i n marital therapy, may employ very d i f f e r e n t interventions. Margolin and Weinstein (1983) focus on the s k i l l of emotional expression whereas Bockus (1980) focuses upon the displacement of family of o r i g i n patterns onto present r e l a t i o n s h i p s and uses gestalt techniques to enact past emotional experiences i n the present. What then i s the role of emotional experience i n changing r e l a t i o n -ships? If Zajonc i s correct 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 that Fincham and O'Leary ( i n press) found that behavioral responses i n marriage seemed to be primarily mediated by a f f e c t i v e responses rather than casual a t t r i b u t i o n s . It would seem that strong emotional experience, such as fear or v u l n e r a b i l i t y , which has become associated with a p a r t i c u l a r s i t u a t i o n ( for example, closeness with ones spouse) tends to provide a powerful framework which gives meaning to experience. If we are a f r a i d we see our spouse's actions as threatening. Emotion experience tends to dominate, to override other cognitive and behavioral cues. Weiss (1980) suggests that adult intimate r e l a t i o n s h i p s are "based l a r g e l y upon sentiment, the love, regard and f u l f i l l m e n t promised by relatedness" (p.243) and that the meaning given to i n t e r a c t i o n patterns i s not just a function of the "outcome" of events but a function of sentiment. He speaks of " s e n t i -45 merit o v e r r i d e " , w h i c h e n a b l e s p e o p l e t o g i v e t o each o t h e r n o n c o n t i n -g e n t l y i n p o s i t i v e r e l a t i o n s h i p s . K a p l a n and K a p l a n (1982) a l s o p o i n t ou t 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 o r g a n i s e what t h e y " s e e " and " h e a r " a c c o r d i n g t o t h e i r c u r r e n t e m o t i o n a l s t a t e and e x p e r i e n t a l o r g a n i z a t i o n . Thus c o u p l e s t e n d t o f o c u s on n e g a t i v e s and o v e r l o o k p o s i t i v e b e h a v i o r changes on t h e p a r t o f t h e i r spouse u n l e s s e a ch p a r t n e r ' s e m o t i o n a l e x p e r i e n c e o f t he r e l a t i o n s h i p i s a t t e n d e d t o . A r n o l d (1960) a l s o s u g g e s t s t h a t e m o t i o n s b i a s t he a p p r a i s a l o f new s i t u a t i o n s and i n t e n s i f i e s r e a c t i o n s t o them. I f e m o t i o n a l e x p e r i e n c e i s p r i m a r y and o v e r r i d e s o t h e r cues i t wou l d seem t o be an e s s e n t i a l t a r g e t f o r change i n m a r i t a l t h e r a p y . T h e r e i s a l s o t h e p o i n t t h a t s uch e x p e r i e n c e may b l o c k new l e a r n i n g . C o u p l e s may no t use p r o b l e m s o l v i n g s k i l l s i f c ompe t i n g b e h a v i o r s a r e more s a l i e n t i n t he r e l a t i o n s h i p (Mead, 1981 ) . The 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 d e f e n s i v e r e a c t i o n s wou l d c e r t a i n l y seem t o be one s u ch s e t o f c o m p e t i n g r e s p o n s e s t h a t w o u l d t e n d t o b l o c k t he l e a r n i n g o f new s k i l l s and p e r s p e c t i v e s o r the use o f e x i s t i n g s k i l l s . I f t h i s i s t h e ca se i t may be t h a t no new l e a r n i n g can t a k e p l a c e u n t i l t he a u t o m a t i c s y n t h e s i s o f p a i n , f e a r and v u l n e r a b i l i t y has been a c c e s s e d , v a l i d a t e d and c o n f r o n t e d . As K i n s t o n and B e n t o v i m (1981) s ugge s t t he t h e r a p i s t m i gh t i n t e r p r e t t h e d e p t h mean ing b e h i n d t he s u r f a c e p a t t e r n o f i n t e r a c t i o n s w h i c h a r e g e n e r a l l y r e p e t i t i o u s r e s p o n s e s a imed a t p r o t e c t i o n o f t he s e l f f r o m the s pou se . The a c c e s s i n g 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 i s f a c i l i t a t e d i n m a r i t a l t h e r a p y by t h e f a c t t h a t t he s t i m u l u s f o r s uch an e x p e r i e n c e , namely t h e p a r t n e r , i s p r e s e n t . The t h e r a p i s t howeve r , o f f e r s a c e r t a i n 46 safety to each of the partners, as well as guiding them with probes and i n t e r p r e t a t i o n s . To avoid emotional experience i n marital therapy or regulate i t to a confined and secondary role would not, i n l i g h t of the above remarks seem f u n c t i o n a l . Rather strong emotional experience may be used to evoke and access key cognitions, of which the c l i e n t has hitherto been unaware. Dyfunctional cognitions can then be c l a r i f i e d and modified. The modification of cognitions concerning the nature of the s e l f i n r e l a t i o n to the other would seem to be p a r t i c u l a r l y pertinent here. Bower (1981) suggests that cognitions may be more e a s i l y evoked i f the c l i e n t i s experiencing the state during which those cognitions were f i r s t aroused and were most s a l i e n t . Also p o s i t i v e and useful cognitions may a r i s e out of emotional experience both i n terms of c l a r i f y i n g needs and wants and evoking new responses and solutions to problems. The behaviorists have suggested that one problem with contingency contracting i s that people do not know what they want, or perhaps, are unwilling to communicate t h e i r wants to t h e i r spouse. The experience of previously unacknowledged emotion and the synthesis of new emotion gives r i s e to action d i s p o s i t i o n s which provide a sense of d i r e c t i o n and aid problem solving. Newly formulated wants and needs ar i s e out of emotional experience, and suggest new adaptive responses (Greenberg, 1984). For example i f a partner r e a l i z e s that she i s a f r a i d of close contact with her spouse and needs reassurance, she i s then able to communicate her feel i n g s and needs. This allows her partner to recognize that to comfort may be a better solution than his usual response of withdrawal or r a t i o n a l l e c t u r i n g . 47 The communication of deeply f e l t emotion also tends to increase the acceptance and sense of intimacy i n a r e l a t i o n s h i p e s p e c i a l l y i f the partners are accustomed to receiving reactive emotional responses, such as outbursts of anger. High l e v e l s of intimacy seem to correlate negatively with c o n f l i c t i n a r e l a t i o n s h i p and tend to be very c l o s e l y r e l a t e d to marital s a t i s f a c t i o n (Waring, McElrath, Lefcoe & Weisz, 1981). Waring et a l . found expressiveness or s e l f - d i s c l o s u r e to be the key ingredient of intimacy. Tolstedt and Stokes (1983) d i f f e r e n t i a t e between verbal intimacy ( s e l f - d i s c l o s u r e ) , p h y s i c a l intimacy and a f f e c t i v e intimacy or fee l i n g s of closeness which include "emotional bonding, including i n t e n s i t y of l i k i n g , moral support, and a b i l i t y to t o l e r a t e flaws i n the s i g n i f i c a n t other," (p. 574). These authors found a l l three kinds of intimacy e s p e c i a l l y a f f e c t i v e intimacy, were s i g n i f i c a n t l y related to marital s a t i s f a c t i o n . Altman and Taylor (1973) i n t h e i r s o c i a l penetration theory d i f f e r e n t i a t e the concept of intimacy into verbal exchanges which may vary i n breadth, (range of topics about which an i n d i v i d u a l d i s c l o s e s ) , depth (closeness to the innermost core of the person) and valence ( p o s i t i v e or negative q u a l i t y ) . The communication of r e l a t i v e l y "deep" personal needs fear and emotional 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 the b u i l d i n g of emotional bonds through r e c i p r o c a l s e l f - d i s c l o s u r e . This kind of process would seem to be n a t u r a l l y a n t i t h e t i c a l to the distance, a l i e n a t i o n and p o l a r i s a t i o n normally found i n recurring dyadic c o n f l i c t . The disclosure of unacknowledged fe 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 also tends to lower the other partners tendency to protect themselves and encourages responsiveness. A new view of the partner, for example one which 48 recognizes the need f or contact underlying 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 responses and encourages the formation of new bonds. As t h i s process continues, the overriding emotional climate may become les s threatening and goodwill between partners may expand allowing the r e l a t i o n s h i p to be defined d i f f e r e n t l y . The expression of f e e l i n g i s then not, as Jacobson suggests, only to make the impact of one partner's behavior on the other c l e a r , but 1) to defuse blocks to new learning; 2) to help couples explore and formulate previously unacknowledged f e e l i n g s , needs and wants; 3) to access important dysfunctional unconscious cognitions; 4) to f a c i l i t a t e new perceptions of the other which evoke new responses and opportunities for intimacy. The end r e s u l t of th i s process i s that the r e l a t i o n s h i p i s experienced i n new and more intimate ways and defined i n a less r i g i d and defensive manner. The Emotionally Focussed therapy used i n t h i s study attempts to help c l i e n t s access, explore and express key underlying emotional responses to t h e i r spouse to change the way partners perceive each other and respond to each other, and thus to create new opportunities for intimacy. A D e s c r i p t i o n of Interventions Used i n This Study This study w i l l then attempt to address the need for a comparative study of an e f f e c t i v e cognitive-behavioral intervention, problem solving, and e x p e r i e n t i a l emotionally focused intervention for the res o l u t i o n of marital c o n f l i c t . 49 Problem Solving (PS) The r a t i o n a l problem solving treatment i s taken from Jacobson and Margolin (1979) and i s outlined i n Appendix A. The a f f e c t i v e treatment (Greenberg & Johnson, i n press) i s based on the e x p e r i e n t i a l t r a d i t i o n i n psychotherapy which emphasises the role of a f f e c t i n change (Greenberg & Safran, 1984; P e r l s , H e f f e r l i n e & Goodman, 1951; S a t i r , 1973) and the systemic t r a d i t i o n which emphasises the role of communication and i n t e r a c t i o n a l cycles i n maintaining problem states ( S l u z k i , 1978; Watlawick, Beavin & Jackson, 1967). This treatment i s also outlined i n Appendix A. The Problem Solving Intervention seems at present to epitomize the cognitive behavioral approach to marital therapy and to be the most em p i r i c a l l y validated intervention s p e c i f i c to t h i s model (Jacobson, 1977, 1978, 1979, i n press). This intervention focuses upon the teaching of problem solving (or p o s i t i v e control) and communication s k i l l s . Feelings although not ignored are generally regarded as epiphenomenal i n the context of overt behavior change. As Gurman and Knudson (1978) point out "The general goals of behavioral marriage therapy are to increase the rate of rewarding i n t e r a c t i o n s based on p o s i t i v e behavior change operations and decrease the rate of aversive i n t e r a c t i o n s and coercive c o n t r o l , and teach concrete c o n f l i c t r e s o l u t i o n and problem solving strategies and s k i l l s " , (p.123). Weiss (1978) defines problem solving as the a p p l i c a t i o n of reason, i n t e l l i g e n c e or experience, to the production of some outcome such as decison making about chi l d r e n . Problem solving may be applied to s i t u a t i o n s and the communication process i t s e l f . Mahoney (1977) notes 50 that p r a c t i t i o n e r s using problem solving t r a i n i n g i n t h e i r treatment packages employ a basic sequence of s k i l l b u i l d i n g ; that i s s p e c i f y i n g the problem, c o l l e c t i n g information, i d e n t i f y i n g causes and patterns, examining options, narrowing options, experimenting, comparing r e s u l t s and r e v i s i n g solutions. The c l i e n t develops cognitive s k i l l s such as means ends thinking, the evaluation of probable consequences, and the rehearsal of possible options. Jacobson and Margolin (1979) include the components outlined by Mahoney but add refinements such as pinpointing s p e c i f i c problem behaviors i n the problem d e f i n i t i o n stage and the brainstorming of possible solutions leading to a reasonable compromise and the s p e c i f i c a t i o n of an agreement i n the re s o l u t i o n phase. Rules f o r e f f e c t i v e communication are also taught as part of the problem solving sequence. The problem solving components used here are attempts to teach couples new rules and a new cognitive set for approaching marital c o n f l i c t . The Margolin and Weiss study (1978) emphasises the importance of the cognitive r e s t r u c t u r i n g factors i n t h i s approach p a r t i c u l a r l y the creation of a c o l l a b o r a t i v e set and the r e a t t r i b u t i o n of problems i n terms of lack of s k i l l rather than negative intent on the part of the spouse. Such interventions are geared to help couples abandon blaming and accept more personal 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 f a i l u r e . In general the therapist role i s mainly that of a teacher and coach, the therapist states r u l e s , models new behaviors and provides feedback on behavioral rehearsal. These rules might consist of such commands as: be s p e c i f i c , phrase requests i n terms of p o s i t i v e changes, respond d i r e c t l y to a c r i t i c i s m (no cross-complaining), or wait for your spouse v. to complete a thought before giving your reactions. These rules are usually stated p o s i t i v e l y since i t i s easier to reinforce the occurrence of a behavior than i t s non-occurence. Negative feedback may be given i n the form of pointing out non-productive behavior, and explaining the negative consequences that ensued. Behavioral therapists also teach stimulus control s t r a t e g i e s , that i s , the couple i s instructed to bring t h e i r problem solving attempts under the control of p a r t i c u l a r times and settings; f o r example, Margolin, Christensen and Weiss (1975) suggest helping couples to l a b e l whether they are involved i n emotional expression or problem solving. The focus i s upon the control of bad habits and conscious r a t i o n a l problem orientated behavior. The effectiveness of th i s treatment as opposed to other behavioral treatments, such as simple contingency contracting, has been demonstrated (Jacobson, 1977). Jacobson and Margolin (1979) state that problem solving i s f i r s t "an expeditious way of teaching behavior management" and second provides "stimulus control over couples c o n f l i c t related i n t e r a c t i o n s , thus a l t e r i n g the q u a l i t y as well as the connotations of such i n t e r a c t i o n s " (p.213). These authors suggest that problem solving s k i l l s t r a i n i n g serves a preventative function since i t helps couples to acquire self-management s k i l l s . The expression of feeli n g s i s part of 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 incidents i n terms of fe e l i n g s and val i d a t e t h e i r partner's f e e l i n g s . The focus here i s the enhancement of p o s i t i v e exchanges rather than the expression of negative f e e l i n g s . The problem solving process begins with a discussion of manifest 52 observable complaints i n terms of mutuality i n order to create a c o l l a b o r a t i v e set. Problems are then defined i n terms of s p e c i f i c behaviors and derogatory labels are discouraged i n favor of descriptions of problem behaviors. Partners are encouraged to admit to t h e i r part i n the problem, be b r i e f and present-orientated i n t h e i r presentation of problems, discuss only one problem at a time (no side tracking), paraphrase each others remarks, and avoid making inferences or mind reading. Jacobson (1981) defines steps towards the d e f i n i t i o n of a problem as: Always begin with something p o s i t i v e (since distressed couples seem to s e l e c t i v e l y track displeasing behaviors), be s p e c i f i c using pinpointing s k i l l s , encourage f e e l i n g expressions e s p e c i a l l y concerning the negative impact of behaviors, help partners to acknowledge t h e i r part i n the problem, and keep d e f i n i t i o n s b r i e f . A f t e r d e f i n i t i o n , Jacobson suggests that the remaining discussions should be s o l u t i o n focused, using brain-storming to generate solutions. Behavior change, then, i s based upon "mutuality and compromise". He also points out (Jacobson & Margolin, 1979) that the tendency of the spouses to defend themselves and t h e i r transgressions i s the most d i f f i c u l t response class to modify. Spouses w i l l deny the legitimacy of the others complaint, deny r e s p o n s i b i l i t y for actions, or enumerate circumstances which render the behavior beyond t h e i r c o n t r o l . Jacobson suggests that the therapist deal with t h i s by s e t t i n g the ground rule that legitimacy i s assumed, since one partner i s upset. The l i n e between communication t r a i n i n g , problem solving and contingency contracting i n behavioral marital therapy i s often d i f f i c u l t to draw. Tasks such as the appropriate expression of f e e l i n g , or 53 pinpointing behaviors (discrimination training) and o p e r a t i o n a l i z i n g one's expectations could be seen as communication tasks or components of problem solving. As may be seen i n Appendix A the Problem Solving Treatment i n t h i s study consisted of the teaching of communication s k i l l s , followed by the teaching of problem d e f i n i t i o n and solution s k i l l s and ending i n good f a i t h contracting. Good f a i t h contracts are structured so that each spouse's rewards and penalties are independently determined i n terms of his or her own contractual o b l i g a t i o n to change. Emotional Focussed Therapy E x p e r i e n t i a l models of therapy based on the work of authors such as Perls (1973) and Rogers (1951) have con s i s t e n t l y emphasised the role of a f f e c t i n changing perception (Greenberg & Safran, 1982, 1984) and the Emotionally Focused therapy used i n t h i s study focuses on present a f f e c t i v e experience i n an i n t e r a c t i o n a l framework i n order to change perception. The therapist i n t h i s approach attempts to enter each person's frame of reference and explore the r e a l i t y of the r e l a t i o n s h i p as i t appears to t h i s person, and as i t translates into r e l a t i o n s h i p events. Partners are regarded as active perceivers who construct meanings and organise perceptions and responses on the basis of current emotional states, and who tend to disown aspects of t h e i r experience because of i n t e r n a l blocks or s p l i t s or because of perceived requirements of the r e l a t i o n s h i p as presently defined. Change i n t h i s perspective can then occur by changing one person's experience and perceptions of s e l f i n r e l a t i o n to other, or by changing the other partner's p o s i t i o n and pattern of responses, or most l i k e l y by 54 changing both simultaneously and i n a r e c i p r o c a l l y determining fashion. Insight i n t h i s approach i s not enough to bring about change i n the r e l a t i o n s h i p . Rather partners must experience, on an emotionally meaningful l e v e l , new aspects of themselves and new i n t e r a c t i o n s . Thus partners encounter each other i n the session and p a r t i c i p a t e i n a "corr e c t i v e emotional experience". The 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 rather than bringing i t about. The experiencing of new feelings motivates problem solving and good communication as does the perception of the partner as more accessible and responsive. Change occurs then i n t h i s approach by a deepening of experience which brings new aspects of s e l f into f o c a l awareness and into the i n t e r a c t i o n . S p e c i f i c i n t e r a c t i o n a l behaviours are reframed i n a p o s i t i v e manner i n terms of these underlying emotional states, i n order to change the sequence of i n t e r a c t i o n s . At least f i v e processes of change appear to occur i n the emotionally focused treatment of couples. (Greenberg & Johnson, i n press). 1. An i n d i v i d u a l perceives him or he r s e l f d i f f e r e n t l y by bringing into f o c a l awareness experiences not previously dominant i n t h i s person's view of s e l f ; for example, "I see and accept my v u l n e r a b i l i t y . " 2. The spouse on witnessing the partner's new a f f e c t i v e expression, perceives the partner in a new way; for example, "I see your need for caring and contact rather than your h o s t i l i t y . " 55 3. The i n d i v i d u a l ' s personal reorganization leads to d i f f e r e n t behaviour i n the i n t e r a c t i o n between the spouses; for example, "I now ask you for reassurance from a positon of v u l n e r a b i l i t y . " 4. The spouse's new perceptions of the partner lead to d i f f e r e n t responses; for example, "I comfort you rather than withdraw." 5. As a function of t h e i r partner's new behaviours, the i n d i v i d -uals come to see themselves i n new ways; for example, "since I can f u l f i l l your needs, I see myself as valuable and necessary to you." The combination of the above processes leads to a r e d e f i n i t i o n of the s e l f i n the r e l a t i o n s h i p for both partners. D i f f e r e n t aspects of the s e l f are expressed and accepted i n the r e l a t i o n s h i p and t h i s leads to a change i n i n t e r a c t i o n a l patterns. The partners' perceptions of each other are framed i n new terms which f a c i l i t a t e the creation of a new responsiveness to the other partners needs. Spouses then are more able to accept c e r t a i n behaviours from t h e i r partners, that might previously have been unacceptable and offensive. This whole process, due to i t s high demand for d i s c l o s u r e , i s i n i t s e l f conducive to the b u i l d i n g of intimacy and emotional bonds, both of which are key aspects of marital s a t i s f a c t i o n (Tolstedt & Stokes, 1982). The treatment manual for t r a i n i n g i n t h i s approach contains the nine steps outlined below: 1. Delineate c o n f l i c t issues i n the core struggle. 2. I d e n t i f y the negative i n t e r a c t i o n cycle, for example pursue and withdraw. 3. Access unacknowedged feelings inherent i n the p o s i t i o n each partner takes i n the i n t e r a c t i o n c y c l e . 56 4. Reframe the problem i n terms of underlying f e e l i n g s . 5. Promote i d e n t i f i c a t i o n with disowned needs. 6. Promote acceptance of partner's experience. 7. F a c i l i t a t e expression of needs and wants. 8. E s t a b l i s h the mergence of new solutions. 9. Consolidate new p o s i t i o n s . The therapist i n t h i s approach must e s t a b l i s h the kind of therapeutic a l l i a n c e which allows new experience to be explored with confidence, p a r t i c u l a r l y experiences of v u l n e r a b i l i t y fear and unexpressed resentment. The therapist also s t r i v e s to l e g i t i m i s e the responses of each partner as r e f l e c t i o n s of universal human needs. In order to access and heighten emotional responses the therapist uses the methods of Gestalt therapy ( P e r l s , et a l , 1951) and innovations from c l i e n t centered therapy (Rice, 1974). The therapist also guides the formulation of meanings as new experiences occur, for example, reframing h o s t i l i t y as desperation or distance as fear i n such a way that t h i s reconstruction remains true to the c l i e n t s present experience, evokes acceptance from both the experiencing and observing spouse, and promotes contact between the partners. 57 CHAPTER H I THE METHODOLOGY OF THE STUDY This chapter begins with a de s c r i p t i o n of the c l i e n t population and t h e r a p i s t s , followed by a delin e a t i o n of the instruments used and the research procedures. The hypotheses of the study are then o u t l i n e d , followed by a d e s c r i p t i o n of data analysis procedures. C l i e n t Population The subjects for t h i s study requested counselling a f t e r reading a newspaper a r t i c l e (Long, 1983) describing the Couples Problem Solving Project. Couples were offered eight marital therapy sessions designed to help them resolve marital c o n f l i c t . The c l i e n t s a f t e r screening and an assessment interview then attended the Education C l i n i c at The U n i v e r s i t y of B r i t i s h Columbia for therapy. C l i e n t couples were screened on the telephone and again i n the assessment interview according to the following c r i t e r i a : 1. C l i e n t s had to have been cohabiting for a minimum of twelve months. 2. C l i e n t s had to have no immediate plans for divorce or separation. 3. Individual c l i e n t s had to have received no p s y c h i a t r i c treatment or h o s p i t a l i z a t i o n within the l a s t two years. 4. Individual c l i e n t s had to report having no problems with alcohol or drugs. 5. Individual c l i e n t s had to report experiencing no primary sexual dysfunciton. 58 6. C l i e n t s had to score i n the distressed range on the Dyadic Adjustment Scale (Spanier, 1976); i n this study that i s defined as at least one partner scoring below 100 on t h i s scale. 7. C l i e n t s had to be w i l l i n g to consent to research procedures, t e s t i n g and video-taping. 8. C l i e n t s had to be currently uninvolved i n any other psycho-l o g i c a l l y oriented treatment either on an i n d i v i d u a l or couple basis. There were 45 couples included i n the study, 15 i n each of the two treatment groups and 15 i n the wait l i s t c o n t r o l . The following demographic data was c o l l e c t e d from these 45 couples. The mean for the number of years couples had been l i v i n g together was 8.6 years (range: 1-24). There was an average of 1.75 children per family (range: 0-7). Seven couples had been involved i n previous marital counselling (15% of the t o t a l ) , and 20 i n d i v i d u a l s (22% of the t o t a l ) had been previously married before engaging upon t h e i r present r e l a t i o n s h i p . The mean age of the partners involved i n the study was 35.3 years (range: 25 - 55). The median range of family income was reported to be $35,000 -45,000 Canadian d o l l a r s per year. The mean number of years of education completed by spouses was 15; t h i s was defined on the questionnaire as having completed a community college program or part of a degree. The occupations of the spouses were categorised on the Blishen Scale (1971). T y p i c a l l y the male spouses f e l l into the semi-professional category, while the female spouses f e l l into the trades catagory on t h i s scale. The v a r i a b l e s , number of years together, family income, male and female occupation, educational l e v e l and age were examined for 59 d i f f e r e n c e s u s i n g an a n a l y s i s of v a r i a n c e and no s t a t i s t i c a l l y s i g n i f i c -a nt d i f f e r e n c e s were found between the t h r e e groups (two t r e a t m e n t groups and t h e c o n t r o l ) . Thus the r a n d o m i s a t i o n p r o c e s s seemed t o s u c c e s s f u l l y s e l e c t groups t h a t were e q u i v a l e n t on t h e s e demographic v a r i a b l e s . F o r d e t a i l s o f t h i s a n a l y s i s p l e a s e t u r n t o T a b l e E - l , A p pendix E. These s u b j e c t s were p r e d o m i n a n t l y members of the dominant c a u s c a s i a n c u l t u r a l group not from d i s t i n c t e t h n i c backgrounds where p a r t i c u l a r c u l t u r a l v a l u e s may i n f l u e n c e e x p e c t a t i o n s c o n c e r n i n g m a r r i a g e . The assignment of s u b j e c t s t o group was completed u s i n g t h e sequence o f one, two and t h r e e found i n a random number t a b l e . C o u p l e s d e s i g n a t e d as ones were a s s i g n e d t o the EF g r o u p , two's t o the PS group and t h r e e ' s t o the C o n t r o l . As a c o u p l e was a c c e p t e d i n t o the s t u d y a f t e r assessment t h e y were g i v e n the f i r s t number on the l i s t . There was one e x c e p t i o n t o t h i s p r o c e d u r e . I f a c o u p l e s c o r e d under 80 on the DAS they were s e t a s i d e u n t i l t h r e e such c o u p l e s were c o l l e c t e d and t h e n a s s i g n e d as above. T h i s was t o e n s u r e t h a t any one t r e a t m e n t group d i d not c o n t a i n a d i s p r o p o r t i o n a l number of v e r y low s c o r i n g c o u p l e s . A f t e r a s s i g n m e n t t o g r o u p , t r e a t m e n t c o u p l e s were p l a c e d w i t h t h e r a p i s t s (one to s i x ) a c c o r d i n g t o a random number t a b l e . The s u b j e c t s were a l s o a d m i n i s t e r e d the T e s t o f E m o t i o n a l S t y l e ( 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 e m o t i o n , E x p r e s s i v e n e s s , and R e s p o n s i v e n e s s t o e m o t i o n a l s t i m u l i , 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 between the t h r e e s u b j e c t g r o u p s . D e t a i l s of t h i s a n a l y s i s may a l s o be found i n T a b l e E-2, Appendix E. 60 Therapists There were 12 therapists involved i n t h i s study; s i x (two males and four females) administering each treatment. The therapists ranged i n age from 28 to 43. Five of the therapists administering the Problem Solving Treatment were senior or recently graduated c l i n i c a l psychology doctoral students. The mean number of years of academic t r a i n i n g for t h i s group was 4.6 (range: 2-6). The therapists administering the Emotionally Focussed Treatment were s o c i a l workers or counselling psychologists, a l l possessing a masters degree. The mean number of years of academic t r a i n i n g for 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 therapist 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 to be operationally s i g n i f i c a n t . A l l PS therapists were trained primarily i n a behavioral approach to psychotherapy and t h e i r professed o r i e n t a t i o n was Behavioral or Cognitive - Behavioral. A l l EF therapists were trained i n systemic and humanistic approaches to psychotherapy, and th e i r professed orientations were E x p e r i e n t i a l and Systemic. In terms of c l i n i c a l experience the mean for both the EF and PS therapists was 4 years. The d i s t r i b u t i o n of years of experience across therapists i n each group was also very s i m i l a r (range: 2-7). In general the therapists conducting the two treatments were as f a r as possible balanced as to t r a i n i n g and experience, however the PS therapists did 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 saw two couples, one therapist saw three couples and one therapist saw four couples. The therapists had 61 been trained i n a group s e t t i n g (approximately 12 hours of training) to implement the two therapy manuals. The EF therapists were trained by Dr. L. Greenberg of The University of B r i t i s h Columbia and the PS therapists were trained by Ms. L i s a Wood who collaborates with Dr. N. Jacobson of the University of Washington. Two group supervision meet-ings were conducted during the study, one for each therapist group. A l l therapists were also given a minimal amount of telephone consultation and feedback during the study (not exceeding 15 minutes per couple). An analysis of variance treating therapists as a fixed v a r i a b l e and post-test measures as dependent variables found no s i g n i f i c a n t d i f f e r e n t i a l therapist e f f e c t s . D e t a i l s of th i s analysis may be found i n Tables E5 and E6, Appendix E. Instruments A l l constructed instruments, questionnaires and i n s t r u c t i o n s for the i r completion are to be found i n Appendix B. Subject Variables 1. Demographic Questionnaire This questionnaire addressed the following questions: the number of years spent together as a cohabiting couple, the number of ch i l d r e n l i v i n g i n the home, whether spouses has been previously married or had been involved i n previous marital therapy, the approximate amount of the family income, the age of the spouses as well as t h e i r educational l e v e l and present occupations. This l a s t v ariable was categorised according to the Blishen Scale (Blishen & McRoberts, 1976). The purpose of th i s 62 questionnaire was to provide an accurate d e s c r i p t i o n of the sample population. Couples completed relevant parts of t h i s measure together and i n d i v i d u a l l y focused parts separately. A l l other measures were completed separately by both spouses. 2. The Test of Emotional Styles (ES) (Allen & Hamsher, 1974). This test was given to ascertain i f the treatment groups were i n i t i a l l y equivalent on scores indexing the three factors of emotional s t y l e , Orientation, Expressiveness and Responsiveness. This was necessary since a high l e v e l of these factors i n the couples assigned to the EF treatment might p o s i t i v e l y bias the treatment e f f e c t s . The three dimensions of emotionality addressed i n the test may be defined thus; responsiveness, as i n t e n s i t y of experienced a f f e c t , expressiveness, as the p r e d i s p o s i t i o n to communicate a f f e c t i n t e r p e r s o n a l l y , and o r i e n t a t i o n as a t t i t u d e towards emotion. The test consists of 75 items (25 per subscale) i n the form of forced choices. Subjects are requested to choose between two statements marking the one that i s most true as a d e s c r i p t i o n of themselves. A l l e n and Hamsher report v a l i d i t y and r e l i a b i l i t y data. On t h e i r sample (N = 173) they indicate that i n t e r n a l consistency l e v e l s ( c o e f f i c i e n t alpha) were, Orientation .92, Expressiveness .90, and Responsiveness .85, and found these subscales to be unconfounded with independent measures of adjustment or s o c i a l d e s i r a b i l i t y . Females scored s i g n i f i c a n t l y higher than males on a l l dimensions. An analysis of variance revealed no s t a t i s t i c a l l y s i g n i f i c a n t differences between the three subject groups i n t h i s study on t h i s 63 measure. The d e t a i l s of t h i s analysis may be found i n Table E-2, Appendix E. Therapy Process Variables 3. The Couples Therapy A l l i a n c e Scale (AS) (Pinsoff & C a t h e r a l l , 1983) This instrument was completed by each c l i e n t a f t e r the t h i r d therapy session as a measure of the c l i e n t ' s view of the therapeutic r e l a t i o n s h i p . The measure has three components, agreement between c l i e n t and therapist on therapeutic goals, the existence of personal bonds between therapist and c l i e n t and the development of tasks that are perceived by the c l i e n t as relevant to his/her concerns. These components are i d e n t i f i e d by Bordin (1979) as the key elements i n the concept of therapeutic r e l a t i o n s h i p . These three components are also viewed i n r e l a t i o n s h i p to the s e l f , the other partner and the couple's r e l a t i o n s h i p as a whole. The measure consists of 28 items (11 relate to s e l f , 11 to other partner, and 6 to the couple r e l a t i o n s h i p ) which the subject responds to on a L i k e r t type f i v e point scale. This instrument was intended to control for the general or r e l a t i o n s h i p factors which have been shown to be important i n p r e d i c t i n g therapeutic outcomes. The task dimension which measures engagement i n the tasks of therapy would also appear to be p a r t i c u l a r l y relevant i n t h i s study to show that c l i e n t s were equivalently engaged i n both types of therapy and perceived them as equally relevant. Since t h i s instrument i s s t i l l i n the process of being revised an item analysis was conducted to determine r e l i a b i l i t y for t h i s sample 64 population. The r e s u l t s of t h i s analysis are presented i n the r e s u l t s chapter. 4. The Implementation Checklist This c h e c k l i s t of therapist interventions was devised by the researcher for the purposes of t h i s study. The purpose of the c h e c k l i s t was to enable trained raters (three hours of training) to ascertain whether the interventions s t i p u l a t e d i n the treatment manuals occurred. These raters examined two ten minute samples of therapy taken from the second and f i n a l t h i r d of randomly selected sessions. The c h e c k l i s t consists of 20 categories of therapist interventions taken from the treatment manuals. As well as ten categories of interventions from each treatment three a d d i t i o n a l categories not assignable to either treatment were included, namely, information gathering, refocus on t o p i c , and non-codable. The implementation c h e c k l i s t was p i l o t - t e s t e d f i r s t on four couples and judged to be s a t i s f a c t o r y , i n the sense that the process of treatment was e a s i l y codable into the given catagories. 5. Therapist Intervention Report Therapists were required to complete a c h e c k l i s t at the end of each session. This c h e c k l i s t consisted of the same categories of interventions as the Implementation Checklist and therapists were requested to check off the interventions they had used i n the session and report an estimate of the frequency of use. Therapists also recorded how "resolved" they considered the couple to be at the end of each session. These reports were simply monitored by the researcher and 65 the research assistant and also served to remind therapists of the interventions required i n the treatment manuals. Outcome Variables 6. The Dyadic Adjustment Scale (DAS) (Spanier, 1976). This instrument was used as a screening and pre-treatment measure and as a general measure of outcome at termination and follow-up. The DAS consists of 32 items arranged into four subscales measuring dyadic consensus (13 items), s a t i s f a c t i o n (10 items), cohesion (5 items) and a f f e c t i o n a l expression (4 items). It i s at present considered to be the instrument of choice for the assessment of marital adjustment i n terms of r e l i a b i l i t y ( c o e f f i c i e n t alpha i n Spanier's sample, .96) and v a l i d i t y . Spanier presents 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 Scale (1959) of .86. In the Koren et a l . study (1980) d i s t r e s s l e v e l measured on th i s instrument correlated with s a t i s f a c t i o n concerning c o n f l i c t outcomes and objective c o n f l i c t r e s o l u t i o n . Conceptually, Spanier suggests that the scale can be considered to be a measure of the adjustment of the dyad as a functioning group rather than a measure of Individual adjustment to the r e l a t i o n s h i p . The scale has a maximum possible range of 0 to 151. The mean t o t a l score i n Spanier's sample for married and divorced couples was 114.8 (S.D. 17.8) and 70.7respectively. Spanier reports the r e l i a b i l i t y of the subscales as Consensus .90, S a t i s f a c t i o n .94, Cohesion .86 and A f f e c t i o n a l Expression .73. Most of the items involve a six or f i v e point L i k e r t 66 scale defining the amount of agreement or the frequency of an event. Included i n the s a t i s f a c t i o n subscale i s also a global happiness r a t i n g and a ra t i n g of committment. An item analysis was conducted on t h i s instrument for the purposes of t h i s study, the re s u l t s of which are presented i n the re s u l t s chapter. 7. Target Complaints (TC) (Ba t t l e , Imber, Hoehn-Saric, Stone, Nash & Frank, 1966). A d e s c r i p t i o n of 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 assessor during the i n i t i a l interview and rated as to improvement or de t e r i o r a t i o n at the termination of the sessions and at follow-up. The measure i s recommended by Waskow and P a r l o f f (1975) as a core battery Instrument for use i n psychotherapy outcome research. I t consists of three f i v e point scales on which each c l i e n t i n t h i s study was asked to rate the amount of change on three d i f f e r e n t complaints related to the core c o n f l i c t i n the r e l a t i o n s h i p . In t h i s study one score (TC) was computed based on the c l i e n t ' s r a t i n g of the status of the primary target complaint. Battle et a l . (1966), give evidence as to the v a l i d i t y of t h i s measure i n terms of s i g n i f i c a n t c o r r e l a t i o n s with other outcome measures p a r t i c u l a r l y the correspondence of target complaints to the complaints obtained i n an intensive p s y c h i a t r i c interview. These authors state that they found t h i s measure to be "informative, and i t made good c l i n i c a l sense and seemed to respond d i f f e r e n t i a l l y to experimental manipulation" (p. 187). The authors report the c o r r e l a t i o n between the h 67 rankings of problems by patients on two d i f f e r e n t occasions as .68. The sever i t y ratings of the target complaints did not change. A f i n a l study by the above authors also found that the content of target complaints did not d i f f e r s i g n i f i c a n t l y when these ratings were reported to d i f f e r e n t interviewers. The type of Target Complaints a r t i c u l a t e d by c l i e n t s i n t h i s study are described i n Appendix B. Jacobson, F o l l e t t e and Elwood ( i n press), suggest that measures which tap the couples presenting problems most d i r e c t l y such as problem c h e c k l i s t s l i k e t h i s instrument and goal attainment scales are the instruments of choice i n marital therapy. 8. Goal Attainment Scaling (GAS) (Kiresuk & Sherman, 1968) The GAS measurement procedure i s a method of goal d e f i n i t i o n and goal measurement. It i s a method of obtaining from c l i e n t s s p e c i f i c observable and qu a n t i f i a b l e i n d i v i d u a l goals. The procedure includes a means of formally specifying the actual goals undertaken by a c l i e n t i n r e l a t i o n to his/her presenting concerns. With t h i s procedure i t i s possible to determine the extent to which the c l i e n t ' s goals have been attained. The GAS scores are based on a standard score system (T scores) having a mean of 50 and a standard deviation of 10. The goal outcomes range from "much worse than expected" (-2) through "expected" (0) to "much better than expected" (+2), with each outcome l e v e l defined by a p a r t i c u l a r observable behavior or group of behaviors. A scale must have at l e a s t two points that are s u f f i c i e n t l y precise and objective i n the i r d e s c r i p t i o n so that an unfamiliar observer would have no trouble i n 68 determining 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 point. The scale thus becomes an evaluative transformation of the treatment outcome into an approximate random variable with a mean of zero and a variance of one (before transformation to the standard T score having a mean of 50 and standard deviation of 10). One purpose i n the development of the GAS system was to allow outcome data to be grouped for easy analysis without l o s i n g the import of i n d i v i d u a l c l i e n t goals. A standard score may be generated f o r each c l i e n t to evaluate his/her p o s i t i o n before and a f t e r therapy. Kiresuk and Sherman point out that e s s e n t i a l l y the GAS has the following c h a r a c t e r i s t i c s : 1) a set of statements of goals for an i n d i v i d u a l ; 2) a system of weights for these goals; 3) a set of expected outcomes f or these goals ranging from- "most unfavorable" to "most favorable"; 4) a follow-up scoring of these outcomes; and 5) a score summarizing the outcome across a l l goals. In t h i s study the c l i e n t s were asked to focus upon the main goal i n r e l a t i o n to t h e i r marital issues and to define 5 l e v e l s of attainment of that goal i n terms of three observable and qua n t i f i a b l e behaviors and one subjective emotional reaction. One l e v e l of attainment was described as "worse", that i s the instrument, l i k e the TC instrument allows f o r d e t e r i o r a t i o n . An example of the way i n which a l e v e l of attainment might be defined may be c l a r i f y i n g . A spouse might describe the "somewhat better than expected" l e v e l of goal attainment i n terms of, 1) being able to reach consensus on decisions 75% of the time, 2) being able to ta l k clamly about issues 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) only encountering one 69 escalating distressing fight a month. As a result the spouse might expect to feel generally calmer and more secure in the relationship. In the assssment interview clients formulated their goals and rated their present level of attainment on an individual independent basis. At termination and follow-up the level of attainment was measured again. 9. The Personal Assessment of Intimacy in Relationships Inventory  (PAIR) (Schaefer & Olson, 1981) This instrument consists of 36 items arranged into 6 subscales, Emotional Intimacy, Social Intmacy, Sexual Intimacy, Intellectual Intimacy, Recreational Intimacy, and Conventionality. Definitions for these subscales may be found in Appendix B. Each subscale is a separate entity; there is no total score. The instrument attempts to operationalise different kinds of intimacy. Intimacy is presumed to be a key dimension of the marital relationship and one which may be expected to correlate positively 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 in each of the five areas of intimacy mentioned above. The conventionality subscale was designed to measure social desirability factors and is scored only as perceived. Each partner responds to each item "as i t is now" (perceived) and then "how he/she would like i t to be", (expected) indicating agreement or disagreement on a five point Likert scale. Olson and Schaefer (1982) report in the manual that in their sample (N = 384), the PAIR subscales correlated positively with the Locke 70 Wallace M a r i t a l Adjustment Scale (1959) and negatively with the C o n f l i c t Scale on the Moos Family Environment Scale (1976). The authors report the r e l i a b i l i t y (Cronbach's alpha) of each of the subscales as .75 for the Emotional (EM) subscale, .71 for the S o c i a l (SO), .77 for the Sexual (SX), .70 for the I n t e l l e c t u a l (IN), and .70 for the Recreational (RC) subscales. They also state that scores on the subscales were found to have a f a i r l y normal d i s t r i b u t i o n (range = 0 - 96). They found that except for S o c i a l Intimacy and Conventionality (CON) the mean perceived score f e l l between 42 and 58 f o r each scale. The average score for S o c i a l Intimacy was somewhat higher (x = 61) and for Conventionality was somewhat lower x*= 38). They report that large discrepancies between male and female perceived scores were common (0 - 70 points on each s c a l e ) , however the mean discrepancy was 14 - 20 points. Means for expected subscales ranged between 80 - 86. The authors suggest that a high score on the Conventionality subscale i s the r e s u l t of the couple "faking good" and a tendency to i d e a l i z e the r e l a t i o n s h i p (PAIR Manual, 1982). These two formulations would seem to present 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 subscale. Clayton (1975) suggests that the meaning of conventionality as i t r e l a t e s to the measurement of marital adjustment may i n fact be i d e a l i s a t i o n of the spouse and of the r e l a t i o n s h i p , and that t h i s i d e a l i s a t i o n may i n fact be a p o s i t i v e marital adjustment technique. The process of i d e a l i s a t i o n has been considered by many t h e o r i s t s as e s s e n t i a l to the experience of romantic attachment (Csikszentmihalyi, 1980). Clayton also c r i t i z e s Edmonds (1967) o r i g i n a l work on s o c i a l d e s i r a b i l i t y factors i n the measurement of marital adjustment since 71 Edmonds only recorded one of his sample spouses responses and did not describe his sample's demographics. In fact Clayton and other authors such as Dean and Lucas (1974) suggest i n general that the issue of 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 been overstated. In the l i g h t of the above the conventionality subscale on the PAIR w i l l be considered as a measure of functional i d e a l i s a t i o n of the spouse and the r e l a t i o n s h i p . An item analysis was conducted on t h i s instrument for the purposes of t h i s study and the r e s u l t s are presented i n the r e s u l t s chapter. 10. The Post Treatment Standardised Interview This standardised interview was constructed for t h i s study to explore the subjects experience of the process of therapy. Questions concerned the perceived changes i n the r e l a t i o n s h i p , the factors each spouse perceived as f a c i l i t a t i n g treatment, or hindering treatment, c r i t i c a l incidents during therapy which seemed to contribute to change, and whether spouses would have preferred more sessions. The interview was used by the assessor a f t e r administering the post-tests to obtain the couples impessions on the above areas. Subjects gave t h e i r answers o r a l l y and they were noted by the assessor. 11. The A c t i v i t i e s While Waiting Inquiry The questionnaire was administered by the assessor to the control group at the pre-treatment interview. The questionnaire was given to attempt to monitor possible therapeutic factors or a c t i v i t i e s experienced by the couple during the waiting period. 72 12. The Rating of C o n f l i c t Resolution Observers rated the attainment of s p e c i f i c r e s o l u t i o n behaviors during a task set by the therapist i n the l a s t session (see Appendix B for a d e s c r i p t i o n of the task). The raters used a simple outcome coding system suggested by Koren (1978) to rate the i n therapy performance. According to t h i s measure a r e s o l u t i o n can then take the form of one spouse c a p i t u l a t i n g to the other or both spouses reaching some kind of compromise. In e i t h e r case at l e a s t one s o l u t i o n proposal and a subsequent statement of acceptance or agreement i s required for a r e s o l u t i o n c l a s s i f i c a t i o n . Unfortunately the performance of the required task was not successful. It seems i n t h i s study to have been influenced by the demand c h a r a c t e r i s t i c s of the s i t u a t i o n , that i s couples seemed to do what t h e i r therapist asked them to do regardless of the state of t h e i r r e l a t i o n s h i p . The measure did not seem to be v a l i d as an assessment of c o n f l i c t r e s o l u t i o n i n t h i s study and so was not rated i n the a n a l y s i s . Data C o l l e c t i o n Procedures Data c o l l e c t i o n took place from A p r i l to November, 1983. A l l couples except two requested counselling a f t e r reading a newspaper a r t i c l e describing the Couple Problem Solving Project and o f f e r i n g d i s t r e s s e d couples eight sessions of marital therapy. The other two couples heard of the project from p a r t i c i p a n t s . The couples were screened on the telephone and were scheduled e i t h e r for an assessment interview or referred elsewhere i n the l o c a l i t y for treatment or assistence. 73 The couples screened out of the study were as follows: two couples were screened out because they had been l i v i n g together less than a year; f i v e couples were screened out because they had already separated and were l i v i n g apart; seven couples were screened out because they had recently been or were currently receiving p s y c h i a t r i c treatment for problems such as depression; two couples were screened out because one of the partners reported that one of them was a l c o h o l i c ; three couples were screened out because they reported t h e i r marital problem as pr i m a r i l y involving sexual dysfunction; s i x couples were screened out during the assessment interview because they scored too high on the DAS; three couples were excluded because of t h e i r extremely low DAS scores, that i s a couple score of 65 and below (Spanier (1976) reports 70 as the mean for divorced couples); two couples objected to the taping of sessions, and one couple was excluded because of extensive upcoming vacations. The assessment interviews were conducted by the reseacher plus two as s i s t a n t s and consisted of giving information concerning the Project and what was expected of p a r t i c i p a n t s , addressing issues such as c o n f i d e n t i a l i t y of information, signing consent forms, and completing the DAS, PAIR, TC, GAS, and Emotional Style questionnaires. An example of the Consent Form may be found i n Appendix C. The couples were then assigned randomly to treatment and t h e r a p i s t . The treatment couples then completed eight hours of marital therapy, completing the A l l i a n c e scale after session three. This scale was completed after the therapist had l e f t the room and placed i n a sealed envelope which was the l e f t i n the c l i n i c . The couple also 74 completed a process oriented questionnaire a f t e r every session. This data was c o l l e c t e d for use i n a future study on the process of change. Af t e r the eighth session an assessor, other than the researcher, administered the post tests (DAS, PAIR, TC, GAS) and the Post Treatment Questionnaire. A l l therapy sessions were audio and video taped and randomly selected sessions were checked by raters for treatment f i d e l i t y . The control group couples were t o l d that i t was necessary for them to wait u n t i l a therapist could be assigned to them. Aft e r eight weeks they were contacted, given a post wait assessment interview c o n s i s t i n g of the pre-tests (DAS, PAIR, TC, GAS) and the A c t i v i t i e s While Waiting Questionnaire, and began therapy. The therapists t r e a t i n g the control group were graduate students i n the Counselling Psychology Department of The University of B r i t i s h Columbia who were then supervised by Dr. Greenberg and the researcher. An analysis of the outcome data for the control group i s not included i n t h i s study. Once treatment had begun there were no drop outs from the study. This unusual phenomena the reseacher believes 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 therapists who were able to create a strong therapeutic a l l i a n c e with t h e i r c l i e n t s . A t o t a l of 45 couples (n = 15) were included i n the study. Couples came into therapy every week for eight weeks unless summer holidays Intervened. A l i m i t of one break between sessions of no longer than 12 days was arranged i n the assessment interview. Approximately one quarter of the couples from both treatment groups did take t h i s kind of a break. 75 Eight weeks after treatment couples were contacted on the phone and asked standardised questions as to the present level on their Target Complaint and Goal Attainment. A description of the questions may be found in Appendix C. The DAS and PAIR questionnaires were then sent in the mail to the couples who completed and returned them. A l l test scoring and key punching was verified. 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 reliably differentiate between treatments on an implementation checklist instrument applied to random samples of audio-taped interventions. Thus treatments would be different as implemented and the interventions used would be appropriate to the designated treatment. 2. The treatment groups were not expected to differ significantly on a measure of theraputic alliance. Outcome hypotheses 1. The following means of the treatment groups were expected to be significantly different at the end of treatment from the means of a wait l i s t control group: 76 a. The t o t a l score and subscales of the Dyadic Adjustment Scale, a measure of marital adjustment. b. The s i x subscales of the PAIR, a measure of intimacy l e v e l s i n d i f f e r e n t areas of the r e l a t i o n s h i p . c. The Goal Attainment measure. d. The Target Complaint measure. 2. The treatment groups were expected to show d i f f e r e n t i a l e f f e c t s at the termination of treatment on: a. The t o t a l scores and subscales of the DAS. b. The s i x subscales of the PAIR. c. The Goal Attainment measure. d. The Target Complaint measure. e. An observed measure of c o n f l i c t r e s o l u t i o n . 3. The treatment groups were also expected 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 termination of treatment when assessed i at follow-up. Data Analysis Procedures The computer programs used i n t h i s analysis were, S.P.S.S.:X (SPSS Inc., 1983) and S.P.S.S.:9 (Nie et a l . , 1975), LERTAP (Nelson, 1974) and BMDP (Dixon, 1981). The data analysis was divided into three stages. The preliminary a n a l y s i s consisted of an item analysis of the DAS, the PAIR, and the A l l i a n c e Scale to ascertain the r e l i a b i l i t y of the above instruments. The second stage involved the t e s t i n g of assumptions concerning group equivalence on instruments such as the A l l i a n c e Scale, the Test of 77 Emotional Style and Demographics and the examination of Implementation Checks. The t h i r d stage consisted of t e s t i n g for pre-treatment dif f e r e n c e s and the multivariate analysis of treatment outcome measures. Variables found to d i f f e r e n t i a t e between the two treatment groups at termination of treatment were also analysed at follow-up by means of a repeated measures multivariate analysis of variance. In addition, variables found not to d i f f e r e n t i a t e between treatment groups at termination were analysed to check for "sleeper" e f f e c t s . Some ad d i t i o n a l analyses of i n d i v i d u a l post-treatment scores and follow-up scores were also completed. Hypotheses were tested allowing a Type 1 error p r o b a b i l i t y of .05 (two t a i l ) . However when multiple analyses were conducted i n order to control the experiment-wise error rate the c r i t i c a l s i g n i f i c a n c e l e v e l was computed as .05 divided by the number of variables i n the analysis (Hays, 1981). Differences among le v e l s for a p a r t i c u l a r factor were examined using Tukey's procedure (Glass & Stanley, 1970). In a l l multivariate analyses the test s t a t i s t i c used was the P i l l a i - B a r t l e t t , recommended by Olson (1976) as being the most generally powerful and robust s t a t i s t i c a v a i l a b l e . In a l l analyses the homogeneity of variance assumptions were checked and no s i g n i f i c a n t differences found, except on the Couples A l l i a n c e Scale (Table 5) and on the pre-test scores of the PAIR Perceived, subscale 6 (Table 7). Although i n these analyses the assumption of homogeneity of variance i s v i o l a t e d since the n's are equal, i n which case the influence of t h i s v i o l a t i o n i s very small, and the e f f e c t s of non-normality on the nominal l e v e l of s i g n i f i c a n c e of the F-test are extremely s l i g h t (Glass & Stanley, 1970), the ANOVA procedure was considered to be v a l i d . 78 In the pretest posttest and follow-up analyses of DAS scores the t o t a l DAS score, often used as a main outcome variable i n other m a r i t a l therapy outcome studies (Jacobson, i n press) could not be included i n the multivariate analyses which involve the subtests on t h i s scale since such i n c l u s i o n would then v i o l a t e the assumption of independence. Ad d i t i o n a l analyses of the t o t a l DAS score are then reported separately. Follow-up scores were analysed using a repeated measures analysis to account for the dependency between posttest and follow-up scores. L i m i t a t i o n s of the Study Since therapists are nested within treatments i n th 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 sets of therapists were trained i n and oriented towards the treatment they were asked to implement. Therapists were a l l experienced and from the point of view of t h e i r t r a i n i n g and amount of experience would appear to be s i m i l a r . The therapists were also monitored during the study by two raters during implementation checks; (120 out of 240 sessions were monitored). These raters found only 2.5% of the therapist interventions observed to be inappropriate to t h e i r designated treatment. When therapist e f f e c t s were tested as a fixed variable i n an ANOVA analysis (dependent variables being the post-test measures) no evidence for d i f f e r e n t i a l e f f e c t s was found. There were also no s i g n i f i c a n t d ifferences found between treatment groups on the A l l i a n c e measure, and mean scores were r e l a t i v e l y high which suggests that couples i n both groups found t h e i r therapists relevant, e f f e c t i v e and easy to rela t e to. O'Leary and Turkewitz (1978) discuss the issues concerning the 79 crossing versus the nesting of therapists and treatment. They point out that crossing therapists and treatment can create systematic bias unless therapists are as e f f e c t i v e i n and equally committed to both treatments. In fact i n the cross model study by Liberman et a l . (1976) the researchers state that t h e i r r e s u l t s were confounded by the fact that therapists biased towards the behavioral model conducted both treatments. Jacobson, F o l l e t t e and Elwood ( i n press) also point out that the crossing of therapists and treatments tends to increase the common elements among treatments, d i l u t i n g the a b i l i t y of researchers to detect treatment d i f f e r e n c e s . The fact that therapists are nested under treatment i n t h i s study ensures a "pure" sample of each therapy i n that each treatment was conducted by therapists committed to the treatment and trained i n just that treatment before the project. The r e l a t i v e l y large number of therapists used (n = 12) also helps to protect against d i f f e r e n t i a l therapist e f f e c t s and increases external v a l i d i t y . The short duration of treatment can also be regarded as a l i m i t a t i o n i n t h i s study. Eight sessions were chosen as the minimum number of sessions i n which therapists could f a c i l i t a t e change i n marital therapy. Matarazzo (1965) suggests that most c l i e n t s do not continue therapy for more than 10 sessions, and the trend i n psychotherapy and e s p e c i a l l y i n marital therapy seems to be towards short term therapy i n which the therapist a c t i v e l y structures his interventions toward c l e a r l y formulated goals (Malan, 1976, Mann, 1973); nevertheless a longer treatment period of, for example 12 sessions, would have given time to address issues such as the maintenance of changes made during treatment. There was also some concern that the 80 short time frame i n fact favored the s k i l l teaching process and placed the emotionally focussed treatment at a disadvantage. Another issue i n the implementation of the present study was the use of the p r i n c i p a l i n v e s t i g a t o r as one of the ther a p i s t s . There i s no evidence to suggest d i f f e r e n t i a l therapist e f f e c t s however, eit h e r on the A l l i a n c e Scale, the analysis of therapist e f f e c t s , or the implementation checks. The p r i n c i p a l investigator also did not administer any of the post tests to any couples involved i n the study, nor assess any of the couples assigned to her as c l i e n t s . Nevertheless i t would have been preferable to have kept the therapist and in v e s t i g a t o r roles separate. Also, although every attempt was made to operationalise both treatments i n a p a r a l l e l and equitable fashion, the researcher was not i n the p o s i t i o n of valuing the treatments equally, being biased towards the Emotionally Focussed treatment. To insure external v a l i d i t y the study should then be r e p l i c a t e d by other i n v e s t i g a t o r s . The mean l e v e l of d i s t r e s s (a score of 92.1 on the DAS) i n th i s study suggests that t h i s sample i s most accurately considered as moderately rather than severely distressed; the mean score for Spanier's normative sample being 114.8 and 70.7 for divorced couples. Some couples scoring as severely distressed were included i n t h i s sample, each group containing couples with couple scores under 80 on the DAS. Also the means indic a t e that couples are i n the distressed range with scores that range from mildly to severely d i s t r e s s e d . Jacobson et a l . ( i n press) make the point that even though the i n c l u s i o n of some mildly distressed couples may appear to ease the task of therapy i n fact the 81 i n c l u s i o n of such couples increases the d i f f i c u l t y of demonstrating treatment e f f e c t s . As a r e s u l t of the fact that couples who p a r t i c i p a t e d i n the study were s o l i c i t e d a question a r i s e s as to how representative t h i s sample i s of a c l i n i c a l population who v o l u n t a r i l y seek treatment. However, Last, Thase, Hersen, Bellack and Himmelhoch (1984) found no differences between s o l i c i t e d and n o n - s o l i c i t e d depressed patients on treatment outcome measures, thus supporting the i n c l u s i o n of s o l i c i t e d c l i e n t s i n c l i n i c a l studies. In t h i s study there c e r t a i n l y were couples who had considered or who were considering separation included i n the study, and some had separated previously. A l l couples were concerned about t h e i r r e l a t i o n s h i p to the point that they were w i l l i n g to commit themselves to the assessment sessions, therapy sessions and follow-up procedure. A l l couples completed the eight sessions, there were no drop-outs. However to address t h i s question properly data on the average DAS scores for c l i n i c a l couples would seem to be necessary. The study would perhaps be enhanced by objective behavior r a t i n g s , for example a measure of problem solving behavior i n the l a s t session. The attempt to set out a task 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 did not d i f f e r e n t i a t e between couples; a l l couples were able to complete i t . The study could be viewed as being l i m i t e d by the fact that a l l measures except 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 were e s s e n t i a l l y s e l f - r e p o r t measures. However th i s kind of measurement seems to be p a r t i c u l a r l y appropriate i n the sense that marital s a t i s f a c t i o n or well-being i s by nature a q u a l i t a t i v e subjective factor rather than an externally q u a n t i f i a b l e phenomena, and t h i s i s perhaps one of the reasons 82 researchers i n t h i s area have focussed upon s e l f - r e p o r t measures. Also objective phenomena and subjective factors do not always correspond. Margolin (1978) found that trained observers coding of p o s i t i v e and negative communication behaviors did not i n fact correlate with marital s a t i s f a c t i o n whereas spouse reports of pleasing behaviors did. Also i n recent studies Jacobson et a l . ( i n press) have suggested that observational coding systems are r e l a t i v e l y i n s e n s i t i v e to r e l a t i o n s h i p changes produced during behavioral marital therapy. The Goal Attainment measure could be viewed as more objective i n that i t was s p e c i f i c a l l y t i e d to observable behaviors, although the i n d i v i d u a l s t i l l s u b j e c t i v e l y judged, as to whether those behaviors did i n fact occur i n the r e l a t i o n s h i p . It i s arguable that i t i s the perception of behaviors that i s s a l i e n t to marital adjustment rather than t h e i r objective occurrence. The d i f f i c u l t y of a t t a i n i n g relevant objective measures i s also an issue i n t h i s f i e l d , and i t has been suggested that use of these measures w i l l be j u s t i f i e d only when i t has been demonstrated that such systems measure constructs that are not adequately measured by less expensive means (Jacobson et a l . , i n press). The issue of s o c i a l d e s i r a b i l i t y factors on measures such as the PAIR and the DAS has been addressed i n t h i s chapter. It would also appear l o g i c a l 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 across both groups and therefore not confounded with differences between groups. As suggested by O'Leary and Turkewitz (1978) research procedures were set up i n such a way as to minimise c l i e n t s investment i n impression management, for example ensuring that therapists were absent when questionnaires were completed. 83 CHAPTER IV RESULTS AND DATA ANALYSIS Stage 1. Preliminary Item and Test Analysis The f i r s t part of the preliminary analysis consisted of an item analysis of the Dyadic Adjustment Scale or DAS (Spanier, 1976) using the LERTAP computer program (Nelson, 1974). The means, standard deviations and r e l i a b i l i t i e s calculated for the pre-treatment DAS couple scores are presented i n Table 1. R e l i a b i l i t i e s were calculated using Hoyt's ANOVA ( i n t e r n a l consistency) method; the r e l i a b i l i t y for the DAS as a whole was calculated at .84. Table 1 DAS: Test S t a t i s t i c s Subtests (N = 90) Con. S a t i s . Coh. A. Ex. To t a l Mean 41.46 31.63 12.18 6.71 91.98 S.D. 5.96 5.11 3.55 1.96 11.71 R e l i a b i l i t y (Hoyt) .73 .78 .79 .58 .84 Cronbach's (Alpha) — — - - .57 Note: Consensus contains 13 items S a t i s f a c t i o n contains 10 items Cohesion contains 5 times A f f e c t i o n a l expression contains 4 items 84 The r e l a t i v e l y 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 Expression subscale would appear to be a r e f l e c t i o n of the lack of variance on t h i s s c a le. Most of the items on the test correlated at a p o s i t i v e and adequate l e v e l with other test items and the o v e r a l l r e l i a b i l i t y of the subscales appears to be s a t i s f a c t o r y . The Cronbach's Alpha l e v e l for the t o t a l test (.57) suggests that four separate but related aspects of marital adjustments are being measured by t h i s t e s t . The Hoyt r e l i a b i l i t y f o r the t o t a l (.84) 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 test items (32); the Cronbach's alpha c o e f f i c i e n t 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 the four subscales. Some items correlated at less than a .30 l e v e l with the other subscale items p a r t i c u l a r l y on the Consensus subscale (5 items out of the 13). This suggests that consensus concerning subjects such as ways of dealing with inlaws or parents and philosophy of l i f e may not be as related to the concept of marital adjustments as consensus regarding other more dyadically focussed issues such as the amount of time spent together. Subtest c o r r e l a t i o n s are given i n Table D-l, Appendix D. R e l i a b i l i t i e s were also calculated for the scores of males and females independently. The r e l i a b i l i t y for the males on the t o t a l test being .86 and for the females .80; these data are presented i n Tables D-2 and. D-3 i n Appendix D. The subscales of the Personal Assessment of Intimacy i n Relationships Inventory or PAIR which was constructed by Schaeffer and Olson (1981) were also subjected to an item a n a l y s i s . The Perceived part of t h i s test contains s i x subscales and the Expected part only f i v e since the subscale Conventionality i s not included i n the second part of the t e s t . The means, standard deviations and r e l i a b i l i t i e s for the PAIR 85 Perceived and for the PAIR Expected subscales are presented i n Tables 2 and 3 r e s p e c t i v e l y . Table 2 PAIR Perceived: Test S t a t i s t i c s Subtests (N = 90) Em. Soc. Sx. Int. Rec. Con. 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 R e l i a b i l i t y .69 .64 .79 .57 .72 .67 (Hoyt) Note: Possible range = 0 to 24 A l l subscales contain 6 items. Although t h i s test was not constructed to y i e l d a t o t a l score the Hoyt r e l i a b i l i t y for the perceived form of the t o t a l test was computed as .87 and the Cronbach's Alpha for the composite as .77. The r e l i a b i l i t y for the I n t e l l e c t u a l subscale i s r e l a t i v e l y low, and may be the r e s u l t of items one and four c o r r e l a t i n g at below the .30 l e v e l with the rest of the subscale items. This suggests that experiencing a partner as helping to c l a r i f y one's thoughts (item one) or fi n d i n g that i t i s useless to discuss some issues together (item four) may not be of the same relevance to a distressed couple as the experience of r e l a t i n g to a partner who frequently t r i e s to change one's ideas or frequently "puts down" t h e i r partner In a serious discussion. Items such as the l a s t two mentioned would seem to re l a t e to the coercive patterns of i n t e r a c t i o n found more frequently i n distressed couples than items one 86 and four. The .57 r e l i a b i l i t y of this subscale however s t i l l seems adequate given the. small number of items (6). The subtest c o r r e l a t i o n s for the PAIR Perceived are given i n Table D-4, Appendix D. The means, standard deviations and r e l i a b i l i t i e s for males and females scored independently are to be found i n Table D-5, Appendix D. The r e l i a b i l i t i e s for the female scores seem to be somewhat lower however the standard deviations are also smaller suggesting a lowered r e l i a b i l i t y due to lack of variance. The i n t e r p r e t a t i o n of the Conventionality subscale as I d e a l i s a t i o n i s supported somewhat by the fact that t h i s subscale was found to correlate with the DAS subscale S a t i s f a c t i o n at the .78 l e v e l for male subjects and the .60 l e v e l for female subjects i n t h i s sample. The PAIR Expected scores represent the couple 1s i d e a l of how the r e l a t i o n s h i p should be i n the f i v e areas of intimacy included i n the te s t . The means, standard deviations and r e l i a b i l i t i e s for the PAIR Expected are presented i n Table 3. Table 3 PAIR Expected: Test S t a t i s t i c s 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 R e l i a b i l i t y .60 .52 .62 .52 .50 (Hoyt) Note: Hoyt for t o t a l = .78 Cronbach's Alpha = .70 A l l subtests contain 6 items 87 These r e l i a b i l i t i e s are lower than those of the PAIR Perceived subscales. Once again however standard deviations are also low; couples tended to answer many of the items i n a s i m i l a r fashion. This suggests that on these scales and i n th i s sample people's ideals as to what constitutes a good re l a t i o n s h i p did not d i f f e r to any great extent. The subtest c o r r e l a t i o n s for the PAIR Expected are given i n Table D-6, Appendix D. The means, standard deviations and r e l i a b i l i t i e s for males and females scored independently are to be found i n Table D-7, Appendix D. An item analysis was conducted on the Couples Therapy A l l i a n c e Scale (Pinsoff & C a t h e r a l l , 1983) and the means, standard deviations and r e l i a b i l i t i e s are presented i n Table 4. Table 4 Couples Therapy A l l i a n c e Scale: Test S t a t i s t i c s Subtests (N = 60) Self Other Relationship T o t a l Mean 46.12 44.55 25.17 115.83 S.D. 5.58 5.95 3.30 14.04 R e l i a b i l i t y (Hoyt) .88 .92 .85 .96 Cronbach's (Alpha) - - — .91 Note: T o t a l T o t a l observed possible range = range = 81-140 0 - 1 4 0 , 28 items 88 Each item i n t h i s instrument correlated at a p o s i t i v e and adequate l e v e l with the other test items. Thus each item can be said to be performing c o r r e c t l y . The o v e r a l l r e l i a b i l i t y of the test for this sample of subjects seems to be very s a t i s f a c t o r y . The Cronbach's Alpha l e v e l for the t o t a l test (.91) suggests that the subtests are correlated to the point that they may be considered as a unit rather than as separate f a c t o r s . The means on a l l the subtests are r e l a t i v e l y high which implies that the a l l i a n c e of couples and therapists i n t h i s sample was i n general p o s i t i v e ; that i s that couples were able to bond with t h e i r t h e r a p i s t , perceived the therapist as working with them towards the same goals and viewed the therapist as s k i l l e d and able to help change t h e i r relationshp. Stage I I : Testing Assumptions of Group Equivalence An analysis of variance was conducted on each of 8 demographic variables (group by demographic v a r i a b l e ) . Number of Years Together, Family Income, Level of Occupation of both spouses, Age of both spouses, and Level of Education of both spouses. No s i g n i f i c a n t differences were found on these factors when tested at the .05 l e v e l of s i g n i f i c a n c e corrected by the Bonferroni procedure (Hays, 1981). Det a i l s of t h i s analysis may be found i n Table E - l , Appendix E. Individual responses on the subscales of the Test of Emotional Style ( A l l e n & Hamsher, 1974), namely Orientation, Expressiveness were also analysed using an analysis of variance (group by male and female subscales). In this analysis no s i g n i f i c a n t differences were found between groups on any of the three subscales. The c r i t i c a l s i g n i f i c a n c e 89 l e v e l was set at .05, corrected by Bonferroni (.05/6 = .008). The means, standard deviations and p_ values are presented i n Table E-2, Appendix E. The scores of the two treatment groups on the Couples Therapy A l l i a n c e Scale (Pinsof & C a t h e r a l l , 1983), were analysed i n order to test the assumption that there was no s i g n i f i c a n t group differences i n the q u a l i t y of the a l l i a n c e between therapist and couple. I f a s i g n i f i c a n t difference existed i t would present a confounding factor i n the i n t e r p r e t a t i o n of treatment e f f e c t s . The means on th i s scale for both groups were r e l a t i v e l y high (maximum posible i s 140), the EF couples mean score being 121.3 (SD = 19.8) and the PS couples mean score being 113.6 (SD = 10.9). The higher mean i n the EF group might be expected i n a treatment i n which the therapist focusses upon emotional experience rather than the teaching of s k i l l s since the former tends to create bonds between therapist and c l i e n t . The re s u l t s of the analysis of the couples a l l i a n c e scores are presented i n Table 5. No s i g n i f i c a n t d ifferences were found i n th i s analysis or i n an analysis of male and female a l l i a n c e scores considered seperately, (Table E-3, Appendix E ), or i n an analysis of the i n d i v i d u a l subtests of the A l l i a n c e Scale. Since the Task dimension of th i s scale was considered p a r t i c u l a r l y relevant i n that i t r e f l e c t s how relevant and engaging couples found the therapeutic interventions to be; an add i t i o n a l analysis was conducted on the items pertaining to this dimension. The means of both groups on th i s dimension were high; the maximum possible score was 50, and the mean of the EF couples was 42.6 (SD = 4.6), while the PS couples mean was 41.7 (SD = 4.2). No s i g n i f i c a n t differences were found between 90 Table 5 Summary Anova: Couple Therapy A l l i a n c e Scale Source of V a r i a t i o n SS MS DF F P Between 433.2 433.2 1 1.69 .204 Within (N = 30) 7,178.2 256.4 28 treatment groups on t h i s v a r i a b l e . D e t a i l s of the re s u l t s may be found i n Table E-4, Appendix E. These re s u l t s suggest that both groups had s i m i l a r expectations as to the effectiveness of the treatment they were offered and found both treatments relevant to t h e i r concerns. D i f f e r e n t i a l therapist e f f e c t s were tested by a series of oneway analyses of variance (Therapist (N = 12) by each post-measure) i n which therapists were treated as a fixed f a c t o r . Although 18 analyses on male and female post-treatment scores were conducted and a Bonferroni procedure would then r e s u l t on a c r i t i c a l s i g n i f i c a n c e l e v e l of .05/18 = .0027, these analyses were not s i g n i f i c a n t even at the .01 l e v e l . The d e t a i l s of these analyses are to be found i n Tables E-5 and E-6, Appendix E. Before analysing treatment outcome data i t was necessary to confirm that the treatments were implemented i n accordance with the manuals. For the purpose of t h i s implementation check a t o t a l number of 120 out of the 240 sessions were observed. The sessions to be observed were chosen at random. Two segments of 10 minutes duration were taken from 91 the middle and f i n a l t h i r d of these 120 sessions. Each couple was thus observed during therapy for a t o t a l of 80 minutes. These segments were rated from video and audio tapes by two trained independent raters and coded on the Implementation C h e c k l i s t . This Checklist consists of 23 coding catagories, 3 of which were general categories, the remaining categories describing 10 interventions c h a r a c t e r i s t i c of each of the treatments. An intervention was defined as a complete therapist statement, the beginning and end of which was noted by the raters to ensure that they were both coding the same u n i t s . In a l l 1866 interventions were coded by the raters who were b l i n d as to the treatment condition they were observing. Out of the 1866 interventions coded 47 were categorised i n such a way as to be inappropriate to the treatment condition being observed. Thus i n t o t a l 2.5% of the t o t a l interventions observed were rated as belonging to inappropriate categories. Of these 47 inappropriate interventions 15 occurred i n the Problem Solving condition and 32 i n the Emotionally Focussed condition. This may r e f l e c t the fact that the former treatment i s by nature somewhat more structured and e a s i l y delineated. In the Problem Solving treatment the emotionally focused intervention most often used was intervention number 7, where the therapist probes for emotional experience, for example by asking one spouse "how do you f e e l when he does that". In the Emotionally Focussed treatment the problem solving intervention most often used was number 8 where the therapist helps the couple pinpoint s p e c i f i c behaviors, for example by asking, "and when he does th i s what do you do, how you react". These kinds of questions would seem to be necessary no matter what kind of therapeutic model the therapist i s using. 92 The small proportion of interventions appropriate to the other treatment suggests that the treatments were very e a s i l y distinguishable and able to be implemented according to the therapy manuals. Inter- r a t e r r e l i a b i l i t y was calculated on 406 observations taken from 25 randomly chosen sessions (20.8% of the t o t a l sessions observed). The two raters agreed on 379 of the interventions observed (93% agreement). The 27 disagreements which occurred between raters consisted of 2 cross treatment (n = 2) disagreements, and 25 cross intervention (n = 20) disagreements. Inter-rater r e l i a b i l i t y was calculated using Cohen's (1960) s t a t i s t i c Kappa. This s t a t i s t i c i s a conservative estimate of r e l i a b i l i t y corrected for the proportion of agreement to be expected by chance alone. The Kappa s t a t i s t i c for between treatment agreement was then computed as .99. The Kappa 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 interventions (within treatments) was computed as .95. These s t a t i s t i c s suggest that treatments and interventions were able to be r e l i a b i l y d i f f e r e n t i a t e d . At the end of Stage 2 of the analysis i t was then possible to assert that no s t a t i s t i c a l l y s i g n i f i c a n t differences were found between experimental groups on Demographic variables or the Test of Emotional Style, and 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 therapeutic a l l i a n c e . Therapist e f f e c t s were tested for and found to be non-significant; also Implementation Checks and the i n t e r - r a t e r r e l i a b i l t y on these checks were found to be s a t i s f a c t o r y , for the purposes of t h i s i n v e s t i g a t i o n . 93 Stage I I I ; Analysis of Treatment E f f e c t s : Pre-Test Post-Test  and Follow-Up Measures Pre-Treatment Measures The f i n a l stage of the analysis began with an examination of pre-treatment DAS and PAIR scores to assess whether there were any important i n i t i a l differences between the three experimental groups. Analyses of variance were computed on these measures and no s i g n i f i c a n t differences were found (the s i g n i f i c a n c e l e v e l being set at .05). The multivariate F s t a t i s t i c being F_ (20,68) = .83, £ < .665. The couples pre-test scores on the t o t a l DAS are presented i n Table 6. The mean for couples scores (male plus female scores divided by 2) was calculated as 92.1. The mean for the EF group being 92.8 (SD = 8.8), for the PS group 91.7 (SD = 8.1) and for the Control group 91.9 (SD = 10.7). Scores for a l l three groups ranged from 71 to 105. The homogeneity of variance assumption was checked and no s i g n i f i c a n t differences found; B a r t l e t t Box _F = .59, p_ < .555. Table 6 Summary Anova: Pretest DAS Couple Scores (N = 45) Source of V a r i a t i o n SS MS DF F P Between 10.8 5.4 2 .06 .940 Within 3,645.8 86.8 42 - -94 The means, standard deviations, F r a t i o s and P values for the pre-treatment PAIR Perceived scores are presented i n Table 7. There were no s i g n i f i c a n t differences between groups on these s i x subscales. The subscale means here are comparable to those of Schaefer and Olson's o r i g i n a l sample referred to i n Chapter 3. Couples appeared to experience great d i f f i c u l t y completing the Expected subscales on the PAIR during both assessment and termination procedures. This was perhaps because of the double negatives involved i n the wording of the Expected part of this instrument. For example, agreeing or disagreeing with whether "when i t comes to having a serious discussion i t seems we have l i t t l e i n common" i s the i d e a l for a r e l a t i o n s h i p . The assessors assisted the couples i n completing these scales whenever possible but the r e l a t i v e l y low r e l i a b i l i t y reported for these sub-tests may be not only a r e s u l t of the homogeneity of responses but the r e s u l t of a large amount of error variance. The Expected subscales were included o r i g i n a l l y i n the PAIR to provide a reference point for the Perceived subscales. Since these subscales were administered three times i t was decided that the three sets of Perceived scores served as v a l i d reference points for each other and that i t might be preferable to use only the Perceived scales as an outcome instrument rather than the differences between Perceived and Expected scores. F i r s t i t was necessary to test for differences i n pre-test and post-test Expected scores. No s t a t i s t i c a l l y s i g n i f i c a n t differences were found between groups on the pre-test PAIR Expected subscales .05). The means, standard deviations, F r a t i o s and P values for these subtests are presented i n 95 Table 7 Pre-Test PAIR Perceived Couple Scores Groups Variables ET PS C F P (N = 45) M/SD M/SD M/SD (2,42) PP1 (Em) 52.3 13.7 53.1 15.2 52.5 18.0 .01 .990 PP2 (Soc) 57.5 14.4 56.1 16.6 53.1 15.6 .32 .732 PP3 (Sx) 54.5 22.7 57.2 18.8 57.1 17.3 .09 .917 PP4 (Int) 52.0 9.4 48.1 11.3 46.0 15.8 .89 .419 PP5 (Rec) 61.2 11.9 61.1 15.5 57.7 14.8 .29 .751 PP6 (Con) 37.3 10.0 37.1 8.8 38.7 17.8 .06 .939 96 Table E-7, Appendix E. The multivariate F_ s t a t i s t i c (10, 78) on these subscales was calculated at .62, p_ < .794. There were also no s i g n i f i c a n t differences found on any of the post-test PAIR Expected subscales; the multivariate F_ s t a t i s t i c (10, 78) being computed at .42, _ < .930. The means, standard deviations, F r a t i o s and P values of these subscales are presented i n Table E-8, Appendix E. In addition a repeated measures analysis of variance (BMDP version, Dixon, 1981) was conducted on the pre-test and post-test treatment PAIR Expected scores to ascertain i f couples changed t h e i r ideals as a r e s u l t of treatment. No s i g n i f i c a n t changes or group by time interactions were found on any of the subscales (ofc = .05/5 = .01, corrected by the Bonferroni procedure). The d e t a i l s of t h i s analysis are reported i n Table E-9, Appendix E. A l l these non-significant r e s u l t s suggested that any 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 i n the Perceived scores. In l i g h t of the above concerns and analyses i t was then decided to set aside the Expected subscales and take the Perceived subscales as the outcome v a r i a b l e . A l l subsequent analyses then considered only the PAIR Perceived subscales. On the Target Complaints measure couples described t h e i r major concern i n t h e i r r e l a t i o n s h i p which was then designated as the focus f o r therapeutic change. None of the spouses presented complaints which were incompatible with each other and a l l appeared to be relevant to the couples at termination and follow-up. Couples also described i n behavioral terms f i v e l e v e l s of treatment goals. The l e v e l designated as "less than expected r e s u l t s " described three observable behaviors and one f e e l i n g reaction characterizing the r e l a t i o n s h i p at the time of assessment. 97 Post Treatment Measures The t o t a l DAS couples score could not be included i n the multivariate analysis since t h i s score was not independent of the DAS subscales. A separate univariate analysis was then conducted on t h i s measure and i s presented i n Table 8. These scores are post-treatment for the ET and PS groups and post-wait for the Control group. The mean for the EF group was computed as 112.7 (SD = 10.8), for the PS group the mean was 102.4 (SD = 9.5), and for the Control group the mean was 91.5 (SD = 9.7). Post hoc comparisons using the Tukey procedure (Glass & Stanley, 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 other at the .05 l e v e l of s i g n i f i c a n c e . Table 8 Summary Anova: Post-test DAS Total Scores Source of V a r i a t i o n SS MS DF F P Between 3,371.9 1,685.9 2 16.80 .001 Within 4,215.8 100.4 42 - -A MANOVA (SPSS:9 version) was conducted between the three groups over a l l 12 treatment outcome va r i a b l e s , that i s on DAS subscales, 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 Expression, on PAIR Perceived subscales, Emotional, S o c i a l , Sexual, I n t e l l e c t u a l and Recreational Intimacy and Conventionality, on Target Complaints and Goal Attainment. 98 The r e s u l t s of t h i s multivariate analysis of treatment outcome variables are presented i n Table 9. The multivariate F_ s t a t i s t i c (24, 64) was calculated at 4.33, _p < .001. In order to guard against the problem of esca l a t i n g Type 1 error rate, the Bonferroni procedure was used to calculate the c r i t i c a l s i g n i f i c a n c e l e v e l for each univariate test (.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 differences were found on DAS subscales 1, 2, and 3, PAIR subscales 4 and 6 (DAS subscale 4 and PAIR subscale 1 narrowly missing s i g n i f i c a n c e ) , Target Complaint, and the Goal Attainment Scale. Post hoc comparisons were conducted on the variables showing s i g n i f i c a n t F r a t i o s using Tukey's procedure to ascertain i f mean differences were between treatment groups and Controls or between the two treatment groups or both. These comparisons yielded the following r e s u l t s : 1. Both treatment groups were s i g n i f i c a n t l y higher than controls on the variables DAS 1 (Consensus), PAIR 4 ( I n t e l l e c t u a l Intimacy), Target Complaint, and Goal Attainment. 2. The PS treatment group did not d i f f e r s i g n i f i c a n t l y from controls on the variables DAS 2 ( S a t i s f a c t i o n ) , DAS 3 (Cohesion), and PAIR 6 (Conventionality), whereas the EF treatment group did d i f f e r s i g n i f i c a n t l y from controls on these v a r i a b l e s . 3. The EF treatment group scored s i g n i f i c a n t l y higher than the PS treatment group on the variables DAS 2 ( S a t i s f a c t i o n ) , DAS 3 (Cohesion), PAIR 4 ( I n t e l l e c t u a l Intimacy), PAIR 6 (Conventionality, here interpreted as i d e a l i s a t i o n ) and Target Complaint improvement. Table 9 99 Mu l t i v a r i a t e Analysis of Variance: Treatment Outcome Variables Groups Variable EF PS M/SD M/SD M/SD (2,42) DAS Consensus 0 48.13 47.53 40.8 8.25 .001* 3.27 7.42 4.97 S a t i s f a c t i o n 5 38.43 34.10 31.70 8.60 .001* 4.86 4.29 4.34 Cohesion 3 17.27 13.80 11.90 13.91 .001* 3.18 1.49 3.41 A f f e c t i o n a l 8.87 7.0 7.13 5.12 .010 Expression 1.55 1.89 1.88 PAIR Emotional 64.13 51.33 45.60 4.68 .015 17.19 17.49 16.26 So c i a l 65.33 56.40 52.26 2.74 .076 13.52 15.82 17.33 Sexual 69.33 62.80 59.06 .92 .405 21.59 21.48 19.74 I n t e l l e c t u a l 70.26 58.66 43.33 20.29 .001* 11.73 10.52 12.51 Recreational 72.0 64.67 57.27 3.98 .026 13.46 13.06 16.19 Conve n t i o n a l i t y 8 64.80 45.07 38.40 7.74 .001* 18.53 17.59 21.05 TC Target Complaint A 3.70 4 & 3.07 g 4 1.17 ^ 69.89 .001* GAS Goal Attainment 0 60.0 57.33 42.33 31.11 .001* 7.51 8.34 2.29 Note: = 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) 100 4. The EF and PS treatment groups did not d i f f e r s i g n i f i c a n t l y on the variables DAS 1 (Consensus) and Goal Attainment. Although group differences on the variables DAS 4 ( A f f e c t i o n a l Expression) and PAIR 1 (Emotional Intimacy) did not reach the l e v e l of s t a t i s t i c a l s i g n i f i c a n c e set by the Bonferroni procedure (.004) the trend here was for the EF treatment group mean to be higher; on the DAS 4 subscale the EF mean was higher than both PS and Control groups and on the PAIR 1 subscale the EF treatment mean was higher than the Control. A l l of these r e s u l t s are summarised i n Table 9. To summarise, both treatment group means were higher than controls on Consensus (DAS), I n t e l l e c t u a l Intimacy (PAIR), TC and GAS. Only the EF treatment means were higher than controls on S a t i s f a c t i o n , Cohesion (DAS) and Conventionality (PAIR). Af t e r treatment the EF group scored s i g n i f i c a n t l y higher than the PS group on the variables S a t i s f a c t i o n and Cohesion (DAS), Conventionality and I n t e l l e c t u a l Intimacy (PAIR) and on TC improvement. Results show both treatment and d i f f e r e n t i a l treatment e f f e c t s i n favor of the EF treatment. At the termination of treatment a Post Treatment Standardised Interview was given to the treatment groups, and a f t e r the waiting period an A c t i v i t i e s While Waiting Questionnaire was administered to the control group. On the A c t i v i t i e s While Waiting Questionnaire the r e s u l t s were as follows. Of the 15 control couples four stated that they had attempted to improve t h e i r r e l a t i o n s h i p during the eight week waiting period. Of these couples three had been on some kind of vacation, and stated that t h i s time together had helped somewhat. Two of these couples had also 101 read s e l f help books during t h i s time. One partner had received advice from a f r i e n d concerning his r e l a t i o n s h i p . The couples who were a c t i v e l y seeking to improve t h e i r r e l a t i o n s h i p before coming to therapy seemed to t r y more than one a c t i v i t y , t a l k i n g to a f r i e n d , reading a book, and using holiday time to be together. In general the responses seem to suggest that the waiting period was not contaminated with other powerful therapeutic v a r i a b l e s . The holiday variable would seem to be the most s i g n i f i c a n t and the e f f e c t of t h i s was balanced by the treatment couples who also took vacations. In fact the control group mean t o t a l DAS scores did not change appreciably during the waiting period; the pre-assessment mean on the DAS scale for t h i s group was 91.9 (SD = 10.9) and the post-wait score was 91.5 (SD = 9.7). The Pearson Product Correlation C o e f f i c i e n t between pre-assessment and post-wait DAS scores was computed as .87 (p < .001). No follow-up was possible with couples i n t h i s group since they were placed i n treatment a f t e r the waiting period. The r e s u l t s of the Post Treatment Standardised Interview were as follows. A l l treated couples stated that t h e i r r e l a t i o n s h i p had improved as a r e s u l t of therapy. The couples appeared to characterize the perceived r e l a t i o n s h i p changes i n terms of three categories: 1) emotional climate, here couples talked of communication becoming more open and less defensive and the l e v e l of trust and sense of safety increasing; 2)awareness of each other and r e l a t i o n s h i p dynamics; 3) new responsivenessto each others needs and a new sense of closeness. The PS group talked more i n terms of avoiding issues less and having more s k i l l s and tools with which to confront issues. The E.F. group talked 102 more i n terms of perceiving each other d i f f e r e n t l y , for example, "we see how we are acting and reacting to each other." They also spoke of being less blaming and of c o n f l i c t s becoming less intense. The demand c h a r a c t e r i s t i c s of this s i t u a t i o n for the couple were obvious and to attempt to minimise these as much as possible the assessor attempted to write down exactly what the spouses said and to maintain a distant and neutral stance during the interview. In response to a question as to what was h e l p f u l about therapy both groups spoke of the therapist as creating a safe place to work out issues, f u l f i l l i n g a mediator role and contributing an objective perspective. The E.F. couples also talked of the therapist helping them to c l a r i f y issues and patterns in the r e l a t i o n s h i p ; the P.S. couples spoke of the s p e c i f i c d i s c i p l i n e and structured techniques the therapist had shown them. The question concerning c r i t i c a l incidents i n therapy e l i c i t e d more responses from the couples Involved In the E.F. therapy than from those involved i n the P.S. treatment, as might be expected since the E.F. treatment i s based upon the creation of intense emotional experiences. The P.S. couples stated that the therapy process was a gradual process of teaching. One P.S. couple spoke of "dramatic revelations" at home between therapy sessions, another stated that the impact of dealing with his anger s u c c e s s f u l l y was c r i t i c a l for him. Another couple stated that an incident occurred which made i t clear that they both f e l t very committed to the r e l a t i o n s h i p and that t h i s seemed to change the process between them. The E.F. couples described c r i t i c a l incidents i n terms of times when v u l n e r a b i l i t i e s were exposed which resulted i n partners 103 seeing t h e i r spouse i n a d i f f e r e n t way and being able to respond p o s i t i v e l y to t h i s new view of each other. One partner spoke of r e a l i s i n g that her spouse needed help from her i n knowing how to be close, another of t a l k i n g of his hurt and his spouse responding to him so that he could decide not to withdraw, another of incidents where he f e l t emotional rather than "staying l o g i c a l " and "understanding the pain that our patterns create". In response to a question concerning factors which hindered progress i n therapy or were unpleasant couples spoke of the T.V. cameras, small counselling rooms and the questionnaires. One E.F. spouse spoke of the counsellor expressing fee l i n g s i n a stronger manner than that spouse was comfortable with, and one spoke of too much focus being placed on the other partners problems. Of the P.S. couples 2 spoke of paraphrasing pr a c t i c e being tedious, one of the couples spoke of not dealing with the main issue, one of emotional issues not being adequately addressed, and one of s k i l l teaching getting i n the way of emotional discussions which the couple then had at home. In response to the question of whether more sessions were needed i n the E.F. group two couples said they would have " l i k e d " a few more to resolve issues completely, only one couple stated that they d e f i n i t e l y needed more sessions. In the P.S. group eight couples and two i n d i v i d u a l partners stated that they needed more sessions. This was a su r p r i s i n g f i n d i n g i n that the researcher considered the P.S. treatment to be more e a s i l y accomplished i n the 8 sessions than the E.F. treatment. It may be perhaps explained i n terms of the s k i l l t r a i n i n g at times appearing less relevant to couples than the exploration of immediate emotional issues. 104 These data are i m p r e s s i o n i s t i c . They do seem to suggest that the couples indeed experienced the two treatments i n ways that are congruent with the intended nature of those treatments. The E.F. treatment was experienced as delving into emotional v u l n e r a b i l i t i e s and c l a r i f y i n g patterns and the P.S. treatment was experienced by the couples as communication and problem solving s k i l l t r a i n i n g . The Rating of C o n f l i c t Resolution A l l 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 partner made of t h e i r spouse i n the l a s t session. The task did not discriminate between couples or treatments. F i r s t t h i s may be because of the nature of the task; the requests although r e l a t i n g to the core c o n f l i c t were often very s p e c i f i c and small, for example, "Can you hug me i f I ask you to when I come home at night?" and thus l i k e l y to evoke verbal 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 . Second t h i s task was given by the therapist i n the l a s t session and the desire to comply with and please the therapist might be expected to be a key factor i n t h i s s i t u a t i o n and r e s u l t i n couple agreement. The d i f f i c u l t i e s of a t t a i n i n g relevant i n t e r a c t i o n a l data which can be coded by raters into simple categories i s demonstrated by t h i s measure. The S t r u c t u r a l Analysis of S o c i a l Behavior (Benjamin, 1977) a measure which indexes q u a l i t y of i n t e r a c t i o n rather than verbal agreement to a request might be preferable . 105 A d d i t i o n a l Individual Analyses Although the main unit of analysis i n t h i s study was the couple, the researcher decided to also examine i n d i v i d u a l male and female scores i n p a r t i c u l a r domains such as the DAS and the PAIR Perceived at the termination of treatment. Preliminary analysis of variance on male and female pre treatment PAIR scores had found no s i g n i f i c a n t differences between groups when the c r i t i c a l l e v e l for s i g n i f i c a n c e was set at .05. These r e s u l t s may be found i n Table E-10, Appendix E. Individual spouses post-test PAIR scores were analysed using a MANOVA (SPSS: 9, Nie, 1975). In the analysis of post-test scores (Table E - l l ) for males the multivariate F_ (12, 76) was computed at 2.38, £ < .011. The only s i g n i f i c a n t univariate F_ r a t i o s (a = .05/6 = .008) were found on subscales 4 and 6, that i s I n t e l l e c t u a l Intimacy (F_ (2, 42) = 11.8, £ < .001) and Conventionality (F_ (2, 42) = 7.7, £ < .001). Post-hoc analyses using Tukey's procedure found the mean of the EF group to be s i g n i f i c a n t l y higher than PS and Control groups on subscale s i x , and the mean of the Control group to be s i g n i f i c a n t l y lower than PS and EF groups on subscale four. For male spouses the EF treatment seemed then to increase s i g n i f i c a n t l y the i d e a l i s a t i o n of the spouse and the 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 treatment e f f e c t was found on the vari a b l e I n t e l l e c t u a l Intimacy. For Females the multivariate F_ (12, 76) was computed as 1.98, £ < .038. The only s i g n i f i c a n t univariate F r a t i o s (a = .05/6 = .008) were found on I n t e l l e c t u a l Intimacy, subscale 4 (F_ (2, 42) = 10.9 £ < .001), and Emotional Intimacy subscale I (F (2, 42) = 6.22, £ < .004). 106 Post-hoc analyses found the mean of the EF group to be s i g n i f i c a n t l y higher than PS and Co n t r o l groups on subscale 1, and the mean of the EF group to be s i g n i f i c a n t l y higher than that of the Controls on subscale 4. For female spouses the EF treatment seemed to increase the Emotional 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 based 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 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 Intimacy when female scores are considered s e p a r a t e l y . When both spouses are considered 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 treatment. D e t a i l s of these analyses may be found i n Table 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 scores were analysed using a MANOVA (SPSS: 9, Nie , 1975). For Males the m u l t i v a r i a t e F (8, 80) was computed as 3.35, _ < .002. The only 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 subscales 2, S a t i s f a c t i o n (F_ (2, 42) = 8.39, £ < .001) and 3, Cohesion (F (2, 42) = 11.85, p < .001). Subscale 1, Consensus, narrowly missed reaching 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 (p_ < .015). Post-hoc analyses using Tukey's procedure found the mean of the EF group to be s i g n i f i c a n t l y higher than PS and Co n t r o l groups on subscales 2 and 3. For Females the 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 to be s i g n i f i c a n t . Post-hoc analyses using Tukey's procedure found the c o n t r o l group mean to be lower than both treatment means on subscale 1, Consensus. Only EF and Co 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 subscale S a t i s f a c t i o n . On subscale 3 - Cohesion, and 4 -A f f e c t i o n a l Expression, the mean of the EF group was found to be 107 s i g n i f i c a n t l y higher than those of the PS and Control group. The only a d d i t i o n a l information added by t h i s i n d i v i d u a l analysis would seem to be that subscale 4, A f f e c t i o n a l Expression while not reaching the required l e v e l of s i g n i f i c a n c e i n the couples analysis appears to have been s i g n i f i c a n t l y affected by the EF treatment when female spouses are considered separately. The d e t a i l s of these analyses are presented i n Table E-12, Appendix E. The male and female scores on Target Complaints were cons i s t e n t l y s i m i l a r across groups and were s i m i l a r to the re s u l t s of the analysis of couples scores. The male mean score for the EF group was 3.7 (SD = .62) and the female mean score was 3.7 (SD = .46); the male mean score for 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 also very close, 1.4 (SD = .63) and .93 (SD = .46) resp e c t i v e l y at the post-wait assessment. The Goal Attainment means showed a s i m i l a r pattern. 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 waiting period was 42 (SD = 3.8) and the female mean was 42.7 (SD = 2.6). Follow-Up Measures Eight weeks a f t e r termination of treatment couples completed follow-up measures. A l l couples except one returned the follow-up data (n = 29). The hypotheses of the study concerned possible d i f f e r e n t i a l e f f e c t s of the two treatments EF and PS. The main focus of the 108 follow-up 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 found at treatment termination would also be found at follow-up. On a preliminary repeated measures analysis of variance of t o t a l DAS scores for the two treatment groups s i g n i f i c a n t differences were found; F_ (1, 27) = 9.4, _ < .0049. The mean for the EF group (n = 15) at follow-up was 112.4 (SD = 11.2) and for 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 for Time, or Time by Group Interactions. These r e s u l t s are summarised i n Table 10. Table 10 Summary Repeated Measures Anova: To t a l DAS Follow-Up Scores (N = 30) Source of V a r i a t i o n SS MS DF F P Group 1,762.7 1,762.7 1 9.38 .005 Error 5,076.4 188.0 27 - -Time 5.2 5.2 1 .25 .620 Time by Group Interaction 1.3 !«3 1 .06 .805 E r r o r 554.2 20.5 27 - -A multivariate repeated measures analysis of variance (2 times, that i s termination and follow-up, by 2 groups, and the 5 d i f f e r e n t i a t -ing outcome variables) was then conducted 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 (DAS 2 and 3), I n t e l l e c t u a l Intimacy and Conventionality (PAIR 4 and 6) and Target Complaints. These variables had d i f f e r e n t i -ated between treatment groups at termination. At follow-up the 109 mu 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 variables were considered together there was an o v e r a l l s t a t i s t i c a l l y s i g n i f i c a n t difference i n favor of the EF treatment between the treatment groups at follow-up. This analysis was conducted using the SPSS:X program (SPSS, 1983). The r e s u l t s may be found i n Table 11. Once again to avoid es c a l a t i n g Type 1 err o r the c r i t i c a l s i g n i f i c a n c e l e v e l was corrected using Bonferroni's procedure (.05/5 = .01). In t h i s analysis no 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 were found; t h i s suggests that the means of the groups did not change s i g n i f i c a n t l y from post-treatment to follow-up. The variable Conventionality f a i l e d to d i f f e r e n t i a t e between the two groups at follow-up. An examination of means revealed that the EF group appeared to regress on t h i s variable during the eight weeks a f t e r treatment. The variables I n t e l l e c t u a l Intimacy and Target Complaint just f a i l e d to reach s i g n i f i c a n c e (p_ >.014) i n t h i s a n a l y s i s . The consistency of the trend 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 for s i g n i f i c a n c e suggests that with a larger sample or more powerful instruments these variables might 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 . The variables S a t i s f a c t i o n , F (1, 27) = 8.48, £ < .007, and Cohesion, F (1, 27) = 15.89, £ < .005, remained s i g n i f i c a n t l y higher i n the EF group. The EF group then maintained s i g n i f i c a n t l y higher l e v e l s of S a t i s f a c t i o n and Cohesion as well as higher t o t a l DAS scores (which included the S a t i s f a c t i o n and Cohesion subscales) over the eight weeks following treatment than did the PS group. 110 Table 11 Repeated Measures Analysis: Follow-Up Scores on D i f f e r e n t i a t i n g Variables Groups Variables (N = 29) Time EF PS F P M/SD M/SD (1 ,27) S a t i s f a c t i o n I 38.6 (4.8) 34.0 (4.2) G 8.48 .007* (DAS) II 38.3 (4.8) 34.1 (3.0) T .03 .855 TG .21 .649 Cohesion I 17.6 (3.3) 13.9 (1.3) G 1 5.89 .001* (DAS) II 16.9 (3.2) 13.6 (1.8) T 2.11 .158 TG .25 .620 TC I 3.8 (.35) 3.3 (.99) G 6.87 .014 II 3.7 (.46) 3.1 (.86) T .97 .335 TG .00 .973 I n t e l l e c t u a l I 70.3 (11.7) 58.3 (10.8) G 6.87 .014 Int. (PAIR) II 68.7 (16.3) 58.6 (14.2) T .06 .809 TG .12 .729 Conventionality I 64.8 (18.5) 45.0 (18.2) G 5.38 .028 (PAIR) II 55.5 (22.3) 44.6 (19.3) T 2.47 .128 TG 2.19 .151 Note: EF, n = 15; PS, n = 14 a = .05/5 = .01 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 = Interaction, Time and Group p < .01 * = I l l The variables which did not d i f f e r e n t i a t e between treatment groups at termination of treatments were also analysed to assess whether treatment had created e f f e c t s that were not immediately apparent at post assessment, so c a l l e d "sleeper e f f e c t s " . These variables were Consensus and A f f e c t i o n a l Expression (DAS 1 and 4), Emotional, S o c i a l , Sexual and Recreational Intimacy (PAIR 1, 2, 3 and 5), and Goal Attainment. The mutivariate F s t a t i s t i c was not s i g n i f i c a n t , F_ (7, 21) = 1.26, p_ < .315, and none of the univariate F r a t i o s on these variables reached the c r i t i c a l l e v e l for s i g n i f i c a n c e (.05/7 = .007). Thus there was no s t a t i s t i c a l l y s i g n i f i c a n t evidence found for any treatment "sleeper" e f f e c t s . The r e s u l t s of t h i s analysis may be found i n Table E-13, Appendix E. There were no s i g n i f i c a n t Time or Time by Group Interactions found i n t h i s a n a l y s i s . A d d i t i o n a l I n d i v i d u a l Analysis on Follow-Up Data As with post-treatment data a d d i t i o n a l i n d i v i d u a l analyses were conducted on follow-up data. A preliminary repeated measures analysis of variance on both male and female t o t a l DAS scores found s i g n i f i c a n t differences between groups; the F r a t i o s being computed at F (1, 27) = 9.08, p_ < .006, and J_ (1, 27) = 7.48, _p < .011 r e s p e c t i v e l y . The mean for the EF males was 113.0 (SD = 11.4) and for the PS males was 102.2 (SD = 10.0). The means for the EF females was 111.8 (SD = 12.0) and for the PS females was 100 (SD = 10.0). No s i g n i f i c a n t Time e f f e c t s or Time by Group Interactions were found. Results are shown i n Table E-14, Appendix E. 112 A repeated measures analysis of the variables which d i f f e r e n t i a t e d between the treatment groups at termination and the variables which did not d i f f e r e n t i a t e between the groups was conducted for males and females using the BMPD program (Dixon, 1981). The results for the i n d i v i d u a l analysis of d i f f e r e n t i a t i n g variables that i s for S a t i s f a c t i o n and Cohesion (DAS 2 and 3), I n t e l l e c t u a l Intimacy (PAIR 4 and 6), and Target Complaints are found i n Table E-15, Appendix E. The r e s u l t s for the n o n - d i f f e r e n t i a t i n g variables may be found i n Table E-16, Appendix E. No s i g n i f i c a n t Time or Time by Group Interaction e f f e c t s were found i n eit h e r of these analyses. As can be seen i n Table E-15 when scores on the d i f f e r e n t i a t i n g variables are analysed i n d i v i d u a l l y the female means miss the c r i t i c a l s i g n i f i c a n c e l e v e l (.01) except for Cohesion; t h i s s i g n i f i c a n t r e s u l t however i s best considered as a Type 1 error, since the o v e r a l l 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; the male 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 i n the EF and PS groups on the variables S a t i s f a c t i o n , and Cohesion, with Target Complaints j u s t missing the c r i t i c a l l e v e l for s i g n i f i c a n c e ; the o v e r a l l m u l t i v a r i a t e F was computed at, F_ (5, 23) = 5.75, p < .001. The EF treatment appears then to have shown a d i f f e r e n t i a l e f f e c t on the l e v e l of male s a t i s f a c t i o n and cohesion at follow-up whereas e f f e c t s on female S a t i s f a c t i o n and Cohesion were 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 . As Table E-16 shows none of the n o n - d i f f e r e n t i a t i n g variables 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 f o r males (multivariate F_ (7, 21) = 1.16, £ < .37) or females (multivariate F (7, 21) = 1.09, £ < .40) i n the treatment groups at follow-up. 113 Descriptive. Data Authors such as Gurman and Kniskern (1978) have emphasised that outcome studies must include information on d e t e r i o r a t i o n as well as on improvement. A l l the instruments used i n th i s study except observed c o n f l i c t r e s o l u t i o n allowed for de t e r i o r a t i o n of the re l a t i o n s h i p during the process of therapy. Jacobson F o l l e t t e and Elwood ( i n press) stated that i n research i n behavioral marital therapy approximately 5% of treated couples a c t u a l l y deteriorate, i n th i s study that would mean 1-2 couples would show scores d e t e r i o r a t i n g to the point of s t a t i s t i c a l s i g n i f i c a n c e . In fact none of the treated couples t o t a l adjustment scores decreased to t h i s point. The post-treatment scores of 2 couples dipped below pre-treatment scores by 5 and 4 points (both couples were i n the PS group) and 2 couples follow-up scores dipped below t h e i r pre-treatment scores, an EF couple by 7.5 and a PS couple by 2 points. One decision to separate was reported by a couple i n the PS group a f t e r treatment termination but t h i s separation was amicable and by mutual consent. Another way of viewing the data i s i n terms of e f f e c t size (Cohen, 1977). Here the difference i n means between treatment groups and controls i s divided by the standard deviation of the control group; t h i s provides an estimate of the magnitude of change. In th i s study i f the couples post-treatment t o t a l dyadic adjustment score f o r each treatment group (112.7 f or the EF group, 102.4 for the PS group) i s subtracted from the mean of the control group (91.5) and divided by the standard deviation for that group (9.7) the e f f e c t sizes are 2.19 for the EF group and 1.12 for the PS group. The mean e f f e c t of the a f f e c t i v e l y 114 focussed treatment, EF, i s then over two standard deviations from the mean of the control measured a f t e r the waiting period. This would seem to be a siz a b l e treatment e f f e c t . However t h i s s t a t i s t i c does not address the issue of v a r i a b i l i t y i n outcome across a sample of subjects. The eta s t a t i s t i c f o r the t o t a l post DAS couples scores was computed at .67; that i s 45% of the variance i n the t o t a l DAS score a f t e r treatment was able to be explained by group membership. Thus a s i g n i f i c a n t amount of the variance i n t h i s variable was a t t r i b u t a b l e to group membership. Another way of viewing the data suggested by Jacobson et a l . ( i n press) i s to report the proportion of treated couples who improve. Jacobson et a l . ( i n press) suggest as a c r i t e r i a for improvement that a couple change from pre-test to post-test by at least 1.96 SE. However since control group couples changed very l i t t l e i n t h i s sample (SD. for change scores i n the control group = 5.38, x" = 1.07) the s t a t i s t i c suggested above i s equal to 4.22 i n t h i s sample. Since t h i s seems small as a c r i t e r i o n f o r improvement the standard deviation of the DAS (SD, 17.8) reported by Spanier (1976) i s used here as the basis for c r i t e r i o n f o r improvement. If then the c r i t e r i o n established for improvement i s a r i s e i n t o t a l adjustment score of 17 - 18 points, then 10 EF couples (66%) and 6 PS couples (40%) met t h i s c r i t e r i o n at post-assessment. At follow-up 9 EF couples (60%), (2 couples just f a i l i n g to reach the c r i t e r i o n with a 16 point improvement) and 4 PS couples (26%) met the c r i t e r i o n . These data are displayed i n Table 12. 115 Table 12 Percentages of Couples Improved on T o t a l DAS Post-Test Follow-Up Group n Improved Unimproved n Improved Unimproved EF 15 66 34 15 60 40 PS 15 40 60 14 26 74 C 15 0 100 Improvement = 17 points on t o t a l DAS. Another way of viewing the data i s to consider not the amount of change but the point at which couples f i n i s h . Do couples come out of therapy non-distressed? I f the c r i t e r i a for non-distressed i s a score of 114 or over on the t o t a l post-treatment adjustment score (114.8 being Spanier's mean for married couples) then 7 of the EF couples q u a l i f i e d as non-distressed at post-test and follow-up assessment (46%), and 2 of the PS couples q u a l i f i e d at post-assessment and follow-up (13%). The mean of the EF group, 112.7, i s however very close to Spanier's norm. If the c r i t e r i a for marital happiness are made a l i t t l e less stringent and taken as 114.8 means hal f of a standard deviation (17.8/2 = 8.9) then couples scoring above 106 would be considered non-distressed. In th i s case 13 of the EF couples (86%) and 6 of the PS couples (40%) would be considered non-distressed at post-assessment and 11 EF couples (73%) and 4 PS couples (27%) would be considered non-distressed at follow-up. 116 The same kind of analyses can be applied to other outcome measures such as Target Complaint. In the EF group 14 couples scored 3 or above (somewhat improved) at post-assessment and at follow-up, i n the PS group 11 couples scored 3 or above at post-assessment and 7 reached t h i s l e v e l at follow-up (n = 14). In the EF group nine couples scored four (very much improved) at post assessment and seven at follow-up. In the PS group four couples scored at t h i s l e v e l at post assessment and one reached t h i s l e v e l at follow-up. The differences i n group means at pretest post-test and follow-up assessment on t o t a l adjustment scores are shown i n Figure I. 116a-F i g u r e 1. Group Means on T o t a l DAS Couple Scores at Pretest, Posttest and ~ Follow-up Assesment. DAS SCORES 120 r 115 110 105 100 95 90 EF PS J^0N-DISTRES_SED DISTRESSED PRE POST FOLLOW-UP TIME OF ASSESSMENT NOTE: EF PS c • • No F measures were p o s s i b l e on the C group. Spaniers (1976) sample mean f o r n o n - d i s t r e s s e d couples At F the PS group mean i s based on n = 14 114 117 CHAPTER V DISCUSSION OF RESULTS Summary The purpose of t h i s study was to delineate an emotionally focussed e x p e r i e n t i a l treatment for marital c o n f l i c t i n distressed r e l a t i o n s h i p s , to test t h i s treatment em p i r i c a l l y and to compare i t s effectiveness with a problem solving s k i l l oriented behavioural treatment which had already received extensive empirical v a l i d a t i o n . The f o r t y - f i v e couples who p a r t i c i p a t e d i n the study were recruited from a newspaper a r t i c l e and randomly assigned to one of the two treatment groups or the wait l i s t c o ntrol group. Each couple i n the treatment groups received eight sessions of conjoint marital therapy implemented according to the two treatment manuals. Implementation checks found that treatments were able 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 with the manuals. No s i g n i f i c a n t differences were found between couples i n the three groups on demographic v a r i a b l e s , a measure of emotional s t y l e , or pre-measures of marital adjustment and intimacy. There were also no differences found between the two treatment groups on a measure of the q u a l i t y of the couples a l l i a n c e with t h e i r therapist. The twelve therapists ( s i x implementing each treatment) were balanced as to experience and education and no evidence was found to suggest d i f f e r e n -t i a l therapist e f f e c t s . A multivariate analysis of post-measures of marital adjustment, intimacy, reduction i n target complaint, and goal attainment found that couples i n both treatments reported s i g n i f i c a n t l y more theraputic gains than those i n the control group. Both treatment 118 groups were superior on the measure of t o t a l marital adjustment, on the consensus aspect of t h i s adjustment, on the measure of i n t e l l e c t u a l Intimacy, improvement i n the target complaint and goal attainment. A d i f f e r e n t i a l treatment e f f e c t was also found. There were s i g n i f i c a n t differences between treatments i n favor of the emotionally focussed treatment on the t o t a l adjustment score, s a t i s f a c t i o n and cohesion aspects of marital adjustment, on a measure of i n t e l l e c t u a l intimacy, i d e a l i s a t i o n of the spouse and the r e l a t i o n s h i p and on the amount of improvement i n the target complaint. Thus s i g n i f i c a n t evidence was found to substantiate both research hypotheses concerning the o v e r a l l effectiveness of both treatments and the existence of d i f f e r e n t i a l treatment e f f e c t s . At follow-up the emotionally focused treatment continued to show s i g n i f i c a n t l y greater o v e r a l l e f f e c t s compared to the Problem Solving treatment, and s i g n i f i c a n t l y greater s p e c i f i c e f f e c t s on the t o t a l DAS score and on the S a t i s f a c t i o n and Cohesion aspects of t h i s score. Differences between treatment groups on the variables Target Complaint Improvement and I n t e l l e c t u a l Intimacy just f a i l e d to reach the c r i t i c a l s i g n i f i c a n c e l e v e l ; the trend however remained consistently i n favor of the Emotionally Focused 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 that a treatment for m a r i t a l d i s t r e s s which does not focus upon changing behaviour has been tested 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) that the psychodynamic model has tended to o f f e r ways of understanding intimate r e l a t i o n s h i p s rather than a clear set of 119 interventions or a technology for the process of therapy. In t h i s study s p e c i f i c interventions directed towards a l l i e v i a t i n g m a rital c o n f l i c t were st i p u l a t e d i n a therapy manual, implemented according to that manual, monitored during implementation, and tested as to t h e i r e f f e c t i v e n e s s . This would seem to represent an advance i n the f i e l d of marital therapy and suggests that focusing upon inner experience as i t i s translated into r e l a t i o n s h i p events during i n t e r a c t i o n , may be a powerful t o o l for changing the nature of r e l a t i o n s h i p s . The fi n d i n g that the Problem Solving (PS) treatment implemented i n the manner of Jacobson and Margolin (1979) was e f f e c t i v e i s consistent with a l l the previous research on the Problem Solving treatment (Jacobson, 1977, 1978, 1979, Jacobson & Anderson, 1980) and further supports the assumption that s k i l l t r a i n i n g of t h i s type does help couples learn to negotiate and change target behaviours. The PS treatment increased the t o t a l adjustment l e v e l (DAS) and the amount of consensus between partners as well as, t h e i r a b i l i t y to share ideas and t a l k about issues with understanding ( i n t e l l e c t u a l intimacy). It also f a c i l i t a t e d the attainment of treatment goals formulated i n terms of reaching a predetermined l e v e l on three s p e c i f i c behaviours, as well as an improvement i n target complaint. However as Jacobson (1983) suggests teaching couples p o s i t i v e control strategies may change behaviour without improving ei t h e r the cognitive or a f f e c t i v e components of marital s a t i s f a c t i o n , e s p e c i a l l y since tru s t would seem to be constituted by independence from immediate contigencies and i t i s t h i s independence which characterises p o s i t i v e marital r e l a t i o n s h i p s . Murstein et a l . (1977) found that a quid pro quo 120 conception of a r e l a t i o n s h i p where spouses negotiate for r e c i p r o c a l exchanges was inversely related to marital s a t i s f a c t i o n and only worked well i n rather distant r e l a t i o n s h i p s . In t h i s study there i s evidence that the PS treatment did impact the couples's behaviours as reported on the goal attainment measure: i t did increase t h e i r a b i l i t y to ta l k to each other i n a r a t i o n a l manner and to problem solve on pragmatic issues and reach consensus with the res u l t that there was an improvement i n the target complaint, however i t did not seem to a f f e c t couples sense of s a t i s f a c t i o n , cohesion or a f f e c t i o n a l expresssion (DAS subscales) or l e v e l s of intimacy except for the i n t e l l e c t u a l intimacy; Margolin (1983) has suggested that increasing intimacy has not up to this point been part of the process of behavioural marital therapy. An increase i n s a t i s f a c t i o n has been found i n other outcome studies using problem solving t r a i n i n g (Jacobson, 1977, 1978), although Teichert (1978) found that problem solving t r a i n i n g increased the marital s a t i s f a c t i o n i n his study only for female spouses and not for the males. The fact that an increase i n s a t i s f a c t i o n was found i n other behavioral outcome studies but not here would seem to be a r e f l e c t i o n of how t h i s variable i s defined. Jacobson ( i n press) defines s a t i s f a c t i o n as the t o t a l DAS score and i f i t i s so defined, then the P.S. treatment when compared with controls was found to have a s i g n i f i c a n t 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 study. However when the subscales of the DAS are analysed separately and s a t i s f a c t i o n i s separated from other elements of marital adjustment then the PS treatment did not seem to s i g n i f i c a n t l y a f f e c t couples s a t i s f a c t i o n within t h e i r r e l a t i o n s h i p . 121 Weiss, Hops and Patterson (1973) have also suggested i n general that i t may be that t r a i n i n g i n behaviour change can appear "far removed from the kinds of hurts brought to us by c l i e n t s " (p. 339) and that the issue i s how to re l a t e s k i l l b u i l d i n g and marital s a t i s f a c t i o n . It i s i n t e r e s t i n g to note that Emotionally Focussed (EF) couples did not d i f f e r s i g n i f i c a n t l y from the PS couples a f t e r treatment on the Consensus variable or on Goal Attainment. This would seem to suggest that the EF treatment as well as the PS treatment had an e f f e c t on couples a b i l i t y to negotiate and change s p e c i f i c behaviours although these areas were not focussed upon i n terms of s k i l l t r a i n i n g . I t may be that the increased a b i l i t y to negotiate i n the EF couples i s a consequence of an increase i n trus t occuring as a r e s u l t of the sharing of emotional experience. As trust increases i n a r e l a t i o n s h i p spouses may be more able to formulate t h e i r needs and ask for them to be met i n a way that evokes a caring response. Responses based on caring tend to lead to e f f e c t i v e negotiations for they are blame free and are motivated by a sincere desire to reach agreement. These r e s u l t s suggest that distressed couples do not neces s a r i l y require s k i l l t r a i n i n g i n order to be able to negotiate differences 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 with the research of B i r c h l e r et a l . (1975) who found that distressed couples show normal problem solving s k i l l s when i n t e r a c t i n g with opposite sex strangers. As Gurman (1981) suggests poor s o c i a l s k i l l s i n a marital r e l a t i o n s h i p often r e f l e c t basic rules of minimal intimacy, s e l f - d i s c l o s u r e and self-exposure. The EF couples spoke i n the Post Treatment Questionaire of seeing each other 122 d i f f e r e n t l y ; 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 positions spouses take i n r e l a t i o n to each other can aid the negotiation process as much as a set of negotiating r u l e s . It would c e r t a i n l y appear l o g i c a l that t r u s t and goodwill are h e l p f u l prerequisites to the attainment of c o n f l i c t r e s o l u t i o n . These r e s u l t s imply that the performance of behaviours 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 negotiation can be f a c i l i t a t e d by focusing upon the emotional r e a l i t y of the r e l a t i o n s h i p fo r both the spouses as well as by d i r e c t t r a i n i n g i n negotiation. The effectiveness of the EF treatment indicates that focusing upon unacknowledged feel i n g s and v u l n e r a b i l i t i e s evoked by the marital i n t e r a c t i o n patterns i s a valuable and powerful intervention i n m a r i t a l therapy. The EF treatment as well as increasing consensus and goal attainment also was found to influence couples sense of s a t i s f a c t i o n and cohesion 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 the r e l a t i o n s h i p , as well as improving spouses I n t e l l e c t u a l Intimacy and Target Complaint above the l e v e l attained by the couples involved i n the PS treatment. The increase i n s a t i s f a c t i o n and cohesion attained by the EF couples may r e f l e c t the fact that the EF treatment attempts to address d i r e c t l y what Gurman (1978) refers to as the " f e l t needs" of the couple. I f as Broderick (1981) suggests " p o s i t i v e a f f e c t " i s considered by most to be the goal of a good r e l a t i o n s h i p an intervention which works d i r e c t l y with a f f e c t might be expected, i f e f f e c t i v e , to influence marital s a t i s f a c t i o n more immediately than a growth i n negotiation s k i l l s . Hahlweg, Schindler, Revenstorf and Brengelmann ( i n press) found 123 i n t h e i r study that the emotional-affective q u a l i t y of the r e l a t i o n s h i p predicted successful outcome i n therapy, and they suggest that whereas a behavioural approach f a c i l i t a t e s the improvement of manifest behaviours such as problem solving i t i s less well suited to "deal with 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 possible to explore and address the f e l t needs of couples and f a c i l i t a t e spouses responding to each others needs then the couples experience of an s a t i s f a c t i o n with the r e l a t i o n s h i p would be expected to change. I t may also be that i f the emotional experience of the r e l a t i o n s h i p overrides other cues spouses may be more open to perceiving and accepting new and more cooperative behaviours and attitudes i n t h e i r spouse a f t e r the emotional climate has changed. The increase i n s a t i s f a c t i o n and cohesion may also be understood i n terms of intimacy and the enhancement of bonds. In the de s c r i p t i o n of couples i n healthy f a m i l i e s given 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 healthy r e l a t i o n s h i p s ; f i r s t , the presence of profound emotional bonds, second, opportunities f or intimacy, and t h i r d the use of r e s p e c t f u l negotiation. The increase i n s a t i s f a c t i o n and cohesion i n the EF treatment group may be regarded as a r e f l e c t i o n of the fact that t h i s treatment d i r e c t l y addresses the f i r s t two issues. This i s supported by the fact that the A f f e c t i o n a l Expression aspect of the Dyadic Adjustment Scale and the Emotional Intimacy subscale on the Intimacy Inventory showed a trend i n favor of the EF treatment. Both factors were a c t u a l l y found to be s i g n i f i c a n t for the female spouses on an analysis of i n d i v i d u a l data; the reason for the d i f f e r e n t i a l response by females may be that they are more se n s i t i v e to these aspects of a 124 r e l a t i o n s h i p or that they were more affected by the elements of treatment. These factors are the kinds of elements one would expect to increase as intimacy and bonding progressed. If as Waring et a l . (1981) suggests s a t i s f a c t i o n for most couples i s c l o s e l y related to intimacy l e v e l and intimacy Is enhanced by the disclosure of r e l a t i v e l y "deep" personal needs and fears then an increase i n s a t i s f a c t i o n and cohesion would appear to be the natural outcome of an e f f e c t i v e implementation of the EF treatment. The increased i d e a l i s a t i o n of spouse and r e l a t i o n s h i p found i n the EF treatment seems as a r e s u l t of the analysis of i n d i v i d u a l scores to be mainly a r e f l e c t i o n of increased i d e a l i s a t i o n on the part of the male spouses. One i n t e r p r e t a t i o n of t h i s r e s u l t i s that the male spouses were faking p o s i t i v e responses on the Intimacy Scale. However, t h i s r e s u l t i s consistent with the trend of the r e s u l t s as a whole and i n the l i g h t of the discussion of t h i s subscale i n Chapter 3 i t seems more l i k e l y that males began to see t h e i r spouses i n a more p o s i t i v e and romantic l i g h t . The Post-Therapy Questionnaire r e s u l t s where couples spoke of seeing t h e i r partner d i f f e r e n t l y and perceiving t h e i r partner's v u l n e r a b i l i t y would seem to support t h i s i n t e r p r e t a t i o n . I t may be that since men are generally less responsive to, oriented towards and expressive of emotional experience, when males are able openly and s a f e l y to express emotions to t h e i r spouse t h i s r e s u l t s In a more p o s i t i v e estimation of t h e i r spouse. This r e s u l t may also be a g e n e r a l i s a t i o n of the o v e r a l l increase i n s a t i s f a c t i o n experienced by couples i n the EF group. 125 I n t e l l e c t u a l Intimacy also changed to a s i g n i f i c a n t l y higher l e v e l i n the EF couples compared to the PS couples. I t may be that openness and trust evoked by the EF therapy generalized from the expression of emotional issues to cognitive r a t i o n a l ^ d i s c u s s i o n . In an emotional climate of h o s t i l i t y and defensiveness issues considered at the l e v e l of r a t i o n a l discussion can quickly escalate into heated struggles and so i n t e l l e c t u a l discussion may be s t i f l e d or avoided. Other facets of intimacy measured by the PAIR appeared unaffected by ei t h e r treatment, namely S o c i a l , Sexual and Recreational Intimacy. S o c i a l Intimacy as a factor correlated at a noticably and uniquely low l e v e l with a l l other outcome subscales, which suggests that issues such as whether couples have many friends i n common are not related to marital adjustment i n the same manner as the other outcome v a r i a b l e s . Recreational Intimacy seemed to be unaffected by higher l e v e l s of s a t i s f a c t i o n and general adjustment; perhaps common a c t i v i t i e s become part of l i f e 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 i n the face of changing r e l a t i o n s h i p happiness or d i s t r e s s . Sexual Intimacy was also unaffected by treatment t h i s may be due to the screening procedures which screened out sexual dysfunction, or perhaps because the treatment procedures s p e c i f i c a l l y did not focus upon t h i s area. This r e s u l t s also suggest that sexual aspects of a marriage are i n some sense a d i s t i n c t i f r elated area within the r e l a t i o n s h i p . The increased reduction of the Target Complaint i n the EF group may be seen as part of the general e f f e c t of EF on s a t i s f a c t i o n and intimacy, or i t can be interpreted as a r e f l e c t i o n of the importance of emotional experience. Fincham and O'Leary ( i n press) have suggested 126 that behavioural responses i n close r e l a t i o n s h i p s seem to be mediated by a f f e c t i v e response rather than casual a t t r i b u t i o n s , and Zajonc (1980) has argued for the primacy of a f f e c t i n general. If emotional experience provides a framework for the creation of meaning i n a r e l a t i o n s h i p and overrides other cues, when that emotional response i s modified, then i n t e r a c t i o n patterns between spouses can become more f l e x i b l e and open and any complaint may be able to be dealt with more e f f e c t i v e l y . Complaints also tended to be emotional i n content so that exploring 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 "hurt" and sense of deprivation which Wile (1981) suggests i s the basis for marital d i s t r e s s . The main s i g n i f i c a n c e of the research re s u l t s seems to be that a treatment intervention which focuses on the emotional experience underlying the i n t e r a c t i o n a l patterns i n r e l a t i o n s h i p s can be s p e c i f i e d 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 couples experienced t h e i r r e l a t i o n s h i p and to f a c i l i t a t e the r e s o l u t i o n of marital c o n f l i c t . The fact that assignment to treatment was random and that the therapeutic a l l i a n c e was monitored and no s i g n i f i c a n t differences found between treatment groups adds c r e d i b i l i t y to the claim that the d i f f e r e n t i a l differences i n outcome between the treatment groups were due to the interventions used rather than confounding factors such as c l i e n t motivation or therapist and c l i e n t r e l a t i o n s h i p f a c t o r s . The responses on the Task dimension of the A l l i a n c e Scale also suggest that both treatments were equally c r e d i b l e and relevant to p a r t i c i p a n t s , and the fact that there were no drop-outs from e i t h e r treatment further supports t h i s view. 127 This study does not s p e c i f i c a l l y show a causal l i n k between the occurrence of emotional processes and outcomes i n marital therapy, however i t i s possible to postulate the mechanisms of change involved i n the EF treatment. The key mechanisms of change i n the EF treatment are proposed to be the modifying of spouses perceptions of themselves and each other. This process creates a new r e c i p r o c i a l responsiveness and undermines the automatic evocation of r e c i p r o c a l s e l f - p r o t e c t i v e stances, and f a c i l i t a t e s the growth of intimacy and trust which r e s u l t s from the exploration and disclosure of personal meanings and needs. Solomon (1977) has noted that emotional 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 and concerned with self-concept. The exploration and heightening of primary emotional experience helps to access the s e l f schema and make ava i l a b l e key cognitions regarding the nature of s e l f as defined i n r e l a t i o n to the other spouse. Such cognitions would seem to be l o g i c a l l y related to the positions taken by the partners i n a r e l a t i o n s h i p and thus how the r e l a t i o n s h i p i s defined. Also, spouses responsiveness to the others needs and affirmation of the others r e a l i t y t i e the partners together, and enhances the development of cresive bonds (Turner, 1970). These bonds are formed i n the process of continued i n t e r a c t i o n . The a b i l i t y to abandon ordinary defence patterns and image management and d i s c l o s e with safety, Turner (1970) suggests, not only enhances spontaneity but quickly creates t i e s between people. Conclusions The main implications of t h i s study are then that a treatment which focuses upon the accessing and expression of underlying emotional 128 experience can modify marital adjustment and intimacy l e v e l s and f a c i l i t a t e the attainment of r e l a t i o n s h i p goals and the reduction of target complaints leading to an a l l e v i a t i o n of marital c o n f l i c t and d i s t r e s s . These r e s u l t s suggest that t h i s e x p e r i e n t i a l approach i s a v i a b l e a l t e r n a t i v e to the s k i l l oriented behavioral approach to marital therapy and attest to the s i g n i f i c a n c e of emotional experience in the process of modifying the nature of intimate 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 issues a r i s i n g from t h i s study would seem to be the salience of emotional experience 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 the question of the appropriateness of a s k i l l o r i e n t a t i o n to intimate r e l a t i o n s h i p s . Both issues are complex i n nature and cannot be adequately addressed by any single study. The question of how emotional processes r e l a t e to and can be used to create change must be addressed by research which s p e c i f i c a l l y focuses upon the process of change. This study however at least delineates s p e c i f i c therapist a c t i v i t i e s designed to evoke and modify emotional responses. The issue of the relevance of s k i l l s and the teaching of s k i l l s i n marital therapy i s also a multifaceted one. The process of learning a l t e r n a t i v e behavior patterns would seem to be an inherent part of any therapy, however how the learning of s k i l l s r e l a t e s to the creation of love and respect i s a d i f f i c u l t question. As Weiss (1978) points out behavioral marital therapy o f f e r s a technology for changing r e l a t i o n s h i p s rather than a theory of adult intimacy. It may be useful to place the modification of intimate r e l a t i o n s h i p i n the context of intimate emotional bonds rather than viewing such r e l a t i o n s h i p s i n terms of exchange theory. 129 On 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 questions as to how best to delineate even more s p e c i f i c a l l y the appropriate therapist interventions at p a r t i c u l a r points i n the c l i e n t ' s change process, and how to t r a i n therapists to implement emotionally focused interventions. The issue of the possible in t e g r a t i o n of behavioral and e x p e r i e n t i a l interventions i s also an i n t e r e s t i n g one. The most e f f e c t i v e marital therapy may be, for example, a series of emotionally focused interventions to change the positions taken by the spouses i n r e l a t i o n to each other, followed by the teaching of problem solving s k i l l s to help the couple maintain and strengthen these new p o s i t i o n s . From the point of view of the c l i n i c i a n the r e s u l t s of t h i s study a t t e s t to the e f f i c a c y of a c l i n i c a l intervention i n which the th e r a p i s t , 1) i d e n t i f i e s themes i n a core struggle, 2) i d e n t i f i e s negative i n t e r a c t i o n cycles and the positions each partner takes i n these cycles, 3) redefines the problem i n terms of newly synthesized emotional experiences, 4) encourages partners to i d e n t i f y with disowned aspects of t h e i r experience, 5) helps each partner to accept the other's p o s i t i o n and, 6) f a c i l i t a t e s the expression of needs and wants and the creation of new solutions. The focus on inner experience as i t translates into r e l a t i o n s h i p events appears to be a f r u i t f u l one i n marital therapy. Future Research The f i r s t task implied 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 behaviorally oriented researcher. The r e s u l t s of the treatment of those couples assigned to 130 the control group i n t h i s study w i l l also be analysed 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 study i n v o l v i n g the control group d i f f e r s from the study presented i n t h i s d i s s e r t a t i o n i n that the therapists used to treat the control couples were inexperienced; the e f f e c t of therapist experience l e v e l on the e f f i c a c y of the EF treatment should then be able to be documented. This i s a p a r t i c u l a r l y relevant issue since one hypothesis concerning the EF treatment i s that a r e l a t i v e l y high l e v e l of therapist expertise and experience i s necessary to s u c c e s s f u l l y implement t h i s treatment. Inexperienced therapists seem to f i n d i t d i f f i c u l t to focus on the process of i n t e r a c t i o n rather than the content and to evoke and heighten emotional experience rather than r a t i o n a l l y discuss such experience (Greenberg & Johnson, i n press). Possible future research might also examine the process of c o n f l i c t r e s o l u t i o n comparing the i n therapy performance of couples who resolve c o n f l i c t s with that of non-resolvers and r e l a t i n g process oriented indices such as the l e v e l of experiencing on the Experiencing Scale ( K l e i n , Mathieu, K e i s l e r , Gendlin (1969) or the q u a l i t y of i n t e r a c t i o n s recorded on the Structural Analysis of So c i a l Behaviour (Benjamin, 1977) to outcome v a r i a b l e s . As suggested by Rice and Greenberg (1983) change events i n therapy may be i d e n t i f i e d and successful performance i n a p a r t i c u l a r change event documented and related to successful eventual outcomes. Such research would f a c i l i t a t e the bu i l d i n g of a model of c o n f l i c t r e s o l u t i o n and the d e t a i l e d d e s c r i p t i v e analysis involved would hopefully begin to explain how change occurs i n the emotionally focused 131 treatment, and s p e c i f i c a l l y l i n k in-therapy events to treatment outcomes. Continued outcome research perhaps with more severely distressed couples using a longer treatment program might also elucidate the factors which predict future success or f a i l u r e i n the Emotionally Focused treatment and so help to delineate the strengths and l i m i t a t i o n s of t h i s approach. 132 BIBLIOGRAPHY Abelson, R.P. Computer simulation of "hot cognitions". In S. Tomkins and S. Messick (Eds.), Computer simulations of p e r s o n a l i t y . New York: Wiley, 1963. Abies, B.S., & E. Brandsma, J . J . Therapy f o r couples. San Francisco, Jossey Bass, 1977. Adams, O.B., & Nagnur, O.N. Marriage divorce and mentality. A l i f e  table analysis for Canada: 1975-77. S t a t i s t i c s Canada, Ottawa, 1981. A l l e n , J.C., & Hamsher, J.H. The development and v a l i d a t i o n of a test of emotional s t y l e s . Journal of Personality and S o c i a l Psychology, 1974, 42, 663-668. Altman, I., & Taylor, D.A. S o c i a l penetration: The development of interpersonal r e l a t i o n s h i p s . New York: Holt, Rinehart & Winston, 1973. Appelbaum, S.A. Pathways to change i n psychoanalytic therapy. New York: Springer, 1982. Arnkoff, D.B. Psychotherapy from the perspective of cognitive theory. In: M. Mahoney (Ed.), Psychotherapy process: Current issues and  future d i r e c t i o n s . New York: Plenum Press, 1980. Arnold, M.B. Emotion and p e r s o n a l i t y . New York: Columbia University Press, 1960. Bandura, A. S o c i a l learning theory. Englewood C l i f f s , N.J.: Prentice H a l l , 1977. Barry, W.A. Marriage research and c o n f l i c t . An i n t e g r a t i v e review. Psychological B u l l e t i n , 1970, 73, 41-54. Bateson, G. A Systems Approach. International Journal of Psychiatry, 1971, 9_, 242-44. B a t t l e , C C . , Imber, S.D., Hoehn-Saric, R., Stone, A.R. , Nash, E.R., & Frank, J.D. Target complaints as c r i t e r i a of improvement. American Journal of Psychotherapy, 1966, __, 184-192. Beck, A.T. Cognitive therapy and the emotional disorders. New York: International U n i v e r s i t i e s Press, 1976. Benjamin, L. S t r u c t u r a l Analysis of a Family i n Therapy. Journal of  Consulting and C l i n i c a l Psychology, 1977, 45, 391-406. 133 Berger, P., & Luckmann, T. The s o c i a l construction of r e a l i t y . Penguin, Harmondsworth, 1966. Bergin, A.E. The evaluation of therapeutic outcomes. In: A.E. Bergin and S.L. G a r f i e l d (Eds.). Handbook of Psychotherapy and Behaviour  Change. New York: Wiley, 1971. Bernal, G. & Baker, J . Toward a metacommunicational framework of couple i n t e r a c t i o n s . Family Process, 1979, _18_, 293-304. B i r c h l e r , G.R., & Webb, L.J. Discriminating i n t e r a c t i o n behaviors i n happy and unhappy marriages. Journal of Consulting and C l i n i c a l  Psychology, 1977, 45, 494-495. B i r c h l e r , G.R., Weiss, R.L., & Vincent, J.P. Multimethod analysis of s o c i a l reinforcement exchange between m a r i t a l l y distressed and non-distressed spouse and stranger dyads. Journal of Personality  and S o c i a l Psychology, 1975, 31_, 349-360. Blake, R.R. & Mouton, J.S. The f i f t h achievement. In S.L. Tubbs (Ed.), A systems approach to small group i n t e r a c t i o n . Reading, Mass.: Addison Wesley, 1978. Blishen, B.R., & Mcroberts, H.A. A revised socioeconomic index for occupations i n Canada. Canadian Review of Sociology and  Anthropology, 1976, 13_, 71-79. Bloom, B.L., Asher, S.J. & White, S.W. M a r i t a l disruption as a str e s s o r : A review and a n a l y s i s . Psychological B u l l e t i n , 1978, 85, 867-94. Bockus, F. Couple therapy. New York: Jason Aronson, 1980. Bordin, E. The g e n e r a l i z a b i l i t y of the psychoanalytic concept of the working a l l i a n c e . Psychotherapy. Theory Research and P r a c t i c e , 1979, 16_, 222-229. Borkovec, T.D. & Grayson, J.B. Consequences of increasing the f u n c t i o n a l impact of i n t e r n a l emotional s t i m u l i . In K.R. Blankstein, P. P l i n e r , & J . Polury (Eds.), Assessment and  M o d i f i c a t i o n of Emotional Behavior. Plenum Press, New York: 1980. Bowen, M. Family therapy and family group therapy. In D.H.L. Olson (Ed.), Treating r e l a t i o n s h i p s . Lake M i l l s , Iowa: Graphic Press, 1976. Bower, G.H. Mood and Memory. American Psychologist, 1981, 36_, 129-148. Broderick, J . A method for deviation of areas of assessment i n marital r e l a t i o n s h i p s . The American Journal of Family Therapy, 1981, 9_, 25-34. 134 Carkhuff, R.R. Helping and human r e l a t i o n s . New York: Holt, Rinehart & Winston, 1969. Carson, R.C. Interaction concepts of personality. Chicago: Aldine Pub. Co., 1969. Clayton, R.R. The family, marriage and s o c i a l change. Lexington, Mass.: Heath & Co., 1975. Cohen, J . S t a t i s t i c a l power analysis f o r the behavioral sciences. New York: Academic Press, 1977. Cohen, J. A c o e f f i c i e n t of agreement for nominal scales. Educational  and Psychological Measurement, 1960, 20, 37-46. Cotton, M.C. A systems approach to ma r i t a l t r a i n i n g : An evaluation. Unpublished doctoral d i s s e r t a t i o n , Texas University, 1976. Csikszentmihalyi, M. Love and the dynamics of personal growth. In K.S. Pope & Associates (Eds.), On love and lovi n g . San Francisco, Jossey Bass, 1980. Davison, G. Psychotherapy process. Special issue, Cognitive Therapy  and Research, 1980, 4_, 269-306. Dean, D.G. & Lucas, W.L. Improving m a r i t a l p r e d i c t i o n : A model and  p i l o t study. Revised version of a paper presented at the annual meeting of the National Council on Family Relations, St. Louis, M i s s o u r i , Oct. 1974. Deutsch, M. C o n f l i c t s , productive and destructive. Journal of S o c i a l  Issues, 1969, 25, 7-43. Dicks, H.V. M a r i t a l tensions. New York: Basic Books Inc., 1967. Dixon, W.J. BMPD S t a t i s t i c a l Software. Berkeley: University of C a l i f o r n i a press, 1981. Duke, M.P., & Nowicki, S. A s o c i a l learning theory concepts and a multidimensional model of human i n t e r a c t i o n c o n s t e l l a t i o n s . In J.C. Anchin, & D.J. Miesler (Eds.), Handbook of interpersonal  psychotherapy, New York: Pergamon Press, 1982. Edmonds, V.H. M a r i t a l conventionalization: D e f i n i t i o n and Measurement. Journal of Marriage and the Family, 1967, 29, 681-688. E l l i s , A. Humanistic psychotherapy: The r a t i o n a l emotive approach. New York: The J u l i a n Press, 1973. Epstein, N.B., & Bishop, D.S. Problem-centered systems therapy of the family. In A. Gurman & D. Kniskern (Eds.), Handbook of family  therapy. New York: Brunner & Mazel, 1981, 444-82. 135 Feldman, L.B. Dysfunctional marital c o n f l i c t : An i n t e g r a t i v e interpersonal-intrapsychic model. Journal of M a r i t a l and Family  Therapy, 1982, 8, 417-428. Feldman, L.B. M a r i t a l c o n f l i c t and marital intimacy: An i n t e g r a t i v e psychodynamic behavioral systemic model. Family process, 1979, 18, 69-78. Fincham, F., & O'Leary, D.K. A f f e c t i n the e i g h t i e s : A new d i r e c t i o n  i n behavioral marital therapy. Paper presented at the 90th Annual Convention of the American Psychological Association, Washington, D.C., Aug. 1982. Fincham, F.D., & O'Leary, K.D. Causal inferences for spouse behavior i n distressed and non-distressed couples ( i n press). Fink, C F . Some conceptual d i f f i c u l t i e s i n the theory of s o c i a l c o n f l i c t . Journal of C o n f l i c t Resolution, 1968, _12, 412-460. Fisher, R.E. The e f f e c t of two group counselling methods on perceptual  congruence i n married p a i r s . Unpublished docotral d i s s e r t a t i o n , U n i v e r s i t y of Hawaii, 1973. Gendlin, E. Focusing. New York: Bantam Books, 1980. Glass, G., & Stanley, J . S t a t i s t i c a l methods i n education and psychology. Englewoods C l i f f s , New Jersey: Prentice H a l l , 1970. G l i c k , B., & Gross, S.J. M a r i t a l i n t e r a c t i o n and marital c o n f l i c t : A c r i t i c a l evaluation of current research s t r a t e g i e s . Journal of  Marriage and the Family, 1975, J3, 505-512. Gottman, J.M. M a r i t a l i n t e r a c t i o n . New York: Academic Press, 1979. Gottman, J . , Markman, H., & Notarius, C. The topography of marital c o n f l i c t : A sequential analysis of verbal and non-verbal behavior. Journal of Marriage and the Family, 1977, 8_, 461-477. Green, R.A., & Murray, E.J. Expression of f e e l i n g and cognitive r e i n t e r p r e t a t i o n i n the reduction of h o s t i l e aggression. Journal  of Consulting and C l i n i c a l Psychology, 1975, 43_, 375-383. Greenberg, L., & Johnson, S.M. Emotionally focused couples therapy: An integrated a f f e c t i v e systemic approach. In N.S. Jacobson & A.S. Gurman (Eds.), The c l i n i c a l handbook of marital therapy. New York: Guildford Press, i n press. Greenberg, L.S. & Safran, J.D. Encoding and cognitive therapy: Changing what c l i e n t s attend to. Psychotherapy Theory Research &  P r a c t i c e , 1981, 8, 163-169. 136 Greenberg, L. & Safran, J. Integrating a f f e c t and cognition: A perspective on the process of therapeutic change. Cognitive  Therapy and Research, 1984, i n press. Greenberg, L.S., & Webster, M. Resolving d e c i s i o n a l c o n f l i c t : Relating process to outcome. Journal of Counselling Psychology, 1982, 29, 468-477. Gurman, A.S. Integrative marital therapy. Toward the development of an interpersonal approach. In S.H. Budman (Ed.), Forms of b r i e f  therapy. New York: Guildford Press, 1981. Gurman, A.S. Contemporary marital therapies: A c r i t i q u e and comparative analysis of psychoanalytic, behavioral and systems theory approaches. In T.J. Paolino, & B.S. McCrady (Eds.), Marriage and m a r i t a l therapy. New York: Brunner and Mazel, 1978. Gurman, A.S., & Kniskern, D.P. Research on marital and family therapy: Progress perspective and prospect. In S.L. G a r f i e l d , & A.E. Bergin (Eds.), Handbook of psychotherapy and behaviour change. New York: Wiley & Sons, 1978. Gurman, A.S., & Kniskern, D.P. Family therapy outcome research: Knowns and unknowns. In A.S. Gurman, & D.P. Kniskern (Eds.), Handbook of  family therapy. New York: Brunner & Mazel, 1981. Gurman, A.S., & Knudson. Behavioral marriage therapy: A psychodynamic systems analysis and c r i t i q u e . Family Process, 1978, 17, 121-38. Gurman, A.S., Knudson, R.M., & Kniskern, D.P. Behavioral marriage therapy: IV. Take two asprins and c a l l us i n the morning. Family  Process, 1978, 1_7, 165-181. Hahlweg, K., Schindler, L., Revenstorf, D., & Brengelmann, J.C. The Munich marital therapy study. In K. Hahlweg & N.S. Jacobson (Eds.), M a r i t a l i n t e r a c t i o n : Analysis and modification. New York: G u i l f o r d press, i n press. Haley, J . Problem solving therapy. San Francisco: Jossey Bass, 1976. Haley, J . Strategies of psychotherapy. New York: Grune & Stratton, 1963. Hays, W.L. S t a t i s t i c s . New York: Holt Rinehart & Winston, 1981. Izard, C. Human emotions, New York: Plenum Press, 1977. Jackson, D.D. The i n d i v i d u a l and the larger context. Family Process, 1967, 6, 139-154. Jacobson, N.S. Problem solving and contingency contracting i n the treatment of marital discord. Journal of Consulting and C l i n i c a l  Psychology, 1977, 45, 92-100. 137 Jacobson, N.S. S p e c i f i c and nonspecific factors i n the effectiveness of a behavioral approach to the treatment of marital discord. Journal  of Consulting and C l i n i c a l Psychology, 1978(b), 46, 442-452. Jacobson, N.S. A review of the research on the effectiveness of marital therapy. In T.J. Paolino & B.S. McCrady. Marriage and M a r i t a l  Therapy. New York: Brunner & Mazel, 1978. Jacobson, N. Increasing p o s i t i v e behavior in severely distressed marital r e l a t i o n s h i p s : The e f f e c t s of problem solving t r a i n i n g . Behavior Therapy, 1979, 10_, 311-326. Jacobson, N.S. Behavioral marital therapy. In A.S. Gurman & D.P. Kniskern (Eds.), Handbook of family therapy. New York: Brunner & Mazel, 1981. Jacobson, N.S. Expanding the range and a p p l i c a b i l i t y of behavoral ma r i t a l therapy. The Behavior Therapist, 1983, 6_, 189-191. Jacobson, N.S. A component analysis of behavioral marital therapy: The r e l a t i v e effectiveness of behavior exchange and communication/problem-solving T r a i n i n g . Journal of Consulting and  C l i n i c a l Psychology, i n press. Jacobson, N.S., & Anderson, E.A. The e f f e c t s of behavior rehearsal and feedback on the a c q u i s i t i o n of problem solving s k i l l s i n distressed and non-distressed couples. Behavior Research and Therapy, 1980, 18_, 25-36. Jacobson, N.S., & Dallas, M. Helping married couples improve t h e i r r e l a t i o n s h i p s . In W.E. Craighead, A.E. Kazdin, & M.J. Mahoney (Eds.), Behavior modification: P r i n c i p l e s , issues and applications (2nd ed.T. Boston: Houghton & M i f f l i n , 1981. Jacobson, N.S., F o l l e t t e , W.C., & Elwood, R.W. Outcome research i n behavioral marital therapy: A methodological and conceptual r e a p p r a i s a l . In K. Hahlweg & N.S. Jacobson (Eds.), M a r i t a l  i n t e r a c t i o n : Analysis and modificaton. New York: G u i l f o r d Press, i n press. Jacobson, N.S., and Margolin, G. M a r i t a l therapy: Strategies based on  s o c i a l learning and behavior exchange p r i n c i p l e s . New York: Brunner & Mazel, 1979. Jacobson, N., & Weiss, R.L. Behavior marriage therapy I I I . The contents of Gurman et a l . Maybe hazardous to our health. Family  Process, 1978, 17_, 149-164. James, W. Pragmatism. New York: Longman, 1907. Kaplan, M.L. & Kaplan, N.R. Organization of experience among family members i n the immediate present: A Gestalt/systems i n t e g r a t i o n . Journal of M a r i t a l and Family Therapy. 1982. 8. 5-14. 138 K i e s l e r , D.J. Interpersonal theory for personality and psychotherapy. In J.C. Anchin, & D.J. K i e s l e r (Eds.), Handbook of interpersonal  psychotherapy. New York: Pergamon Press, 1982. Kinston, W. & Bentovim, A. Creating a focus for b r i e f marital or family therapy. In S.H. Budman (Ed.), Forms of b r i e f therapy, New York: G u i l f o r d Press, 1981. Kiresuk, T.J., & Sherman, R.E. Goal attainment s c a l i n g : General method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 1968, 4^  443-453. Knudson, R.M., Sommers, A.A., & Golding, S.L. Interpersonal perception and mode of re s o l u t i o n i n marital c o n f l i c t . Journal of Personality  and S o c i a l Psychology, 1980, 38, 751-763. Koren, P.E. M a r i t a l c o n f l i c t i n t e r a c t i o n , r e l a t i o n s h i p s among objective  and subjective measures. Unpublished doctoral d i s s e r t a t i o n , U n i v e r s i t y of Utah, 1978. K l e i n , M. Mathieu, P. K e i s l e r , D. & Gendlin, E. The Experiencing Scale. Wisconsin P s y c h i a t r i c I n s t i t u t e , Madison, W i s e : 1969. Koren, P., Carlton, K., & Shaw, D. M a r i t a l c o n f l i c t : r e l a t i o n s among behaviors, outcomes, and d i s t r e s s . Journal of Consulting and  C l i n i c a l Psychology, 1980, 48, 460-468. L'Abate, L. Intimacy i s sharing hurt f e e l i n g s . Journal of Marriage and  Family Counseling, 1977, _3, 13-16. Lang, P. Imagery i n therapy: An information processing analysis of fear. Behavior Therapy, 1977, 8, 862-886. Last, C.G., Thase, M.E., Hersen, M., Bellack, A.S., & Himmlehoch, J.M. Treatment Outcome for S o l i c i t e d Versus Non-Solicited Unipolar Depressed Female Outpatients. Journal of Consulting and C l i n i c a l  Psychology, 1984, 52, 134. Lazarus, R.S. Thoughts on the r e l a t i o n s between emotion and cognition. American Psychologist, 1982, 37_, 1019-1024. Leary, T. Interpersonal diagnosis of p e r s o n a l i t y . A functional theory  and methodology for personality evalution. New York: Ronald Press, 1957. Leeper, R.W. Feelings and emotions. In M.D. Arnold (Ed.), Feelings and  emotions: The l o y o l a symposium. New York: Academic Press, 1970. Leventhal, H. A perceptual motor processing model of emotion. In: P. P l i n e r , K.R. Blankstein & I.M. Spigel (Eds.), Advances i n the study  of communication and a f f e c t , V o l . 5. Perception of emotions i n  s e l f and others. New York: Plenum Press, 1979. 139 Lewis, J.M., Beavers, W.R., Gossett, J.T., & Austin Ph i l l i p s , V. No single thread: Psychological health in family systems. New York: Brunner & Mazel, 1976. Liberman, R.P., Levine, J., Wheeler, E., Sanders, N., & Wallace, L.J. Marital therapy in groups: A comparative evaluation of behavioral and interactional formats. Acta Psychiatrica Scandinavica, 1976, Supplement 266, 1-34. Locke, H.J., & Wallace, K.M. Short marital adjustment and prediction tests: Their r e l i a b i l i t y and validity. Marriage and Family  Living, 1959, 8_, 251-256. Long, W. Keeping Love Off the Rocks. The Vancouver Sun, Friday, April 29, 1983. Lowenthal, M.F. & Haven, S.W. Interaction and adaptation: Intimacy as a c r i t i c a l variable. American Sociological Review, 1968, 33, 20-30. Lowenthal, M.F., & Weiss, L. Intimacy and crises in adulthood. The  Counselling Psychologist, 1976, 6_, 88-94. Mahler, M.S. On human symbiosis and the vicissitudes of individuation. New York: International Universities Press, 1968. Mahoney, M.J. Cognition, consciousness and processes of personal change. In K.D. Craig & R.J. McMahon (Eds.), Advances in c l i n i c a l  behavioral therapy. New York: Brunner & Mazel, in press. Mahoney, M.J. Psychotherapy and the structure of personal revolutions. In M.J. Mahoney (Ed.), Psychotherapy process: Current issues and  future directions. New York: Plenum Press, 1980. Mahoney, M.J. Personal science. A cognitive learning therapy. In A. E l l i s & R. Grieger (Eds.), Handbook of rational psychotherapy. New York: Springer, 1977. Mahoney, M., & Arnkoff, D.B. Cognitive and self-control therapies. In S. Garfield & A. Bergin (Eds.), Handbook of psychotherapy and  behaviour change. New York: Wiley & Sons, 1978. Malan, D.H. The frontier of brief psychotherapy. New York: Plenum Press, 1976. Mann, J. Time-limited psychotherapy. Cambridge, Mass.: Harvard University Press, 1973. Margolin, G. Relationships among marital assessment procedures: A correlational study. Journal of Consulting and Cl i n i c a l  Psychology, 1978, 46, 1556-1558. 140 Margolin, G. Behavioral marital therapy. Is there a place for passion play and other non-negotiable dimensions? The Behavior Therapist, 1983, _, 65-68. Margolin, G., Christensen, A., & Weiss, R.L. Contracts, cognition, and change: A behavioral approach to marriage therapy. Counselling  Psychologist, 1975, _5» 15-26. Margolin, G., & Wampold, B.E. Sequential analysis of c o n f l i c t and accord i n distresed and non-distressed marital partners. Journal  of Consulting and C l i n i c a l Psychology, 1981, 49, 554-567. Margolin, G. , & Weinstein, CD. The role of a f f e c t i n behavioral therapy. In L.R. Wolberg & M.C Aronson (Eds.), Group and family  therapy. New York: Brunner & Mazel, 1983. Margolin, G., & Weiss, R.L. Comparative evaluation of therapeutic components associated with behavioral marital treatment. Journal  of Consulting and C l i n i c a l Psychology, 1978, 46, 1476-1486. Matarazzo, J. Psychotherapeutic process. Annual Review of Psychology, 1965, _6, 181-224. Mead, D.E. Reciprocity counselling: practice and research. Journal of  M a r i t a l and Family Therapy. 1981, 7_, 189-199. Meichenbaum, D. Cognitive behavior modification. New York: Plenum, A 1977. Meissner, W.W. The conceptualization of marriage and family dynamics from a psychoanalytic perspective. In T.J. Paolino & B.S. McCrady (Eds.), Marriage and m a r i t a l therapy. New York: Brunner & Mazel, 1978. Millenson, J.R. P r i n c i p l e s of behavioral a n a l y s i s , New York: MacMillan, 1967. Moos, R.H., & Moos, B.A. A typology of family s o c i a l environments. Family Process, 1976, 15, 357-372. Morton, T.L., Alexander, J.F., & Altman, I. Communication and r e l a t i o n s h i p d e f i n i t i o n . In G.R. M i l l e r (Ed.), Explorations i n  interpersonal communication. V o l . 5. Beverly H i l l s , C a l i f o r n i a : Sage, 1976. Murstein, B., Cerreto, M., & MacDonald, M. A theory and i n v e s t i g a t i o n of the e f f e c t of exchange - o r i e n t a t i o n on marriage and f r i e n d s h i p . Journal of Marriage and the Family, 1977, 39, 543-548. Myers, J.K., Lindenthal, J . J . , Pepper, & Ostrander, D.R. L i f e events and mental status. A l o n g i t u d i n a l study. Journal of Health and  S o c i a l Behavior, 1972, 13, 389-406. 141 Nadelson, C C . Ma r i t a l therapy from a psychoanalytic perspective. In T.J. Paolino & B.S. McCrady (Eds.), Marriage and marital therapy. New York: Brunner & Mazel, 1978. Nelson, L.R. Guide to LERTAP use and i n t e r p r e t a t i o n . Dunedin, New Zealand: University of Otego Press, 1974. Nichols, M., & Zax, M. Catharsis i n psychotherapy. New York: Gardener Press, 1977. Nie, N.H., H u l l , C , Jenkins, J . , Steinbrenner, K., & Bent, D. SPSS:  S t a t i s t i c a l package f or the s o c i a l sciences (2nd ed.). New York: McGraw H i l l Co., 1975. O'Leary, D.K., & Turkewitz, H. A comparative outcome study of behavioral marital therapy and communication therapy. Journal of  Ma r i t a l and Family Therapy, 1981, ]_, 159-169. O'Leary, K.D., & Turkewitz, H. Methodological errors i n marital and c h i l d treatment research. Journal of Consulting and C l i n i c a l  Psychology, 1978, 46, 747-758. Olson, C.L. On Choosing a Test S t a t i s t i c i n Mul t i v a r i a t e Analysis of Variance. Psychological B u l l e t i n , 1976, 83_, 579-586. Olson, D.H., & Schaefer, M.T. PAIR: Procedure manual. Family s o c i a l science, St. Paul, Minn.: Uni v e r s i t y of Minnesota, 1982. Orvis, B.R., Kelley, H.H., & Butler, D. A t t r i b u t i o n a l c o n f l i c t i n young couples. In J.H. Harvey, W.J. Icres, & R.F. Kidd (Eds.), New  di r e c t i o n s i n a t t r i b u t i o n a l research, V o l . I . H i l l s d a l e : New Jersey, Erlbaum, 1976. Paolino, T. Introduction: Some basic concepts of psychoanalytic psychotherapy. In T. Paolino, & B. McGrady (Eds.), Marriage and  marital therapy. New York: Brunner & Mazel, 1978. Patterson, G.R., & Hops, H. Coercion, a game for two. In R. U l r i c h & P. Mountjoy (Eds.), The Experimental analysis of s o c i a l behavior. New York: Appleton Century Crofts, 1972. Patterson, G.P., Hops, H., & Weiss, R.L. Interpersonal s k i l l s t r a i n i n g for couples i n early stages of c o n f l i c t . Journal of Marriage and  the Family, 1975, JL, 295-302. Pe r l s , F. The Gestalt approach and eyewitness to therapy. San Francisco: Science and Behavior Books, 1973. P e r l s , F., H e f f e r l i n e , R., & Goodman, P. Gestalt therapy. New York: J u l i a n Press, 1951. Pinsof, W., & C a t h e r a l l , D. The couples therapy a l l i a n c e scale manual. The Chicago centre for family studies, Northwestern University, Chicago, 111.: 1983. 142 P l u t c h i k , R. Emotion: A Psychorevolutionary synthesis. New York: Harper & Row, 1980. Rachman, S. The Primary of A f f e c t . Some Theoretical Implications, Behavior Research and Therapy, 1981, _9, 279-290. Raush, H.L., Barry, W.A., H e r t e l , R.K., Swain, M.A. Communication  c o n f l i c t and marriage. San Francisco: Jossey Bass, 1974. Rapaport, D. Emotions and memory. New York: International University Press, 1970. Renne, K.S. Health and marital experience i n an urban population. Journal of Marriage and the Family, 1971, 2_3, 338-350. Rice, L. The evocative function of the ther a p i s t . In D. Wexler & L. Rice (Eds.), Innovations i n c l i e n t centered therapy. New York: Wiley, 1974. Rice, L.N., & Greenberg, L.S. Patterns of Change. New York: Guildford Press (1983). Robinson, E.A., & P r i c e , M.G. Pleasurable behavior i n marital i n t e r a c t i o n : An observational study. Journal of Consulting and  C l i n i c a l Psychology, 1980, 48, 117-118. Rogers, CR. Client-centered therapy. Boston: Houghton & M i f f l i n , 1951. Rosow, I. S o c i a l i n t e g r a t i o n of the aged. Glencoe, New York: Free Press, 1967. Sager, C.J. Couples therapy and marriage contracts. In A.S. Gurman & D.P. Kniskern (Eds.), Handbook of Family Therapy. New York: Brunner & Mazel, 1981. S a t i r , V. Peoplemaking. Palo A l t o : Science and Behavior Books, 1973. S a t i r , V. Conjoint family therapy. Palo Alto: Science and behavior Books, 1967. Schachter, S. Emotion obesity and crime. New York: Academic Press, 1971. Schaefer, M.T., & Olson, D.H. Assessing intimacy: The p a i r inventory. Journal of M a r i t a l and Family Therapy, 1981, _, 47-60. Shevrin, H., & Dickman, S. The Psychological Unconscious. American  Psychologist, 1980, 35, 421-434. Skynner, A.C. One f l e s h , separate persons: P r i n c i p l e s of family and  m a r i t a l psychotherapy. London: Constable & Co., 1976. 143 S l u z k i , C.E. M a r i t a l therapy from a systems theory perspective. In T. Paolino & B. McGrady (Eds.), Marriage and ma r i t a l therapy. New York: Brunner & Mazel, 1978. Solomon, R. The passions. New York: Anchor Press, 1977. Spanier, G. Measuring Dyadic Adjustment. Journal of Marriage and the  Family, 1976, 38, 15-28. SPSS Inc. SPSS: X. New York: McGraw H i l l , 1983 Strongman, K.J. The psychology of emotion. London: Wiley Sons, 1978. Strupp, H.H., & Hadley, S.W. A t r i p a r t i t e model of mental health and therapeutic outcomes. American Psychologist, 1977, 32, 187-196. Stuart, R.B. Operant interpersonal treatment for marital discord. Journal of Consulting and C l i n i c a l Psychology, 1969, 33_, 675-682. S u l l i v a n , H.S. The interpersonal theory of psychiatry. New York: Norton, 1953. U.S. Bureau of the Census. Current population reports. Washingon, D.C.: U.S. Government P r i n t i n g O f f i c e Series, 1975. Taylor Segraves, R. M a r i t a l therapy: A combined psychodynamic-behavioral approach. New York: Plenum Press, 1982. Te i c h e r t , C H. Teaching problem solving s k i l l s to distressed couples:  A treatment program without the use of contracting. Unpublished t h e s i s . Brigham Young Un i v e r s i t y , Provo, Utah, 1978. Thibaut, J.W., & Kel l e y , H.H. The s o c i a l psychology of groups. New York: Wiley, 1959. Tolst e d t , B.E. & Stokes, J.P. Relation of verbal, a f f e c t i v e and physi c a l intimacy to marital s a t i s f a c t i o n . Journal of Counselling  Psychology, 1983, 30, 573-580. Turner, R.H. Family i n t e r a c t i o n . New York: Wiley & Sons, 1970. Venema, H.B. Marriage enrichment: A comparison of the behavioral  exchange negotiation and communication models. Unpublished doctoral d i s s e r t a t i o n , F u l l e r Theological Seminary, 1975. Waller, W., & H i l l , R. The Family, New York: Holt, Rinehart & Winston, 1951. W a l l e r s t e i n , J.S., & Kel l e y , J.B. The e f f e c t s of parental divorce: Experiences of the preschool c h i l d . Journal of the American  Academy of C h i l d Psychiatry, 1975, 14, 600-616. Waring, E. McElrath, D. Lefocoe, D., & Weisz, G. Dimensions of intimacy i n marriage, Psychiatry, 1981, 44, 169-175. 144 Waskow, I.E., & P a r l o f f , M.B. Psychotherapy change measures. Ro c h v l l l e , M.D.: National I n s t i t u t e of Mental Health, 1975. Watzlawick, P. The psychotheapeutic technique of "reframing" In J.L. Claghom (Ed.), Succesful psychotherapy. New York: Brunner & Mazel, 1976. Watzlawick, P., Beavin, J.H., & Jackson, D.D. Pragmatics of Human Communication: A study of i n t e r a c t i o n a l patterns, pathologies and  paradoxes. New York: W.W. Norton, 1967. Watzlawick, P., Weakland, J . , & F i s h , R. Change: P r i n c i p l e s of problem  formation and problem r e s o l u t i o n . New York: W.W. Norton, 1974. Weiss, R.L. Strategic behavioral marital therapy. In J.P. Vincent (Ed.), Advances i n family intervention: Assessment and theory: Greenwich, Connecticut: JAI Press, 1980. Weiss, R.L. The conceptualization of marriage from a behavioral perspective. In T.J. Paolino & B.S. McCrady (Eds.), Marriage and  marital therapy. New York: Brunner & Mazel, 1978. Weiss, R.L., Hops, H., & Patterson, G.R. A framework for conceptualizing marital c o n f l i c t : A technology for a l t e r i n g i t . Some data for evaluating i t . In L.A. Hammerlynck, L.C. Hardy & E.J. Mash, (Eds.), Behavior change: Methodology, concepts and  p r a c t i c e . The 4th Banff Conference on behavior modification. Champaign, I l l i n o i s : Research Press, 1973. Weiss, R.L., & Margolin, G. Assessment of marital c o n f l i c t and accord. In A.R. Ciminero, H. Adams, & K. Galhoun (Eds.), Handbook of  behavioral assessment. New York: Wiley & Sons, 1977. Wexler, D. A cognitive theory of experiencing s e l f a c t u a l i z a t i o n and therapeutic process. In D. Wexler & L. Rice (Eds.), Innovations i n  c l i e n t centered therapy. New York: Wiley, 1974. Wieman, R.J. "Conjugal r e l a t i o n s h i p modification and r e c i p r o c a l reinforcement: A comparison of treatments for m a r i t a l discord. Unpublished doctoral 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: A n o n - t r a d i t i o n a l approach. New York: Wiley & Sons, 1981. Williams, A.M.A. A behavioral analysis of the quantity and q u a l i t y of mari t a l i n t e r a c t i o n related to marital s a t i s f a c t i o n . Journal of  Applied Behavioral Analysis, 1979, 12, 665-678. Williams, A.M., M i l l e r , W.R. Evaluation and Research on ma r i t a l therapy. In G. Pirooz Sholevar (Ed.), The handbook of marriage and  mar i t a l therapy, New York: Spectrum Pubs., 1981. 145 Woolfolk, R.L. A multimodal perspective on emotion. In A Lazarus (Ed.), Multimodal behavioral therapy, New York: Springer, 1976. Zajonc, R.B. Feeling and thinking. Preferences need no inferences. American Psychologist, 1980, 35, 151-175. APPENDIX A TREATMENT MANUALS 147 RATIONALE: PROBLEM SOLVING INTERVENTION These counselling sessions are based upon the idea that couples get into habitual ways of r e l a t i n g to and t r y i n g to change each other that 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 for both partners rather than enabling them to work out t h e i r problems together. The sessions w i l l focus upon teaching you both some new communication s k i l l s and some new structured ways of defining and solving problems i n your r e l a t i o n s h i p so that you can both learn to negotiate e f f e c t i v e l y for the changes you would l i k e to see i n each other's behavior. Since a l l problems In a r e l a t i o n s h i p have implications and consequences for both partners every problem i s a mutual problem and 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 partners. This counselling process involves teaching couples how to negotiate with each other for change i n a structured r a t i o n a l way and how to f i n d compromises that w i l l be s a t i s f y i n g to both p a r t i e s . We w i l l be working on modifying communication patterns that i n t e r f e r e with problem solving through the use of feedback and by demonstrating d i f f e r e n t ways of communicating which we can then p r a c t i s e together. You w i l l learn a supportive s t y l e of communication which may not be the way you want to i n t e r a c t with each other a l l the time, but can help you when s p e c i f i c issues come up i n the r e l a t i o n s h i p that you need to resolve i n order to keep the r e l a t i o n s h i p s a t i s f y i n g and i n v o l v i n g f or you both. 148 C.P.S.P. PROBLEM SOLVING MANUAL This manual i s b r i e f since the process of therapy i s also delineated i n Jacobson and Margolin (1979), pages 215-258. General P r i n c i p l e s : A l l new s k i l l s are f i r s t taught using p o s i t i v e or r e l a t i v e l y neutral content. Each session begins with the therapist s e t t i n g the agenda for the session, than reviewing the homework, troubleshooting i f necessary ( e s p e c i a l l y i n sessions 2 and 3), and teaching new s k i l l s . FRAMEWORK Session 1 Assessment. Presentation of treatment r a t i o n a l e . Session 2 Troubleshoot i f necessary. Teach communication s k i l l s , model, rehearse and coach using p o s i t i v e content as much as poss i b l e . Session 3 Troubleshoot i f necessary. Teach problem d e f i n i t i o n and analysis s k i l l s , model rehearse and coach using hypothetical or very minor r e a l issues, using communication s k i l l s . 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 , apply these s k i l l s to an issue i n the couple's r e l a t i o n s h i p . 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 hypothetical or minor issue f i r s t , then to the issue defined i n Session 4. Session 6 Teach contracting s k i l l s , apply to a hypothetical or small issue f i r s t and then to the solutions to the issue brainstormed i n Session 5. Session 7 Revise the contract implemented for homework. Revise the complete process 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 contracting. Session 8 Summarize processes and r u l e s . Deal with transfer and gen e r a l i s a t i o n issues. 149 PROBLEM SOLVING TREATMENT SESSION 1 - ASSESSMENT Therapist Tasks: 1. Amplify strengths, probe for and reinforce the fu n c t i o n a l aspects of the r e l a t i o n s h i p . 2. The therapist enquires as to the h i s t o r y of the r e l a t i o n s h i p . How did the couple meet, what attracted them to each other, how did courtship proceed, what was i t that they found rewarding about each other. Focus on p o s i t i v e s . 3. Encapsulate problems as presented, and attempted solutions. The therapist frames the problem as a mutual one, co l l a b o r a t i o n being i n the i n t e r e s t s of both partners. 4. The therapist observes the couple i n t e r a c t for 8 minutes as they discuss t h e i r problem and notes t h e i r communication patterns. 5. The therapist presents the treatment r a t i o n a l e . The problem i s framed i n terms of lack of s k i l l s necessary to create p o s i t i v e change i n the r e l a t i o n s h i p . The therapist emphasises that hard work and c o l l a b o r a t i o n are necessary and homework assignments are an e s s e n t i a l part of the counselling. Homework: Give the couple the problem solving manual to read, encouraging them to set a time i n the week to do t h i s and any future homework. 150 SESSION 2 The therapist gives the ra t i o n a l e for learning to l i s t e n to each other, sharing and c l a r i f y i n g communication. The therapist models p o s i t i v e non-verbal behavior and paraphrasing and shapes communication s k i l l s through a process of feedback i n s t r u c t i o n and rehearsal. Feedback i s d e s c r i p t i v e , e.g. you interrupted him, as opposed to i n t e r p r e t i v e or evaluative. Later i n the sessions when the couple are f a m i l i a r with the structure the therapist may simply stop the couple's i n t e r a c t i o n and ask "Why I am stopping you" and encouraging the couple to i d e n t i f y and r e c t i f y t h e i r mistake. The therapist focuses upon the e f f e c t of communication patterns, that i s the responses c e r t a i n behaviors e l i c i t from the partner. The couple are encouraged to l a b e l f e e l i n g s and to va l i d a t e those of t h e i r spouses. The therapist focuses p a r t i c u l a r l y upon enhancing p o s i t i v e exchanges. The therapist's main a c t i v i t i e s consist of giving feedback, modelling, s t r u c t u r i n g behavioral rehearsal of 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 practised using p o s i t i v e content, for example t a l k i n g about a pleasant memory. If necessary the Troubleshooting procedure can be used i n t h i s session. Here the therapist l i s t e n s to a problem s i t u a t i o n from both points of view, summarizes the problem which occurred and asks both partners at each play by play step what they could 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 negative. The therapist looks f o r general 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 incident and writes a contract to help the couple avoid a reoccurrence of the c o n f l i c t . 151 Homework: Five minutes each of paraphrasing the partner as they t a l k about a p o s i t i v e issue. SESSION 3 The therapist explains the r a t i o n a l e for learning problem d e f i n i t i o n s k i l l s and environmental contingencies which support the process (e.g. set an agenda, set a time frame, do not problem solve i n the heat of the b a t t l e ) . The couple are now encouraged to use the communication s k i l l s taught i n the l a s t session to define issues more c l e a r l y . The therapist sets out rules f or the problem d e f i n i t i o n process and gives rationales f or these r u l e s : 1. When st a t i n g a problem begin with relevant p o s i t i v e s to maximise the partners a b i l i t y to l i s t e n and to keep issues i n perspective. 2. Be s p e c i f i c . Focus on behavior, s i t u a t i o n , and consequence. The therapist i n s i s t s upon behavior de s c r i p t i o n rather than t r a i t l a b e l s and discourages the use of inferences, suggesting couples speak only of what they can observe. D i f f e r e n t ways to view problems may also be summarized here. Each problem may be viewed i n terms of excess, d e f i c i t , environmental contingencies, d i f f e r i n g expectations, or lack of reward for desired behavior. This structure may be used again when teaching brainstorming. 3. Avoid overgeneralisations. 4. Label your f e e l i n g s , that i s the impact your partner's behavior has upon you. 152 5. Admit to your part i n the problem., e.g., I should have brought i t up sooner. 6. Be b r i e f . Side-tracking and cross-complaining are discouraged, as i n any discussion of causes. The s k i l l s are f i r s t modelled by the therapist and t r i e d out using hypothetical or very minor r e a l problems. Having taught the rules the therapist then stops the i n t e r a c t i o n when they are not observed and helps the couple to modify t h e i r behavior. A good problem d e f i n i t i o n consists of a des c r i p t i o n of behavior, a s p e c i f i c a t i o n of the s i t u a t i o n , and consequences. Homework: Pra c t i s e paraphrasing, and take a very minor issue i n the re l a t i o n s h i p and use the above process to come up with a clear problem d e f i n i t i o n . The therapist also uses Troubleshooting i n t h i s session i f necessary. SESSION 4 In t h i s session the s k i l l s of Sessions 2 and 3 continue to be reinforced and practi s e d . If possible the couple should now use these s k i l l s to define an issue that i s of concern to them i n t h e i r r e l a t i o n s h i p . Legitimacy of the problem i s assumed i f i t i s d i s t r e s s i n g to one of the partners. The partners committment to negotiation i s stressed as e s s e n t i a l to problem s o l v i n g . Homework: Write a problem d e f i n i t i o n on a small 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 perspectives of excess, d e f i c i t , etc. 153 SESSION 5 The procedures f o r problem solving are now taught. The therapist teaches the brainstorming process using a hypothetical or very minor problem. A l t e r n a t i v e solutions are considered i n terms of costs and benefits to each partner. Possible options are narrowed and ref i n e d . The focus here i s upon negotiation, partners are encouraged to 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 practised once the partners then brainstorm solutions to the problem they defined i n Session 4. Aft e r l i s t i n g 5-6 f e a s i b l e solutions a cost benefit analysis should whittle the l i s t down to 2-3. The therapist helps the couple consider the d i f f i c u l t i e s inherent i n the implementation of solutions, and the rewards they can provide to reinforce such implementation. Homework: Brainstorming solutions for one of the small issues 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 session contracting i s taught and a contract i s written up fo r the issue brainstormed i n Session 5. The contract i s a good f a i t h contract, and i s written up i n s p e c i f i c behavioral terms. The therapist helps the couple to consider ways to ensure that the contract i s implemented. Homework: To implement the above contract. To write up a contract for the small issue they brainstormed for homework. 154 SESSION 7 In this session the specific contract made in Session 6 i s evaluated and revisions are made i f necessary. Communication, problem definition and problem solving s k i l l s are then reviewed. If 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 interaction where the couple discuss the problem they discussed during the eight minute interaction in session one. The therapist also prepares the couple for relapse and teaches them how to init i a t e a problem solving session; they then rehearse this i n i t i a t i o n . The therapist helps the couple identify cues which might suggest that such a session is necessary, and how the environment can be made conducive to problem solving, as well as ways the couple might increase the probability of this process occurring in 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 last 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 of 1. Too much of a ce r t a i n behavior 2. Too l i t t l e of a behavior 3. Circumstances i n the s i t u a t i o n which contribute to the problem 4. Partners having d i f f e r e n t expectations 5. Partners not rewarding each other for desired behaviors. Each of these views may lead to d i f f e r e n t s olutions. EXAMPLE - Paul not spending enough time with Mary at the party may be viewed as: 1. Paul t a l k i n g too much to other people. Mary s i t t i n g too much on her own and not s o c i a l i z i n g . 2. Paul not t a l k i n g to Mary enough. Mary not responding to people's approaches enough. 3. The fact that both Paul and Mary were t i r e d of attending p a r t i e s , having attended three the week before. 4. Mary assumed that Paul and she would be together a l l evening since the party was small. Paul assumed that they would be separate since there were business people at the party he wanted to meet. 5. Mary did not respond to Paul when he did ta l k to her. Paul did not include her i n the conversation when she did approach him. 156 ? RATIONALE: EMOTIONALITY FOCUSED INTERVENTION These counselling sessions are based upon the idea that the more you understand and can accept the positions you and your partner take i n the r e l a t i o n s h i p , that i s the way you see and react to each other, the more choice you can have over what happens i n the r e l a t i o n s h i p . It i s often underlying concerns or fee l i n g s that we are not quite aware of or cannot quite express which color the way we react to each other. Emotional chain reactions seem to get set up and then take on a l i f e of t h e i r own, so that both partners end up f e e l i n g misunderstood and f r u s t r a t e d and that they are somehow not r e a l l y getting what they want from each other. Feelings towards each other which are not understood often get i n the way of couples being able to discuss things openly and resolve concrete issues. So these sessions w i l l be geared towards each of you having a clearer picture of what happens i n your r e l a t i o n s h i p , how each of you experience the r e l a t i o n s h i p , and helping you to be aware of and communicate your needs to each other i n a way that your partner can hear and accept. Both of you w i l l then hopefully f e e l more accepted and closer to each other and as a r e s u l t be able to resolve issues openly and f i n d new and p o s i t i v e ways to respond to each other. 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 issues more p r e c i s e l y and attempted solutions. Identify themes i n core struggle. 2. Discuss each partners perception of the problem. Observable behaviors are noted but the focus i s upon how each partner 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 the stances or positions each takes in the r e l a t i o n s h i p . 3. Note and explore patterns i n the process of i n t e r a c t i o n . I dentify sequences of problematic reactions as the couples narrate or enact them. How do t h i s couple connect, maintain distance, attempt to influence and protect themselves against each other and the therapist? Allow a 10 minute discussion of the presenting problem for research purposes. 4. Enquire regarding the h i s t o r y of the r e l a t i o n s h i p . Key events are noted. The coules' expectations of the r e l a t i o n s h i p are explored. Norms as to power/control, dependence/independence, and closeness/distance are noted. The therapist also considers the developmental stage of the r e l a t i o n s h i p and the l e v e l of commitment. 5. Enquire about the family of o r i g i n and l i f e h i s t o r y of the partners. Note partners' views of male and female roles and the norms mentioned above. Hypothesize v u l n e r a b i l i t i e s and sources of anxiety stemming from l i f e experiences which may be r e f l e c t e d i n the present 159 r e l a t i o n s h i p . How do i n t e r a c t i o n patterns impact the i n d i v i d u a l ' s self-concept and self-esteem? 6. Present Treatment Rationale. The therapist frames problems i n terms of deprivation, 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 i n the r e l a t i o n s h i p . The problem i s framed i n terms of stuck emotional chain reactions which have become automatic and which both partners have p a r t i c i p a t e d i n b u i l d i n g and now are imprisoned by. PROCESS NOTE: The goal of the therapist throughout the session i s estabish a working a l l i a n c e , to create rapport and t r u s t with both partners and given them hope for p o s i t i v e outcomes. Since t h i s i s an information gathering and diagnostic session much more of the i n t e r a c t i o n w i l l be t h e r a p i s t - c l i e n t i n nature than i n the following sessions where c l i e n t - c l i e n t i n t e r a c t i o n w i l l increase. The therapist by his/her behaviour also creates expectations for the process of the sessions, for example by encouraging c l i e n t s to speak for themselves not for the other and discouraging disruptive i n t e r r u p t i o n s . T y p i c a l therapist a c t i v i t i e s : Empathic Responding Direct Questions and Probes as to issues, i n t e r a c t i o n patterns and intrapersonal anxieties Observe/Hypothesize regarding the c e n t r a l struggle i n the r e l a t i o n s h i p Framing of problem i n terms of treatment perspective. 160 ' Steps of Treatment This therapy tends to occur i n a c i r c u l a r rather than a l i n e a r sequence therefore t h i s manual w i l l focus on the steps of the process rather than attempt a session by session account. The steps i n the process and the key interventions follow below. These steps are elaborations of the framework stated below. 1. Define issue as presented Define problems as seen by the c l i e n t s . E s t a b l i s h each person's view of the problem, and how they perceive t h e i r own and t h e i r partner's role i n the problem. E s t a b l i s h shared goals. Each person i s encouraged to make a f u l l and complete statement of t h e i r p o s i t i o n . Therapist A c t i v i t i e s : Direct questions and probes; Empathic responding; Sumarizing and inte g r a t i n g information; Validate opposing r e a l i t y claims and positions and each partner's need to be right and innocent of blame. 2. 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 cycle might be "when you demand attention he withdraws by leaving the room. You become more upset as he refuses to t a l k to you. You f i n a l l y give up and also withdraw. F i n a l l y a f t e r a day or so he i n i t i a t e s s u p e r f i c i a l contact." In such cycles each of the partners solutions to the problem i n t e n s i f i e s the problem for the other. The therapist explores behaviours, fee l i n g s and perceptions involved i n the cycle i n order to c l a r i f y each partner's p o s i t i o n i n the "dance". Behaviour towards the partner i s linked to underlying 161 f e e l i n g s . Such cycles may be talked about and reconstructed or they may occur i n the therapy session where the therapist i d e n t i f i e s and comments upon them as they happen. For example, the therapist comments, I notice that when you s t a r t to express your views on t h i s topic your partner asks you why you see things that way, and then you seem to get confused and s t a r t to explain ... etc. Negative messages such as blaming the partner are explored i n terms of underlying needs. The framing of behaviour i n terms of an i n t e r a c t i o n a l cycle fosters a perspective of mutual r e s p o n s i b i l i t y . The 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 t h e i r positions are validated. Therapist A c t i v i t i e s : The therapist i d e n t i f i e s and connects elements i n the cycle by means of questioning, exploring, c l a r i f y i n g and i n t e r p r e t i n g each partner's perceptions feelings and reactions to the other. Negative a l i e n a t i n g reactions occurring i n the session are pointed out and discussed, for example, mind reading of the other partner or making negative d i s p o s i t i o n a l a t t r i b u t i o n s . Blaming behaviour i s not ruled out as unhelpful but used by the therapist to search for the f e e l i n g underlying s p e c i f i c accusations. It i s developed further rather than challenged as unacceptable. The therapist uses open ended explorations and only i n t e r p r e t s i f c l i e n t s are unable to discover t h e i r own experience. Examples: a. To c l a r i f y cycle and positions the therapist says: What did you do then? or When your partner does what do you do? You c r i t i c i z e Jack for never holding you and for being cold to you, when he does t h i s how do you fe e l ? 162 b. To draw attention to i n t e r a c t i o n a l patterns the therapist says: It seems that when your partner talks you interrupt - I'm wondering what i s happening for you, what i s i t that you are experiencing when you do this? 2. Access and accept unacknowledged feelings underlying problematic i n t e r e a c t i o n s . Emotional responses at the periphery of awareness are attended to heightened and linked to self-perceptions. P a r t i c u l a r attention i s paid to v u l n e r a b i l i t i e s fears and unexpressed resentments. S i g n i f i c a n t events arousing strong emotion are at times reconstructed, or enacted i n the session and are focussed upon to reveal underlying emotion. C l i e n t s are thus exposed to aspects of s e l f and the other not previously acknowledged. This i s to be distinguished from the v e n t i l a t i o n of s u p e r f i c i a l and/or defensive reactions; i t i s a new synthesis of emotional experience. An example of such a s u p e r f i c i a l reaction would be an angry reaction expressed with no awareness of a sense of threat or underlying fear. These reactions are explored f o r the underlying experience of fear. Therapist A c t i v i t i e s : Evocative responding (see the end of the manual for a d e t a i l e d d e s c r i p t i o n of the modified form of t h i s i n t e r v e n t i o n ) . This intervention involves focused r e f l e c t i o n , probing and i n t e r p r e t a t i o n by the the r a p i s t . The therapist may attempt to supply missing f e e l i n g s , or supply sentences for a c l i e n t to f i n i s h . The therapist may also attend to bodily sensations the c l i e n t i s 163_' experiencing and to non-verbal behaviour i n general. Images and metaphors may also be created to heighten and c l a r i f y emotional responses. The focus i s upon looking at inner experience and the owning of such experience. This experience i s then validated by the t h e r a p i s t . There i s a continuing focus on the emotional experience occurring in the present. 4. The problem i s redefined in terms of newly synthesized emotional experiences. The problem i s now construed in terms of adult unmet needs and sense of deprivation and a l i e n a t i o n . Interacting s e n s i t i v i t i e s are explored and interpreted and i n d i v i d u a l experience i s translated into the meaning ca r r i e d for the other spouse and the r e l a t i o n s h i p . Such in t e r p r e t a t i o n s integrate the c l i e n t s ' a f f e c t i v e , cognitive and behavioural experiences. Fears and coping reactions are validated and related back to the responses taught i n the family of o r i g i n and to key s e l f images. The current need for these responses i s explored. New perspectives on the r e l a t i o n s h i p and the partners behaviour created by the new emotional synthesis are now integrated. For example, a blaming response may be seen as an expression of a need for love or a withdrawal seen as a fear response instead of as an attempt to punish or hurt. Attempts are made to capture these new feelings as they are occurring i n interactions during the session. The c l i e n t s are encouraged to i n t e r a c t with each other i n the sessions and to share t h e i r underlying fee l i n g s as they emerge in the session i n reaction to 16:4 t h e i r p a r t n e r s . There i s a strong focus on what i s o c c u r r i n g i n the present between the partners. These f e e l i n g s are explored f u l l y , both i n terms of t h e i r personal meanings and t h e i r meaning to the partner. 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 of the personal v u l n e r a b i l i t i e s explored i n Step 3 are 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 of underlying needs and fear 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, Jim i s v i g i l a n t regarding a c t i o n s of J i l l ' s that he perceives 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 i s s e n s i t i v e to b u l l y i n g and responds by r e j e c t i n g . This c y c l e prevents contact and the meeting of the p a r t n e r s ' needs i n the r e l a t i o n s h i p . 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 of is s u e s and defensive r e a c t i o n s i n terms of f a m i l y of o r i g i n schemata. A present centered focus i s maintained and partners are 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 to what t h e i r partners j u s t s a i d . 5. I d e n t i f y i n g w i t h disowned aspects of experience i n the redefined c y c l e . The c y c l e , redefined i n terms of underlying emotional experience and needs, i s enacted d e l i b e r a t e l y i n order f o r the partners to become more aware of t h e i r underlying needs and to gain a sense of c o n t r o l of these automatic responses. The c l i e n t s are i n s t r u c t e d to become more f u l l y "who they are" by engaging d e l i b e r a t e l y i n t h e i r part of the cy c l e 165 rather than t r y i n g not to engage i n t h i s behaviour. For example, the withdrawer and the pursuer are both encouraged to more f u l l y experience t h e i r underlying f e e l i n g s and needs which were previously disowned. Aspects of experience such as the withdrawer's fear of being overwhelmed and need to protect and the blamer's f e e l i n g s of being unloved and need fo r support are f u l l y discussed and then prescribed. Each person i s asked to i d e n t i f y with disowned aspects of t h e i r experience, to develop t h e i r p o s i t i o n f u l l y and to d e l i b e r a t e l y engage i n some of the behaviours associated with t h e i r previously disowned feel i n g s and needs. This i s an i n t r a p s y c h i c a l l y oriented intervention focusing on enacting disowned parts rather than enacting the negative i n t e r a c t i o n a l cycle as occurs i n some paradoxical interventions. Distancing partners, for example, may be asked e i t h e r i n the session or for homework to d e l i b e r a t e l y protect themselves or p r a c t i c e putting up a wall as a way of becoming more aware of and gaining c o n t r o l over t h i s sometimes problematic aspect of t h e i r own behaviour. Pursuers are asked to d e l i b e r a t e l y engage i n support seeking behaviours and to become aware of t h e i r need to be nurtured and the f e e l i n g s associated with t h i s . If one partner f e e l s too dependent or f e e l s anxiety about being intimate, he or she i s asked to i d e n t i f y with the dependent or f e a r f u l aspect of t h e i r experience rather than to deny these parts or t r y to disown them. Both partners are reassured at t h i s point that even though i t might seem strange or be d i f f i c u l t to act i n a manner that they construe as problematic (such as dependent or a f r a i d ) that these are the f e e l i n g s they are a c t u a l l y f e e l i n g and that t h i s i s only being more congruent. 166 I t i s emphasized that i t i s important i n resolving marital c o n f l i c t to take r e s p o n s i b i l i t y f o r one's feel i n g s and that accepting these f e e l i n g s and d e l i b e r a t e l y behaving i n ways associated with these f e e l i n g s w i l l give them more control and choice of these feelings and behaviours. Once partners have i d e n t i f i e d with disowned aspects of t h e i r experience i t i s possible to integrate these aspects both i n t r a p h y s i c a l l y and also into the r e l a t i o n s h i p . I d e n t i f y i n g with disowned aspects of experience i s worked on i n the session and given as homework and people are asked to do i t d e l i b e r a t e l y i f possible, or to "go with" t h e i r experience when they begin to f e e l t h e i r previously disowned experience rather than f i g h t i n g against that aspect of themselves. Therapist A c t i v i t i e s : Suggests people i d e n t i f y f u l l y with previously disowned aspects of t h e i r experience. The therapist conveys an ultimate acceptance of each person's p o s i t i o n , feelings and needs by suggesting that people do what they are doing rather than t r y not to. Although there 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 experiences, the focus i s on having people do what they do with f u l l awareness and r e s p o n s i b i l i t y ( i n order to make previously automatic responses deliberate) rather than to prescribe a paradox to gain therapeutic con t r o l of the i n t e r a c t i o n a l cycle. 6. Acceptance of partners p o s i t i o n . The focus i s now upon the communication to the spouse of the newly experienced emotional responses, and the partner's acceptance of these responses. The therapist f a c i l i t a t e s acceptance of the other's needs on i67-" the part of each spouse, p r i m a r i l y by tracking interactions and blocking or exploring non-accepting responses. The therapist helps the couple construct the conversation they might have had i f they had been i n touch with and able to report 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 . The phobic avoidance of the expression of v u l n e r a b i l i t y i n the r e l a i t o n s h i p i s usually confronted i n t h i s process. This session i s not directed towards the teaching 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 helping partners reveal new aspects of themselves to t h e i r mates and f a c i l i t a t i n g a new intimacy and contact between the partners. Blocks to one partner's a b i l i t y to hear and accept the other's experience are examined and interpreted i n terms of that partner's view of s e l f , past learning i n family of o r i g i n and catastrophic fears. The therapist f a c i l i t a t e s acceptance of s e l f and others i n contrast to the usual pattern 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 distressed r e l a t i o n s h i p . Therapist A c t i v i t i e s : Evocative responding; i n t e r p r e t a t i o n and l a b e l l i g to c l a r i f y r e l a t i o n s h i p events; drawing attention to the nature of responses to the partner and the impact of these responses, and suggesting a l t e r n a t i v e s . Example: a. I f e e l alone (experience of abandonment and helplessness integrated i n previous steps) because you never show yourself, your f e e l i n g s ; never r e a l l y show me how you f e e l . b. I don't show you my f e e l i n g s , well I suppose I don't, I'm a f r a i d to show you, when I have I get attacked. 168-Therapist: (to ( a ) ) . How can (b) show you his feel i n g s i n a way that you can hear them. 7. Expression of needs and wants The emotional synthesis of the issue i n terms of i n t r a - i n d i v i d u a l and interpersonal experience leads 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 . One partner can now d i r e c t l y ask for what he or she wants or needs from the other, and the implications of these desires for 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 can be examined. Key attitudes underlying the positions each partner has taken i n the r e l a t i o n s h i p begin to be explored. Therapist A c t i v i t i e s : Focus i n t e r a c t i o n upon the expression of needs and wants. C l a r i f y and i n t e r p r e t such needs i f necessary. 8. New Solutions The statement of needs and wants, accessed, integrated and accepted by the spouse, leads to the creation of new a l t e r n a t i v e solutions to the couple's struggle and the presenting problem which i s sympomatic of t h i s struggle. The therapist c l a r i f i e s and explores aspects of the sol u t i o n with the couple and again helps them to confront blocks to p o s i t i v e responding. The therapist also draws attention to and hig h l i g h t s new p o s i t i v e patterns of i n t e r a c t i o n . New solutions 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 , for example, a r e l a t i o n s h i p may become one i n which one person can state needs and the other can give support rather 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.-other into seeing and responding i n a ce r t a i n way. New solutions are assessed i n terms of the needs of both partners and t h e i r general f e a s i b i l i t y and i f possible enacted i n the session. 9. Integrate new perspectives The therapist helps the couple develop a shared perspective, a de t a i l e d picture of the r e l a t i o n s h i p , and engage i n metacommunication as to the past and present nature of the r e l a t i o n s h i p . The therapist c l a r i f i e s new positions and p o s i t i v e sequences of emotional response and the new i n t e r a c t i o n a l c y c l e s . The past r e l a t i o n s h i p positions taken by the partners and the negative cycle are discussed. New goals for future r e l a t i o n s h i p development as well as new ways of creating and maintaining intimacy are discussed. Therapist A c t i v i t i e s : Summarizing. Termination issues. PROCESS NOTE: These nine steps tend to be c y c l i c a l ; the therapist may c i r c l e back to previous steps i f necessary, or begin the cycle of steps focussing upon some new aspects of the couples' core struggle. In the sessions the couple continue to expand t h e i r awareness of t h e i r stances i n the r e l a t i o n s h i p and the needs and fears underlying these p o s i t i o n s . As po s i t i o n s , i n t e r a c t i o n patterns and key underlying emotional respones become cl e a r e r the couples' manner of i n t e r a c t i n g becomes less reactive and automatic, a l t e r n a t i v e behavours, feel i n g s and thoughts are experienced and experimented with. The couple develop a shared 170 perspective of the re l a t i o n s h i p and begin to "woo" each other back into intimacy. Since previously unaccepted aspects of the s e l f have been accessed, validated, expressed and integrated into the r e l a t i o n s h i p anxiety reducing defences are less and less evident. As therapy continues i d e a l l y the therapist does less and the partner i n t e r a c t more and more helping each other through the theraputic process. TERMINATION SESSION: This session l i k e assessment w i l l always follow a c e r t a i n format. The treatment process w i l l be reviewed, new i n t e r a c t i o n patterns highl i g h t e d , and the present state of the r e l a t i o n s h i p i n terms of goodwill, t r u s t , open contact, closeness and p o s i t i v e a f f e c t assessed and summarized. The o r i g i n a l presenting problem i s discussed and post treatment measures completed. OPERATIONAL DEFINTIONS: Need - Awareness of an urgent lack of nurturance, safety, or basic relatedness necessary f o r s u r v i v a l and a sense of well-being. Boszbrmenyi-Nagi suggests that the other i s the object, the "ground" f or an i n d i v i d u a l ' s i d e n t i t y d e l i n e a t i o n and security needs and lab e l s t h i s "ontic dependence". I n t e r a c t i o n a l Cycles - Sequences of behaviours where the response of one partner becomes the automatic stimulus for an automatic reaction i n the other, e.g. I nag because you ignore me, no I ignore you because you nag. Such cycles are a l i e n a t i n g and usually s p i r a l into more intense c o n f l i c t . Interacting 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 to cope with the 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 partner which e l i c i t s the s p e c i a l v u l n e r a b i l i t y of the other r e s u l t i n g i n an a l i e n a t i n g emotional chain reaction. The issue to which the partner i s s e n s i t i v e often has h i s t o r i c s i g n i f i c a n c e . This term then refers to the s e n s i t i v i t y which underlies core f e e l i n g reactions which lead to negative i n t e r a c t i o n a l c y c l e s . P o s i t i o n - A point of view, perspective or o r i e n t a t i o n i n a r e l a t i o n s h i p . A view of the s e l f i n r e l a t i o n to the other which creates a set of expectations which guide perceptions, feelings and behaviour. Positions tend to become r i g i d and polarized i n a context of threat to self-esteem or well-being. Contact - to meet or come together, to touch, to connect or experience r e c i p r o c a l openness, allowing the other to impact you. To communicate openly on an intense personal l e v e l . To touch - to permit part of the body/self to come i n contact with so as to f e e l . Interpret - To c l a r i f y meaning by connecting or r e l a t i n g one element i n a s i t u a t i o n to another, for example, by connecting r e l a t i o n s h i p behaviours to intrapsychic perceptions of the s e l f . It i s also a process of imposing meaning upon events, or creating a new frame of reference. Can be more or less confrontive. C l a r i f y - To make the i m p l i c i t e x p l i c i t - deals with what i s j u s t beyond awareness. Symbolize more completely. Can be a mild form of i n t e r p r e t a t i o n . 172. THERAPIST INTERVENTION. EVOCATIVE RESPONDING This intervention consists of probes or statements which attempt to c l a r i f y and heighten the c l i e n t s ' emotional experience i n therapy and make the automatic a focus of conscious awareness. The elements of experience focussed upon are: Stimulus (cue and appraisal) Arousal Response The therapist's focus depends upon the process of therapy: SITUATION 1 If Stimulus, Arousal and Response (SAR) are a l l c l e a r l y experienced i n awareness, that i s i f the stimulus i s clear and d i f f e r e n t i a t e d , arousal i s present and acknowledged, and response i s expressed with ownership and inner awareness then the therapist pushes for more d i f f e r e n t i a t e d inner awareness and a clearer expression of experience and needs. Thus spouses are exposed to aspects of themselves and each other that i s beyond awareness. Examples: C l i e n t - When you look concerned and s i t close to me l i k e that I f e e l very uncomfortable, I f e e l smothered, hemmed i n , so I turn away, close off and ignore you t i l l you go away. 173. Therapist - Smothered, you f e e l l i k e you don't have room to breathe. That's scary, you f e e l anxious? ( C l i e n t nods), what w i l l happen i f you don't turn away? C l i e n t - 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 therapist heightens using images, probes and i n t e r p r e t a t i o n s . Examples: Therapist - Is that p a i n f u l for you? C l i e n t - Yes, very. Therapist - It almost sounds l i k e you're i n a cave and shouting help, help, and a l l you f e e l you get i s the echo of your own voice. C l i e n t - I have to deal with i t , not burden him with my jealousy, he's struggling too. Therapist - Sounds l i k e you want to hold his hand and help him while he makes love to his lov e r . SITUATION 3 If the Stimulus i s not clear s p e c i f i c and a l i v e the therapist 17.4 E x a m p l e s : T h e r a p i s t - What i s t h a t s p a r k s o f f y o u r c y n i c i s m and makes i t h a r d f o r you t o l i s t e n t o him? C l i e n t - H e ' s so c o n d e s c e n d i n g , I ge t h o s t i l e . T h e r a p i s t - What about t h e way he does t h i s g e t s t o y o u . C l i e n t - He i s so l o g i c a l , n e v e r l e t s go , and t h a t l o o k on h i s f a c e o f I know b e t t e r . T h e r a p i s t - He seems c o l d and s u p e r i o r . SITUATION 4 I f t h e Response i s u n c l e a r t he t h e r a p i s t d i f f e r e n t i a t e s t h e S t i m u l u s o r h e l p s t h e c o u p l e e n a c t t h e sequence so t h a t t h e y may u n f o l d and 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 te rms o f e m o t i o n , c o g n i t i o n and b e h a v i o u r . E xamp le : T h e r a p i s t - So what happens when Pa t t e l l s you t h a t she d o e s n ' t want t o make l o v e , and t u r n s away? C l i e n t - N o t h i n g , I a c c e p t i t , m i gh t a sk h e r why. T h e r a p i s t - I 'm w o n d e r i n g i f y ou d o n ' t f e e l h u r t o r f e e l t h a t need t o ge t back a t he r ? APPENDIX B INSTRUMENTS USED IN THE STUDY DEMOGRAPHIC DATA QUESTIONNAIRE COUPLE NUMBER 1. How many years have you l i v e d together as a couple? 2. How many children do you have? 3. Have the two of you had any marital counselling before taking part i n t h i s project? Yes No 4. Please t i c k the catagory within which you gross family income f a l l s : 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. Please state your age ( i n years) 6. What i s your present occupation? If you are currently unemployed please state reasons why 7. Have you had a previous marriage? Yes No 8. Please t i c k the catagory which best describes your educational l e v e l : Grade 10 or les s Grade 12 or less 2 years of post secondary education Community college program completed University degree completed Graduate program completed Ph.D. or equivalent completed This section should be completed hy the female partner only 9. Please state your age ( i n years). 10. What i s your present occupation? If you are currently unemployed please state reasons why 177, 11. Have you had a previous marriage? Yes No 12. Please t i c k the catagory which best describes your educational l e v e l : Grade 10 or les s Grade 12 or less 2 years of post secondary education Community college program completed University degree completed Graduate program completed Ph.D. or equivalent completed 17.8 DESCRIPTION OF TARGET COMPLAINTS DESCRIBED BY SPOUSE IN THIS STUDY The kinds of stated concerns couples brought into the research project seemed to f i t into the following catagories: 1. Lack of intimacy, that i s physical ( a f f e c t i o n and sexual closeness) and communication. 2. Lack of communication i n the sense of recurring power struggles and seemingly unresolvable f i g h t s r e s u l t i n g i n distance between partners and a lack of cooperation i n decision making. 3. S i t u a t i o n a l c o n f l i c t s which were not resolved and became the source of recurring disagreements, for example extra-marital a f f a i r s or the b i r t h of a handicapped c h i l d . 4. C o n f l i c t s concerning role d e f i n i t i o n s and r e s p o n s i b i l i t i e s . Most couples spoke of wanting more open communiation more a f f e c t i o n and a greater responsiveness to each others needs. The f i r s t two catagories were mentioned by the majority of couples. There appeared to be a balance of complaints across groups; for example each group contained one couple where the male spouse had a p a r t i c u l a r problem with outbursts of uncontrollable anger, and a l l groups also contained one couple resolving issues concerning past extra-marital a f f a i r s . The issue most often mentioned was a lack of open communication however t h i s i s a vague and general term which then had to be d i f f e r e n t i a t e d by the couple and assessor. In general couples concerns appeared more expression oriented rather than instrumentally oriented. 17$ TARGET COMPLAINTS QUESTIONNAIRE C We are interested at t h i s time i n the two or three main concerns that you hope to resolve during counselling. Please l i s t them below: (a) (b) (c) 180.... QUESTIONNAIRE D (at termination) We are interested i n how much the following issues i n your r e l a t i o n s h i p has (have) changed since you started the program. Please c i r c l e the words that describe your p o s i t i o n . a. worse... same... s l i g h t l y better... somewhat better... a l o t better b. worse... same... s l i g h t l y better... somewhat better... a l o t better c. worse... same... s l i g h t l y better... somewhat better... a l o t better GOAL ATTAINMENT QUESTIONNAIRE A Couple No. Date: Description of the issue you w i l l be working on. Much worse than expected r e s u l t s : Somewhat less than expected r e s u l t s : Expected or most l i k e l y r e s u l t s : Somewhat better than expected r e s u l t s : Much better than expected r e s u l t s : (place a s t e r i s k (*) next to l e v e l where you are now). 182 .. THE PAIR INVENTORY The following are the d e f i n i t i o n s of intimacy i m p l i c i t i n the PAIR. Emotional Intimacy: The experiencing of closeness of f e e l i n g ; the a b i l i t y and freedom to share openly, i n a nondefensive atmosphere when there i s supportiveness and genuine understanding. S o c i a l Intimacy: The experience of having common friends and a s i m i l a r s o c i a l network. Sexual Intimacy: The experience of showing general a f f e c t i o n , touching, physical closeness, and/or sexual a c t i v i t y . I n t e l l e c t u a l Intimacy: The experience of sharing ideas, t a l k i n g about events i n one's l i f e , or discussing job-related Issues, current a f f a i r s , e tc. Recreational Intimacy: Shared experiences of i n t e r e s t s i n past-times or hobbies; mutual p a r t i c i p a t i o n i n sporting events; mutual involvement i n any general r e c r e a t i o n a l or l e i s u r e a c t i v i t y . 183 POST TREATMENT STANDARIZED INTERVIEW C.P.S.P. Couple No. Please place M or F a f t e r recorded statements. 1. Has your r e l a t i o n s h i p improved as a r e s u l t of t h i s counselling? If so how would you describe the change? 2. What did you fi 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 consider important i n terms of helping you or your partner change your relationship? 4. What was least h e l p f u l or hindering for you about t h i s treatment? 5. Would you have preferred more sessions? M. F. Yes Yes No No M. F. Yes Yes No No .184 , ACTIVITIES WHILE WAITING INQUIRY Assessor: Couple No. Have you and your partner taken any action to try and improve your r e l a t i o n s h i p since the f i r s t assessment? For,example have you received any other outside help, read any books which you found u s e f u l , or taken any other action to help yourselves while you were waiting for counselling? Yes No Document reply: Reading books Talking with friends Speaking to any "expert", e.g. a minister Improving the context of the r e l a t i o n s h i p for example buying a car i f this was an issue, taking a vacation. Other What was i t about t h i s a c t i v i t y that you f e e l helped your r e l a t i o n s h i p . 185/ CONFLICT RESOLUTION TASK Instructions f o r Therapists: In the l a s t f i f t e e n minutes of the session please ask your couples to take a few minutes to t a l k about the issue they have addressed i n therapy. Recap the issue for them i n general terms. Suggest to them that you would l i k e to see what i t i s l i k e for them to make a s p e c i f i c s o l u t i o n proposal to t h e i r partner that addresses some part of t h e i r issue, which seems relevant to them at the moment. You would l i k e them to keep i t as short and as simple as possible, and the way you would l i k e them to do i t i s - they each make a statement as to one thing they are w i l l i n g to do to help create harmony i n the r e l a t i o n s h i p , and then make a request of t h e i r partner as to one thing they would l i k e t h e i r partner to do. The partner then responds, disagreeing or agreeing to t h e i r request. If they f i n d that they cannot agree to t h e i r partners request, that i s f i n e . The purpose of t h i s i s to help the researchers and the therapist gague how resolved, i f at a l l , they f e e l about t h e i r issue. The therapist intervenes i n t h i s procedure only to structure the sequence (e.g. to prompt someone to begin, cut someone off who i s j u s t rambling or to explain the next step). Example: I w i l l i n i t i a t e us spending an evening together once a week, suggesting the time and a c t i v i t y , and I'd l i k e you to respond to me when I ask you for a hug when I come home i n the evening. Individuals responses to t h e i r partners requests were then rated by observers as f a l l i n g into four catagories, Acceptance, Agreement (Resolution), or Rejection, Disagreement. 186. COUPLES PROBLEM SOLVING PROJECT - IMPLEMENTATION CHECKLIST Couple No. Session No. Rater Instructions to Raters: Place one check mark on the r a t i n g form under an intervention each time that intervention i s noted. An intervention i s defined as a therapist statement. Intervention Checklist Problem D e f i n i t i o n 1. The problem i s defined/redefined i n terms of the emotions underlying the positions taken i n the re l a t i o n s h i p and the sense of deprivation experienced by the couple. 2. The problem i s defined i n terms of manifest observable complaints and lack of s k i l l s on the part of the couple. 3. The therapist c l a r i f i e s and elaborates the basic positions taken by the partners i n the r e l a t i o n s h i p . 4. The therapist frames the problem i n terms of mutual bad habits that w i l l need work to overcome, and teaches behavior change concepts. Attacking Behavior 5. The therapist validates or develops the positions implied by negative behavior such as name c a l l i n g ; such behavior i s interpreted i n terms of underlying 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 unhelpful and r e l a t e d to lack of s k i l l . A substitute i s usually suggested. Rules are set and rehearsed. Process Focus 7. The therapist probes for and heightens emotional experience, e s p e c i a l l y fears 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 emotional tr i g g e r s and responses and focussing upon inner awareness. 8. The therapist focusses upon and helps the couple pinpoint s p e c i f i c behaviors. Observable antecedents and consequences of problem behaviors are noted. 9. Emotional meanings are discovered, d i f f e r e n t i a t e d and elaborated upon. 10. Feelings are l a b e l l e d i n a problem/goal oriented context to communicate the impact one partners behavior has upon the other. 11. The i n t e r a c t i n g s e n s i t i v i t i e s underlying behavior are c l a r i f i e d and the meaning of i n d i v i d u a l emotional experience i s interpreted i n terms of the other partner and the r e l a t i o n s h i p . 12. Problem defining and solving sequences s k i l l s and rules are taught and used to structure i n t e r a c t i o n s . LISTENING 13. Blocks/resistance to accepting a partners experience are explored i n terms of underlying f e e l i n g s , self-concept or experience i n family of o r i g i n . (Awareness of inner experience i s focus). 188 14. Communication ground rules are set up and p r a c t i s e d . Paraphrasing i s taught (not r e f l e c t i o n ) , responses are directed by the therapist and rehearsed ( s k i l l focus). PROBLEM SOLVING 15. The therapist f a c i l i a t e s a f f e c t i v e l y based needs and wants being accessed and expressed to the partner. 16. The therapist f a c i l i t a t e s the i d e n t i f i c a t i o n of s p e c i f i c behaviors expected from the partner, without basing them i n f e e l i n g s . 17. The therapist helps 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 view of t h e i r partner, and to explore t h e i r new f e e l i n g response to this perspective. 18. Brainstorming of a l t e r n a t i v e solutions i f f a c i l i t a t e d . Menus of possible solutions are constructed. 19. Shared perspectives on the r e l a t i o n s h i p are c l a r i f i e d . Metacommunciation regarding the r e l a t i o n s h i p i s f a c i l i t a t e d . 20. A s o l u t i o n i s chosen and a contract i s negotiated s t r e s s i n g r e c i p r o c i t y and comprise. Costs and benefits of solutions are weighed. ADDITIONAL CATEGORIES 21. Information gathering. 22. Refocus on t o p i c . 23. Not codable (example: therapist assigning homework). 189 EXAMPLES: EXPLICATION OF IMPLEMENTATION CHECKLIST CATEGORIES 1. So the problem for you in this relationship is that you basically feel alone and isolated from Jim. 2. So these problems, managing the kids and Pam's overinvolvement in activities 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 is 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 is to resist 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 relationship, but the easiest way to get your partner to change is to reward them for changing; to reward them by changing you own behavior. 5. You're feeling pretty angry right now Penny? Yes, he is always so logical, and that makes me feel..., powerless perhaps? Like you can't get through to him? 6. Jane, do you know why I am interrupting you right now? Client "Yes, I guess I was calling him names. Right, and that is not helpful, can you describe to him the behavior that you find so offensive? 7. What happens to you when Linda turns her head like that as you talk? or So as Cary tries to take control of the situation you feel more and more afraid, like a l i t t l e child is afraid? See Evocative Responding Sheet. 190 8. What i s i t exactly that your partner does that disturbs you? when does t h i s occur? what happens then? 9. See evocative responding sheet. So although you f e e l h o s t i l e and overwhelmed when he does t h i s you are too unsure of yourself and a f r a i d of his disapproval to t e l l him so? 10. So when he leaves his clothes on the f l o o r you f e e l angry? .... and even less w i l l i n g to co-operate with his desires? 11. Tom, when you experience Sue withdrawing from you i t seems l i k e you become a f r a i d that you are not important to her and you demand reassurance, but then Sue you panic, when people demand responses from you you tend to f e e l that you are being taken over, and so you withdraw more. 12. The therapist models for the c l i e n t the rule - Admitting your part i n the problem. You could 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 interrupt but i t would be nice i f .... 13. It seems l i k e you f i n d i t hard to accept that Linda i s sometimes a f r a i d of you, that you might create that kind of response i n her? or What happens to you when Mary gets mad l i k e t h i s . . . you know I had the image of your mother attacking you, the way you described e a r l i e r . 14. S a l l y please repeat back the core of what Tom said before responding to him. 191 15. Brenda can you t e l l Cory what i t i s that you r e a l l y want from him right now? How can he reassure you? 16. The therapist helps the c l i e n t frame. I want you to give me a hug and a ki s s every morning before getting 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 t r u l y a f r a i d to have sex with you, to l e t you i n , how do you respond to that? C l i e n t , "I f e e l s o f t e r , not so angry." So you f e e l closer to her? Perhaps you would l i k e to comfort her right now? 18. L i s t a l l possible solutions. Example, page 142, Jacobson and Margolin, 1979. 19. So John i t seems that you are able to help 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 therefore more accessible to you and you are f e e l i n g more accepted. 20. So the agreement i s that, Jerry w i l l be home every day by s i x t h i r t y , and Marlene w i l l ask f i v e questions about Jerry's day at the dinner table. 192; Add Frequency of Use: Minimally moderately often very often THERAPIST INTERVENTION CHECKLIST Couple No. Session No. Therapist Please place a t i c k beside interventions you r e c a l l using i n t h i s session. Problem D e f i n i t i o n 1. Defining the problem i n terms of underlying emotions. 2. Defining the problem i n terms of lack of s k i l l , observable behaviors. 3. C l a r i f y i n g / E l a b o r a t i n g basic positions taken by the couple. 4. Teaching behavior change concepts. Management of Attacking Behavior 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 underlying emotions. 6. L a b e l l i n g blaming as unhelpful, suggesting substitutes -pinpointing. Process Focus 7. Probing f o r , heightening emotional experience, e s p e c i a l l y fears, c l a r i f y i n g t r i g g e r s and responses experienced. 8. Pinpointing s p e c i f i c behaviors, observable antecedents and consequences. 9. Interpreting/Elaborating upon emotional meanings. 10. L a b e l l i n g f e e l i n g to make impact consequences of behavior c l e a 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 behavior for the r e l a t i o n s h i p . Enacting negative cycle 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 . Using rules to structure i n t e r a c t i o n s . L i s t e n i n g 13. Exploring blocks to acceptance of others communication i n terms of f e e l i n g s , self-concept, or family of o r i g i n . 14. Teaching communication s k i l l s d i r e c t l y , rehearsing s k i l l s such as paraphrasing. Problem Solving 15. F a c i l i t a t i n g the expression of a f f e c t i v e l y based needs and wants. 16. Id e n t i f y i n g behaviors expected from partner. 17. F a c i l i t a t i n g c r y s t a l l i s a t i o n of new view of, response to partner. 18. Brainstorming solutions. 19. C l a r i f y i n g shared perspectives on the r e l a t i o n s h i p , new p o s i t i o n s . 20. Negotiate contract with partner. Weigh costs and benefits. 194 THERAPIST SESSION REPORT Therapist Couple No. Session No. 1. How much progress do you f e e l your c l i e n t s made i n dealing with t h e i r issues i n t h i s session? a. A great deal of progress b. Considerable progress c. Moderate progress d. Some progress e. No progress 2. How resolved do you think your c l i e n t s are ri g h t now i n regard to t h e i r issues? a. T o t a l l y resolved b. Considerably resolved c. Moderately resolved d. Somewhat resolved e. Not at a l l resolved APPENDIX C FORMS: CONSENT AND FOLLOW-UP 196. CONSENT FORM: THE COUPLES PROBLEM SOLVING PROJECT We understand that t h i s research project i s concerned with examining methods of helping coupls resolve problems and marital c o n f l i c t . We consent to the use of video-tape recording of our marital therapy sessions, and the release of these video-tapes to the research team supervised by Dr. L. Greenberg. We also give our consent to the use of our written response to the questionnaires f o r the purposes of t h i s research. We understand that we w i l l receive eight one hour counselling sessions and that a l l recordings and written responses w i l l have our names deleted and be coded to protect our privacy before they are given to research assistants for scoring. We also understand that we have the right to withdraw from t h i s project at any time and/or to request that tapes be erased. We understand that withdrawal or tape erasure would not i n any way jeopardize access to further therapy. We further acknowledge that neither of us have received p s y c h i a t r i c treatment during the l a s t two years. 197 . • • -.• -is STANDARADIZED FOLLOW-UP PROCEDURE Each couple were c a l l e d eight weeks a f t e r the termination of treatment. Each partner was spoken to separately and reminded of the Target Complaints and Goal Attainment measures. The T.C. scale anchors were read to each partner twice, followed by the des c r i p t i o n of t h e i r T.C. which they each had given i n the assessment interview. They were then asked to place that complaint on the scale so as to r e f l e c t i t s present status i n the r e l a t i o n s h i p . The Goal Attainment l e v e l s were then presented and each partner was asked to i d e n t i f y the l e v e l most de 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 descriptions of the l e v e l s they had each given at assessment were read out to them. They were then t o l d of the other questionnaires i n the mail and asked to complete them. The process of the c a l l was as follows: Do you remember the target complaint you i d e n t i f i e d as the main issue i n your r e l a t i o n s h i p and rated on a scale a f t e r your l a s t therapy session? The l e v e l s of the scale were, Worse, Same, S l i g h t l y Better, Somewhat Better, Much Better. I am going to ask you to place your compalint as you experience i t now on that scale, so I w i l l read the l e v e l s to you again. You might even l i k e to write them down. The l e v e l s were Worse, Same, S l i g h t l y Better, Somewhat Better, Much Better. Your issue was ..... (the c l i e n t ' s short d e s c r i p t i o n of his or her compalint i s read). Now I would l i k e you to place that issue on the scale. Do you experience i t as, Worse, the Same, S l i g h t l y Better, 198' v Somewhat Better, or Much Better? Thank you. Now I have one more question to ask you and then I would l i k e to speak to your partner. Do you remember the Goal Attainment l e v e l s you described for us and rated a f t e r your l a s t therapy session? The le v e l s were Worse, Less than Expected Results, Expected Results, Better than Expected and Much Better than Expected. I w i l l read out the l e v e l to you and then your d e s c r i p t i o n of that l e v e l . I w i l l read i t twice and then I would l i k e you to t e l l me which l e v e l describes your r e l a t i o n s h i p now. Do you understand? The worse l e v e l you described as , the Less than Expected l e v e l you described as , the Expected l e v e l you described as , the Better than expected l e v e l as , and the Much Better than Expected l e v e l as . I w i l l read these again and I would l i k e you to t e l l me the l e v e l which describes your r e l a t i o n s h i p now. Thank you. 199^ FOLLOW-UP LETTER TO COUPLES Thank you for p a r t i c i p a t i n g i n our follow-up for the Couples Problem Solving Project. There are two questionnaires f o r each of you to complete. The OAS and the PAIR. When you have completed them please place them i n the stamped addressed envelope provided and mail. It w i l l help us i f you could complete the questionnaires within a week of receiving them. The r e s u l t s of the study w i l l be av a i l a b l e early i n 1984 and can be mailed to you upon request. The research team and I would l i k e to thank you for making this study possible and sinc e r e l y hope that you found i t a rewarding experience. Sue Johnson, Coordinator The Couples Problem Solving Project APPENDIX D ITEM ANALYSIS Table D-l DAS: Subtest Correlations 1 2 3 4 T o t a l Con. 1 - .370 .232 .022 .736 S a t i s . 2 - .508 .275 .825 Coh. 3 - .238 .683 A f f . Ex. 4 - .349 T o t a l Table D-2 DAS: Males: Test S t a t i s t i c s Subtests (N = 45) Con. S a t i s . Coh. Aff.Ex. T o t a l Mean 41.84 32.82 12.71 6.71 94.09 S.D. 5.34 5.25 3.76 2.03 12.07 R e l i a b i l i t y (Hoyt) .70 .82 .85 .60 .86 Cronbach's Alpha .65 203 Table D-3 DAS: Females: Test S t a t i s t i c s Subtests (N = 45) Con. S a t i s . Coh. Aff.Ex. T o t a l Mean 41.07 30.44 11.64 6.71 89.87 S.D. 6.54 4.74 3.29 1.92 11.07 R e l i a b i l i t y (Hoyt) .76 .71 .71 .56 .80 Cronbach's Alpha .47 204 Table D-4 PAIR Perceived: Subtest Correlations 1 2 3 4 5 6 T o t a l Em 1 .291 .267 .559 .378 .617 .739 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 T o t a l (N = 90) Note: Emotional Intimacy c o r r e l a t e s with Conventionality ( i d e a l i s a t i o n ) at the .617 l e v e l . 205 Table D-5 PAIR Perceived: In d i v i d u a l Scores Subtests Em (N = 45) Soc Sx Int Rec Con Males: Test S t a t i s t i c s Mean 12.04 13.56 13.80 12.29 15 10.16 S.D. 4.72 3.96 5.57 4.35 4.24 4.10 R e l i a b i l i t y .75 (Hoyt) .49 .79 .60 .76 .71 Females: Test S t a t i s t i c s Mean 9.16 14.22 14.38 12.07 15.11 8.60 S.D. 3.93 4.97 5.42 4.13 4.07 3.62 R e l i a b i l i t y .53 (Hoyt) .73 .79 .55 .68 .61 Note: Males: R e l i a b i l i t y f o r T o t a l (Hoyt) = .88 Cronbach's Alpha = .77 Females: R e l i a b i l i t y for T o t a l (Hoyt) = .87 Cronbach's Alpha = .79 206 Table D-6 PAIR Expected: Subtest C o r r e l a t i o n s 1 2 3 4 5 T o t a l Em 1 .276 .501 .423 .420 .726 Soc 2 .060 .294 .275 .621 Sx 3 - .396 .418 .644 Int 4 - .345 .719 Rec 5 — .712 T o t a l (N = 90) Note: The minimal c o r r e l a t i o n s occur here mainly on the So c i a l Intimacy subscale. When a c o r r e l a t i o n matrix for post scores on a l l dependent v a r i a b l e s was constructed t h i s scale stood out i n that i t correlated only very minimally with any other measure. This suggests that spending time with other couples or having friends i n common i s not of the same s i g n i f i c a n c e to couples as other kinds of intimacy or facets of m a r i t a l adjustment. 207 Table D-7 PAIR Expected: In d i v i d u a l Scores Subtests Em Soc Sx Int Rec (N = 45) Males: Test S t a t i s t i c s Mean 21.89 18.13 22.36 20.58 21.07 S.D. 2.12 2.94 2.14 2.88 2.39 R e l i a b i l i t y .68 .43 .63 .53 .46 (Hoyt) Females: Test S t a t i s t i c s Mean 22.18 19.11 22.60 21.69 21.18 S.D. 1.83 3 2.05 1.88 2.48 R e l i a b i l i t y .51 .60 .62 .42 .54 (Hoyt) Note: Males: R e l i a b i l i t y f o r To t a l (Hoyt) = .78 Cronbach's Alpha = .71 Females: R e l i a b i l i t y for T o t a l (Hoyt) = .78 Cronbach's Alpha = .68 APPENDIX E DATA ANALYSIS 209 Table E - l Summary of Anovas: Demographics Groups Va r i a b l e s ET PS C F P (N = 45) M/SD M/SD M/SD (2,42) No. of Years Together 9.1 5.7 10.2 5.8 6.7 3.9 1.8 .1778 Family Income 3.5 1.4 3.8 1.6 3.8 1.4 .169 .8454 Male Age 35.6 7.3 35.3 5.8 37.8 8.1 .557 .5774 Female Age 34.3 5.5 34.4 6.2 34.5 8.7 .006 .9945 Male Occupation 59.6 9.9 55.9 14.4 52.8 13.0 1.099 .3425 Female Occupation 48.5 12.7 43.9 16.7 41.1 8.6 1.202 .3106 Male Educational Level 4.2 1.7 4.5 1.4 4.1 1.5 .290 .7499 Female Educational Level 4.5 1.1 3.6 1.5 3.3 1.2 3.54 .038 Note: a = .006 (.05/8) Occupational Catagories and Numbers are taken from the Blishen Scale. Family Income and Educational Level numerals represent nominal catagories. 210 Table E-2 Test of Emotional Style: Analysis of Variance Groups Vari a b l e s ET PS C F P (N = 45) M/SD M/SD M/SD (2,42) Male Orientation 17.2 7.5 13.7 8.3. 13.5 6.2 1.17 .322 Male Expressiveness 9.7 7.2 10.5 5.0 10.3 4.9 .07 .938 Male Responsiveness 9.4 4.2 8.5 4.8 10.9 4.9 .96 .390 Female Orientation 19.5 5.5 20.3 5.8 18.0 8.2 .48 .624 Female Expressiveness 14.0 6.9 18.4 4.3 12.8 6.8 3.46 .041 Female Responsiveness 14.1 4.0 15.1 4.5 12.9 5.0 .89 .417 Note: a = .008 (.05/6) 211 Table E-3 Couples Therapy A l l i a n c e Scale: I n d i v i d u a l Scores Groups Var i a b l e s EF PS (N = 45) M/SD M/SD (1,28) Male 118.0 114.6 .23 .636 23.5 13.3 Female 124.5 112.6 3.53 .071 20.9 12.8 Note: a = .05/3 = .016 212 Table E-4 Summary Anova: Task Dimension of A l l i a n c e Scale (N = 30) Source of V a r i a t i o n SS MS DF Between 6.1 6.1 1 .31 .583 Within 552.6 19.7 28 213 Table E-5 Therapist E f f e c t on Posttest T o t a l DAS Scores Males Females No. of Therapists Couples M/SD F ( l l , 1 8 ) p M/SD F ( l l , 1 8 ) 1 2 100.0 1.17 .374 99.0 1.08 .427 18.4 7.07 2 2 99.5 109.5 14.8 26.2 3 2 110.5 107.5 12.0 12.0 4 2 104.0 115.0 16.9 15.6 5 3 104.3 102.3 8.5 6.5 6 4 99.5 91.3 4.4 7.5 7 2 117.5 120.0 9.2 11.3 8 2 124.0 115.5 1.41 2.1 9 2 111.0 108.0 1.4 4.2 10 2 114.0 118.5 9.9 9.2 11 3 109.7 106.7 12.7 13.0 12 4 113.3 105.5 12.4 20.01 Note: N = 60, a = .01 B a r t l e t t Homogeneity of Variance: Males = F = .78, j_ = .659 Females = F = .73, £ = .709 214 Table E-6 Therapist E f f e c t on Post Treatment Variables PAIR Subscales, GAS, TC: F Values Variables Males Females F/p F/p PP1 1.97 1.92 .096 .105 PP2 1.18 1.36 3.66 .273 PP3 .82 .83 .820 .614 PP4 1.33 1.39 .287 .257 PP5 1.42 .51 .245 .872 PP6 2.73 1.74 .028 .144 TC 1.34 1.77 .279 .137 GAS 1.13 1.43 .394 .242 Note: d.f. = 11,18 Set a = .01, corrected a = .05/18 = .0027 A l l B a r t l e t t Box F values were n o n - s i g n i f i c a n t 215 Table E-7 Pretest Pair Expected Couple Scores Groups Variables (N = 45) ET PS C F P M/SD M/SD M/SD (2,42) PE1 (Em) 87.6 86.9 89.3 .56 .574 6.8 6.5 5.9 PE2 (Soc) 77.3 74.1 72.0 1.67 .201 9.7 5.8 8.2 PE3 (Sx) 90.1 88.9 90.5 .18 .835 7.8 6.9 7.9 PE4 (Int) 85.5 83.5 84.6 .30 .745 7.3 7.4 6.7 PES (Rec) 85.5 82.5 84.9 .66 .520 5.6 9.7 6.3 Note: a = .05 216 Table E-8 Post-test PAIR Expected Scores Groups Vari a b l e s ET PS C F P (N = 45) M/SD M/SD M/SD (2,42) PEl (Em) 88.7 5.7 87.4 12.5 88.8 4.4 .13 .874 PE2 (Soc) 78.9 9.9 77.2 8.6 75.2 9.3 .58 .563 PE3 (Sx) 89.6 5.9 89.2 6.2 88.3 7.2 .17 .846 PE4 (Int) 86.2 5.4 86.0 6.1 86.7 4.5 .06 .942 PES (Rec) 87.3 5.9 85.2 14.1 83.1 6.4 .74 .483 Note: set a = .05 corrected a = .01 217 Table E-9 Summary Anova: Pre and Post-test PAIR Expected Scores Groups Vari a b l e s ET PS C F(Time) p (N = 45) 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) .06 .800 PE2 (Soc) Pre Post 77.3 78.9 (9.7) (9.9) 74.1 77.2 (5.8) (8.6) 72.0 75.2 (8.18) (9.3) 4.16 .048 PE3 (Sx) Pre Post 90.1 89.6 (7.8) (5.9) 88.9 89.2 (6.9) (6.2) 90.5 88.3 (7.9) (7.2) 4.2 .519 PE4 (Int) Pre Post 85.5 86.2 (7.3) (5.5) 83.5 86.0 (7.4) (6.1) 84.7 86.7 (6.7) (4.5) 4.34 .043 PES (Rec) Pre Post 85.5 87.3 (5.6) (5.9) 82.5 85.2 (9.7) (4.1) 84.9 83.1 (6.3) (6.5) .51 .480 Note: set a = .01 (.05/5) 218 Table E-10 Individual Pretest PAIR Perceived Scores Groups V a r i a b l e s (N = 45) ET PS C F P M/SD M/SD M/SD (2,42) Male: PP1 46.4 45.6 53.1 .71 .498 15.2 17.7 22.8 PP2 56.8 51.7 54.1 . .37 .693 16.5 17.8 13.8 PP3 52.8 56.5 56.3 .13 .882 24.3 21.7 21.9 PP4 54.1 48.7 44.5 1.16 .324 12.5 16.6 21.7 PP5 62.4 60.0 56.3 .51 .607 14.3 13.8 21.3 PP6 41.9 37.7 42.4 .35 .705 15.8 13.2 20.2 Female: PP1 36.8 36.5 38.1 .04 .957 17.6 14.4 15.3 PP2 58.1 60.5 52.0 .73 .490 20.7 19.6 19.7 PP3 56.3 57.9 57.9 .03 .975 27.4 22.2 16.3 PP4 49.9 47.6 47.5 .10 .907 18.8 14.0 16.9 PP5 60.0 62.1 59.2 .13 .883 16.7 19.2 13.4 PP6 32.8 36.5 34.9 .26 .775 12.8 11.1 18.2 Note: Set a = .05 219 Table E - l l Individual Post-test PAIR Perceived Scores Groups Variables (N = 45) EF PS C F P M/SD M/SD M/SD (2,42) Male: PP1 66.9 58.7 52.0 2.09 .136 (Em) 17.0 20.2 22.5 PP2 62.9 55.4 51.2 1.62 .209 (Soc) 15.4 18.2 20.2 PP3 66.9 63.5 54.9 1.06 .355 (Sa) 24.5 19.9 24.9 PP4 C 73.6 61.9 43.2 11.83 .001* (Int) 16.6 13.3 20.9 PP5 72.3 63.2 55.7 4.16 .022 (Rec) 14.6 12.5 19.3 PP6 B 64.8 45.1 38.4 7.74 .001* (Con) 18.5 17.6 21.0 , Female: PP1 B 61.3 44.0 39.2 6.22 .004* 20.3 18.1 15.4 PP2 67.7 57.3 53.3 2.54 .091 16.6 18.7 18.8 PP3 71.7 62.1 63.2 .80 .456 22.0 27.3 18.0 PP4 D 66.9 55.5 43.5 10.92 .001* 12.2 15.5 13.3 PP5 71.7 66.1 58.8 2.26 .116 16.2 17.1 16.7 PP6 53.1 35.7 32.0 4.92 .012 22.9 21.5 12.9 Note: a = .05/6 = .008 a = _> < .008 B = EF > PS,C C = EF, PS > C D = EF, PS > PS, C, Therefore, EF > C 220 Table E-12 Individual Post-test DAS Scores Groups Variables EF PS C F P (N = 45) M/SD M/SD M/SD (2,42) Males: DAS 1 (Con) 47.7 3.8 46.5 6.7 41.6 6.6 4.64 .015 DAS 2 B (Satis) 39.6 4.5 34.9 4.3 32.3 5.8 8.39 .001* DAS 3 B (Coh) 18.1 2.8 13.9 1.8 12.3 4.7 1.85 .001* DAS 4 ( A f f . Ex.) 8.9 1.8 7.2 2.0 7.66 2.2 2.96 .062 Females: DAS 1 C 48.5 3.4 48.5 10.5 40.0 5.5 7.13 .002* DAS 2 D 37.3 5.9 33.3 5.3 31.1 4.7 5.17 .010* DAS 3 B 16.5 3.9 13.7 1.9 11.53 3.2 9.630 .001* DAS 4 B 8.8 1.5 6.8 2.1 6.7 2.1 5.69 .007* Note: a = .05/4 = .0125 * = £ - < .0125 B = EF > PS,C C = EF, PS > C D = EF, PS > PS, C. Therefore, EF > C 221 Table E-13 Repeated Measures Analysis: Follow-up Scores on Non-Differentiating Variables Groups Variables (N = 29) EF PS F P M(SD) M(SD) (1,27) DAS 1 (Con) I 48.4 ( 3.2) 48.0 ( 7.7) G 1.0 .327 II 49.8 ( 3.4) 46.6 ( 5.3) T 0.0 .983 TG 4.64 .040 DAS 4 ( A f f . Ex.) I 9.1 ( 1.6) 7.2 ( 2.0) G 6.32 .018 II 8.7 ( 1.5) 7.6 ( 1.7) T .01 .942 TG 2.95 .098 PP1 (Emot.) I 64.1 (17.2) 49.8 (17.2) G 3.63 .067 II 63.1 (19.4) 56.0 (14.8) T .69 .413 TG 1.3 .260 PP2 (Soc.) I 65.3 (13.5) 55.7 (16.2) G 1.77 .195 II 66.8 (10.4) 63.9 (15.0) T 5.55 .026 TG 1.34 .258 PP3 (S ) I 69.3 (21.6) 62.0 (22.1) G .86 .363 II 67.1 (20.6) 60.7 (19.5) T .52 .476 TG 2.68 .113 PP5 (Rec) I 72.0 (13.5) 64.0 (13.3) G 2.32 .139 II 72.1 (15.0) 64.6 (18.1) T .02 .877 TG .01 .923 GAS I 60.0 ( 7.5) 57.0 ( 8.5) G 2.58 .120 II 61.3 ( 6.8) 55.9 ( 6.8) T 1.79 .192 TG 1.79 .192 Note: 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 = Interaction, Time by Group 222 Table E-14 Summary Anovas: Individual T o t a l DAS Scores at Follow-up Source of V a r i a t i o n SS MS DF F p Males: Female: Group 1,714.7 1,714.7 1 9.08 .0056* Er r o r 5099.4 188.9 27 Time 22.2 22.2 1 1.05 .3149 TG .13 .13 1 .01 .9378 E r r o r 571.5 21.2 27 Group 1811.3 1811.3 1 7.48 .0109* Er r o r 6541.6 242.3 27 Time .03 .03 1 .00 .9753 TG 6.86 6.86 1 .23 .6385 E r r o r 820.1 30.4 27 Note: a = .05 * = £ < .05. 223 Table E-15 Individual Follow-Up Scores on Variables D i f f e r e n t i a t i n g Groups at Post-Assessment Groups Variables EF PS F (Group) p (N = 29) Time M(SD) M(SD) (1,27) Males - M u l t i v a r i a t e F = S DAS 2 (Satis) I 39.6 ( 4.5 ) 34.9 ( 4.4 ) G 8.51 .007* II 38.6 ( 5.0 ) 34.4 ( 3.6 ) T 1.41 .246 TG .219 .644 DAS 3 (Coh) I 18.1 ( 2.8 ) 13.9 ( 1.9 ) G 18.88 .001* II 16.9 ( 3.4 ) 13.3 ( 2.2 ) T 4.70 .039 TG .577 .454 TC I 3.7 ( .62) 3.1 ( .92) G 7.31 .012 II 3.6 ( .51) 3.0 ( .73) T .787 .383 TG .107 .747 PP4 (Int) I 73.6 (16.6 ) 62.0 (13.8 ) G 3.16 .087 II 69.1 (18.0 ) 62.3 (17.4 ) T .436 .515 TG .519 .477 PP6 (Con) I 64.8 (18.5 ) 44.9 (18.2 ) G 4.73 .039 II 56.5 (23.4 ) 46.3 (21.8 ) T 1.21 .281 TG 2.21 .149 Females - Mu l t i v a r i a t e F = NS DAS 2 I 37.3 ( 6.0 ) 32.6 ( 4.7 ) G 5.46 .027 II 37.1 ( 5.5 ) 33.3 ( 4.5 ) T .188 .668 TG .444 .511 DAS 3 I 16.5 ( 3.9 ) 13.4 ( 1.8 ) G 8.50 .007 II 16.5 ( 3.6 ) 13.4 ( 2.3 ) T .006 .937 TG .007 .935 TC I 3.7 ( .46) 3.0 ( 1.2 ) G 6.62 .016 II 3.5 ( .64) 2.9 ( 1.0 ) T .891 .353 TG .024 .877 PP4 I 66.9 (12.2 ) 54.6 (15.7 ) G 6.48 .017 II 68.3 (17.7 ) 54.9 (16.7 ) T .081 .778 TG .033 .858 PP6 I 53.1 (23.0 ) 33.4 (20.3 ) G 4.51 .043 II 54.4 (24.0 ) 42.9 (21.6 ) T 1.86 .184 TG 1.11 .302 Note: a = .05/5 = .01 * = p < .01 EF, n = 15; PS, n = 14 224 Table E-16 Individual Follow-Up Scores on Variables Not D i f f e r e n t i a t i n g Groups at Post-Assessment Groups Variables (N - 29) EF PS F (Group) P Time M(SD) M(SD) (1,28) Males - M u l t i v a r i a t e F = NS DAS I (Con) I-. 47.7 ( 3.8) (47.2 ( 5.9) .42 .524 II 50.0 ( 4.3) (46.9 ( 5.9) DAS 4 (Ex) I 8.9 ( 1.8) ( 7.2 2.1) 5.19 .031 II 8.6 ( 1.5) ( 7.6 1.7) GAS I 60.0 ( 8.6) (56.3 9.4) 3.39 .076 II 61.3 ( 7.0) (54.9 7.3) PP1 (Em) I 66.9 (17.0) (57.7 20.6) 1.09 .304 II 64.0 (20.3) (60.0 19.3) PP2 (Soc) I 62.9 (15.4) (55.1 18.9) 2.29 .142 II 69.3 (11.7) (60.0 18.7) PP3 (S ) I 66.9 (24.5) (63.7 20.7) .38 .544 II 67.2 (24.8) (60.6 19.5) PP5 (Rec) I 72.3 (14.6) (62.6 12.7) 2.71 .111 II 72.3 (14.7) (64.6 20.1) Females - M u l t i v a r i a t e ¥ = NS DAS I I (48.5 3.4 (47.9 10.7) 1.28 .268 II (50.1 3.3 (45.9 5.7) DAS 4 I ( 8.8 1.5 ( 6.6 2.1) 5.81 .023 II ( 8.1 1.8 ( 7.4 1.8) GAS I (60.0 7.7 (57.7 9.4) 1.30 .264 II (61.3 8.0 (57.0 7.6) PP1 I (61.3 20.3 (42.0 17.0) 5.85 .023 II (62.3 20.5 (52.0 16.8) PP2 I (67.7 16.6 (56.3 18.9) .56 .461 II (64.3 16.3 (67.7 13.2) PP3 I (71.7 22.0 (60.3 27.4) 1.20 .282 II (66.9 20.0 (60.9 22.5) PP5 I (71.7 16.2 (65.4 17.5) 1.34 .257 II (72.0 17.9 (64.6 19.3) Note: a = .05/7 = .007 EF, n = 15; PS, n = 14 

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