Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples

A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved.     

Therapy with religious couples

Although 95% of married couples identify with a particular religion, there is great variation in how couples rely on their religion to define or structure their relationship. Various denominations will imply particular “rules” or will shape how the couple deals with interpersonal and family challenges, such as sexuality, parenting, and power. In this article, we review couple relationships within a religious context and advance several treatment principles for treating religious couples. We present a clinical case to illustrate marital therapy with a religious couple, with an Adlerian context. ©2009 Wiley Periodicals, Inc. J Clin Psychol: In Session 65:1–13, 2009.     

Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy

Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy.     

Till violence does us part: the differing roles of communication and aggression in predicting adverse marital outcomes.

Measures of communication and aggression, taken from 56 newlywed couples, were used to predict marital outcomes 4 years later. Aggression discriminated between separated or divorced couples and those who remained married. In contrast, communication discriminated between couples who were maritally satisfied after 4 years and those who were married but dissatisfied. Thus, over the 1st 4 years of marriage, marital satisfaction and dissolution appear to be predicted by separate factors. These results remained unchanged after controlling for initial marital satisfaction. Additional analyses showed that 68% of the marriages could be accurately classified into their outcome groups using communication and aggression variables. These results help to integrate prior marital research on communication and aggression, and they suggest that it may be necessary to focus on both factors in efforts to strengthen marriages and prevent divorce.     

Marital role dynamics during brief group psychotherapy: Assessment of verbal interactions

Examined the impact of brief group psychotherapy on the marital and sex roles of five volunteer couples who participated in two, 15-session, model therapy groups conducted approximately 2 years apart. Assessments are based on Hill Interaction Matrix (HIM) analysis of the style and content of marital partners' verbal behavior during the sessions. Results show that interactional correlates of traditional marital and sex role variations are attenuated, that communication between spouses is improved, and that the therapeutic quality of verbal behavior is enhanced over the course of therapy. Generally, from the perspective of interactional dynamics, these findings suggest that the group psychotherapy model that was being evaluated is an effective mode of brief, precrisis intervention for married couples.     

Marriage duration, marital adjustment and psychological symptoms: a cross-sectional study

One hundred and nine couples completed questionnaire measures of psychological symptoms, personality, and marital adjustment. They were divided into groups of short, intermediate, and long marriage duration. Psychological symptoms and marital adjustment remained fairly stable over time, although wives scored significantly worse than husbands on most measures in the intermediate duration group. In the short marriages, half the variance in marital satisfaction was predicted by the partner's marital questionnaire score, but when this variable was eliminated from the regression equation, psychological symptoms (phobic anxiety in wives and depression in husbands) were the main predictors of marital satisfaction. In the intermediate group, hostility levels were the main predictors of marital satisfaction. In the long marriages, marital satisfaction was predicted mainly by personality factors (assertiveness in husbands and personal flexibility in wives) and by levels of generalized anxiety. The findings suggest that couples who constructively resolve difficulties in expressing hostility within marriage are more likely to remain married than those who fail to do so.     

Integrative behavioral couple therapy for chronic pain: promoting behavior change and emotional acceptance

Couple therapy has been used with success in treating marital distress, psychological distress, and other problems. Researchers in the pain field have also shown that the inclusion of the spouse in pain treatment may be beneficial to the patient. In this article, we present integrative behavioral couple therapy (IBCT) as one option for therapists treating patients who have pain and marital distress. IBCT improves on traditional behavior therapy because it promotes processes that have been shown to be lacking in pain patients' relationships: emotional acceptance and empathy. After reviewing the use of behavior change and emotional acceptance strategies in couples, we describe a couple for whom IBCT improved functioning.     

Comparison of integrated systemic and emotionally focused approaches to couples therapy.

This study compared couples receiving two marital therapy approaches and a control group over a 10-week treatment period. Integrated systemic therapy (IST) and an emotionally focused approach (EFT) were both found to be superior to the control and to be equally effective in alleviating marital distress, facilitating conflict resolution and goal attainment, and reducing target complaints at termination. IST couples, however, showed greater maintenance of gains from termination to 4-month follow-up on marital satisfaction and goal attainment. Clients' perceptions of how change occurred and issues related to the use of a team of observers in IST are discussed.     

Plasma vasopressin and interpersonal functioning

The neuropeptide vasopressin has traditionally been associated with vasoconstriction and water reabsorption by the kidneys. However, data from experimental animal studies also implicate vasopressin in social bonding processes. Preliminary work suggests that vasopressin also plays a role in social behaviors in humans. The goal of this cross-sectional study was to evaluate associations among plasma vasopressin and self-reported interpersonal functioning in a sample of married couples. During a 24-h admission to a hospital-based research unit, 37 couples completed measures of interpersonal functioning and provided blood samples for neuropeptide analyses. Results showed that vasopressin was associated with markers of interpersonal functioning, but not with general psychological distress. Specifically, greater plasma vasopressin levels were related to a larger social network, fewer negative marital interactions, less attachment avoidance, more attachment security, and marginally greater spousal social support. These results indicate that vasopressin is likely implicated in different relationship maintenance processes in humans.     

Couples critical incidents checklist: A construct validity study

This study examined the initial construct validity of the Couples Critical Incidents Checklist (CCICL; Piedmont & Piedmont, 1996). One hundred nine heterosexual married couples completed the CCICL to assess levels of marital satisfaction and the NEO PI-R to assess personality factors. As hypothesized, the rater-reports (R) and the self-ratings (S) of each of the five personality dimensions correlated systematically with the kinds of marital issues identified on each of the five sections of the CCICL. For instance, the Flexibility scale of the CCICL captured issues related to the dimension Openness (O) or the Cooperativeness scale of the CCICL assessed issues related to Agreeableness (A). Second, it was hypothesized that specific behavioral problems experienced by the spouses within the marital relationship would significantly correlate with the level of marital satisfaction. Overall, the analyses of the data of both the men and the women suggested that the contributing cause of marital dissatisfaction was not a specific behavioral problem experienced with the spouse, but rather the aggregate of all behavioral problems experienced with the spouse. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 785–794, 1998.     

Type A behavior and marital interaction: Hostile-dominant responses during conflict

Previous research has indicated that the risk conferred by men's Type A versus B behavior depends, in part, on the personality characteristics of their spouses. In the present study of 60 married couples, we found that couples consisting of two Structured Interview-defined Type A's showed a larger increase in hostile/dominant behavior during discussions of marital conflicts than did couples consisting of two Type B's or a Type A husband and a Type B wife. Couples consisting of a Type B husband and a Type A wife displayed an intermediate level of hostile dominance. These results are consistent with previous speculations about interpersonal dynamics in Type A behavior and interaction patterns which might underlie spouse effects on Type A behavior and coronary risk.This research was supported by a University Research Committee grant awarded to T.W.S.     

Relationship beliefs, interpersonal perception, and marital adjustment

To test the hypothesis that relationship beliefs are related to marital adjustment, 46 married couples completed the Relationship Belief Inventory (RBI) and the Dyadic Adjustment Scale (DAS). Significant correlations were found between the DAS scores and the D and S subscales of the RBI. It was shown that the low dyadic adjustment group made significantly more extreme evaluations compared to the high adjustment group. It also was found that individuals' perceptions of their spouses' relationship beliefs did not display the same trends observed with traditional personality questionnaire, in which marital adjustment was related to female accuracy and greater real similarity between spouses.     

Complex assessment of relationship quality within dyads

Higher quality relationships have been linked to improved outcomes; however, the measurement of relationship quality often ignores its complexity and the possibility of co-occurring positivity and negativity across different contexts. The goal of this study is to test the added benefit of including multiple dimensions, contexts, and perspectives of relationship quality from both individuals in predicting marital functioning. The Social Relationships Index assessed positive and negative dimensions of relationship quality under neutral, positive, and support-seeking contexts for 183 heterosexual married couples. Models showed that the inclusion of multiple dimensions of relationship quality across all three contexts improved prediction of marital functioning for both women and men. The use of multidimensional multicontextual relationship quality assessments is highly recommended.     

Personality disorder symptoms and marital functioning

Pathological personality is strongly linked with interpersonal impairment, yet no study to date has examined the relationship between concurrent personality pathology and dysfunction in marriage--a relationship that most people find central to their lives. In a cross-sectional study of a community sample of married couples (N = 82), the authors used multilevel modeling to estimate the association of self- and spouse-reported symptoms of personality disorder (PD) with levels of marital satisfaction and verbal aggression and perpetration of physical violence. Inclusion of self- and spouse report of total PD symptoms resulted in improved model fit and greater variance explained, with much of the improvement coming after the addition of spouse report. The incremental validity of spouse report for several of the 10 PD scales was supported for marital satisfaction and verbal aggression, particularly for the Borderline and Dependent PD scales.     

Patterns of support-gaining strategies influence the support received and marital quality

This paper examines the patterns among married couples of usage of support-gaining strategies for receiving support from the spouse, and their influence on the support received and marital quality. Questionnaire data from 452 Taiwanese married couples dealt with three types of support: emotional, substantial, and advice. The six types of support-gaining strategies were threat, other exploitation, roundabout appeal, reward, entreaty, and reasoning. The two aspects of marital quality measured were satisfaction and regret. The results showed that the patterns of usage of support-gaining strategies by couples could be classified as "mutual multiplicity," "husband-reasoning and wife-multiplicity", "mutual reasoning", and "mutual delicacy". The degrees of received support and marital quality varied by sex and patterns of strategy use. Husbands received more substantial support and reported better satisfaction, but received less emotional support and advice. Couples classified as "mutual delicacy" received the highest support and had the best marital quality. In contrast, couples classified as "mutual multiplicity" received the lowest support and had the worst marital quality. The findings suggest that using appropriate support-gaining strategies is important to marital life.     

The role of interpersonal perception in dyadic adjustment

The discrepancy between the way individuals perceive themselves and the way they are perceived by their partners has been proposed as an indicator of dyadic adjustment. The present study employed the CPI to investigate the relation of interpersonal perception within dyads and real similarity of spouses to marital satisfaction. The subjects were 20 married couples. Support was provided for the use of the real similarity-assumed similarity-accuracy paradigm in studies of interpersonal perception. No sex differences were found in the ability of individuals to predict their spouse's responses on the CPI. Accuracy of prediction was correlated significantly with scores on the Hogan Empathy scale for males, but not for females. Conversely, accuracy was related significantly to dyadic adjustment in the case of females, but not males. Real similarity also was correlated positively with dyadic adjustment. Avenues for further research are suggested.     

Improving relationships: mechanisms of change in couple therapy

In a sample of 134 married couples randomly assigned to traditional or integrative behavioral couple therapy (TBCT vs. IBCT), a multivariate hierarchical growth curve analysis using latent variable regression revealed that measures of communication, behavior frequency, and emotional acceptance acted as mechanisms of change. TBCT led to greater changes in frequency of targeted behavior early in therapy, whereas IBCT led to greater changes in acceptance of targeted behavior both early and late in therapy. In addition, change in behavioral frequency was strongly related to improvements in satisfaction early in therapy; however, in the 2nd half of therapy, emotional acceptance was more strongly related to changes in satisfaction. Research and clinical implications are discussed.     

Self-disclosure and its relationship to marital intimacy

Examined the relationship between marital intimacy and self-disclosure from a multidimensional framework within a sample of 10 clinical and 10 nonclinical married couples. The linear combination of various parameters of self-disclosing behavior was able to account for 71.7% (R = 0.853) of the variance in intimacy ratings derived from a structured interview. Results are discussed in terms of both the role that self-disclosure plays in the development of marital intimacy and its therapeutic benefits and limitations in marital therapy.     

Marital therapy as a treatment for depression

The purpose of this study was to compare cognitive-behavioral therapy (CT; n = 20), behavioral marital therapy (BMT; n = 19), and a treatment combining BMT and CT (CO; n = 21) in the alleviation of wives' depression and the enhancement of marital satisfaction. BMT was less effective than CT for depression in maritally nondistressed couples, whereas for maritally distressed couples the two treatments were equally effective. BMT was the only treatment to have a significant positive impact on relationship satisfaction in distressed couples, whereas CO was the only treatment to enhance the marital satisfaction of nondistressed couples. On marital interaction measures CO was the only treatment to significantly reduce both husband and wife aversive behavior and to significantly increase wife facilitative behavior.     

Infidelity and behavioral couple therapy: optimism in the face of betrayal

Infidelity is a common issue with which distressed couples and their therapists grapple. However, there are no data on the efficacy of commonly used therapies to treat couples in which there has been an affair. In the present exploratory study, the authors examined the therapy outcomes of a sample of infidelity couples (n=19) who had participated in a randomized clinical trial of marital therapy (N=134). Results show that infidelity couples began treatment more distressed than noninfidelity couples; however, evidence suggests that couples who had an affair and who revealed this affair prior to or during therapy showed greater improvement in satisfaction than noninfidelity couples. Implications for therapy with infidelity couples are discussed.