Ch. 12: Preventing Distress

Question 1

Metaphoric view of Therapy and Prevention

Answer 1

Therapy is like medicine, you go to the doctor and you say “fix me”
Prevention (enrichment) is like vitamins, it keeps you from having to go to the doctor

Question 2

Why intervene Early?

Answer 2

It might be our only chance to help!
-couples wait before seeking therapy
-few divorcing couples try therapy first
-therapy may not work (or last)
Collateral damage can be avoided
Happy couples might be motivated to keep their relationship strong
prevention: 'easier' than treatment?
many couples can be reached

Question 3

couples wait before seeking therapy

Answer 3

they let things persist and get worse - tend not to seek therapy until after several years of dissatisfaction
subjecting yourself to a miserable relationship for long time until you can’t tolerate it anymore and you realize something needs to change

Question 4

few divorcing couples try therapy first

Answer 4

may be in denial that they need therapy
might be in denial that they would want to go through with therapy
they may try other things before trying therapy

Question 5

therapy may not work (or last)

Answer 5

different forms of therapy and some are better than others

even among the ones that work, the benefits tend to decline or not persist over long periods of time

Question 6

Collateral damage can be avoided

Answer 6

divorce is costly in many ways:
financially
health (high bp and stress)
children (might have poor developmental outcomes)
work - stress in one domain (ie at home) can spill over into other domains (ie work or school)
the list goes on…

Question 7

Happy couples might be motivated to keep their relationship strong

Answer 7

you can give me skills on how to keep my relationship strong, you can show me how I can be more loving or supportive to my partner? - “yeah I want to do that”

Question 8

prevention: ‘easier’ than treatment?

Answer 8

once something is broken it can be really hard to put it back together - how can we keep the egg from getting broken in the first place

Question 9

many couples can be reached

Answer 9

when helping couples that are already happy and just want to strengthen their relationship, this could potentially happen in the group format (not having to go into detail about YOUR particular situation)

Question 10

Enrichment Interventions: some quick observations

Answer 10

available in many forms: counseling (premarital counseling), seminars, questionnaires, books (the 5 love languages), videotapes, on-line exercises

content, duration, leaders, and cost vary widely
-some dig (the stuff that you bring into your relationship really matters - backward approach - talk about history), some build (I’m not going to look back, I’m just going to move forward - non-specific to individuals, I can give you skills that can work for everyone)

couples love these programs (that was fun, interesting, I’ve learned a lot)
LOW risk couples are more likely to attend (that makes sense - they are committed to their relationship and think it may be beneficial - High risk couples might not be as excited to talk about their relationship for hours)

Question 11

Obama Quote

Answer 11

“…preliminary research shows that marriage education workshops can make a real difference in helping married couples stay together and in encouraging unmarried couples who are living together to form a more lasting bond. Expanding access to such services to low-income couples, perhaps in concert with other services already available, should be something everybody can agree on.”

-we don’t know what that research was, how it was done, and we see that it is “preliminary” research - but our very own president thinks we should spend billions of dollars on this

Question 12

prevention programs : beware

Answer 12

“this therapy stuff is scientifically proven to work right?”
-“it’s 100% effective”
the therapist may have a vested interest here

the vast majority of prevention programs are not based on research, nor have they been tested in any systematic way

is this a problem?

Question 13

What do we know about prevention programs

Answer 13

“pre to post” improvements: easy
Durability of effects is unknown
benefits deteriorate (huge problem)
risk matters

Question 14

“pre to post” improvements: easy

Answer 14

it’s really easy to get pre to post program improvements in satisfaction, but what we want to know is “does it last?”

overtime we tend to see skills>satisfaction

• when we do see improvement it tends to be in the behavioral skills (cooperative, less negativity)
• don’t see as much for relationship satisfaction - difficult to change the way someone feels about their relationship apart from the way that they act (the skills that they use)

Question 15

risk matters

Answer 15

people from different backgrounds respond in different ways to prevention programs

Question 16

S-Prep

Answer 16

Self-Premarital Relationship Enhancement Program (Halford, Sanders, & Behrens, 2001)

half the couples were assigned randomly to the SelfPREP intervention

• communication training (learning workshops of skills)
• listen to your partner and then only reflect back what they said (empathasize with them) not allowed to make offenses or have counterarguments

the remainder were assigned to a control group
-couples read a book about relation­ships and met twice with a counselor, who facilitated a small­ group discus­sion of the book

high and low risk couples included

• high risk if parents divorced OR if father was aggressive toward mother
• low risk if neither of these background experiences were present in the couple

satisfaction changes were computed over 4 years

results
high risk couples do better in S-prep than in the control group (especially men - they showed positive satisfaction rather than negative)
- High ­risk couples appear to benefit from more
intensive instruction in communication skills (so that any less intensive in­tervention produces a weaker effect)

low risk couples do better in the control group than in the S-prep group
-low ­risk couples already have strong skills and might need minimal intervention to build on them (so that any more intensive intervention produces a weaker effect)

-One possibility is that preventive interventions might disrupt the effective communication habits healthier couples have established

Question 17

should we have universal prevention programs where everyone gets it (primary prevention) or should only people at high risk get it (secondary prevention)?

Answer 17

All couples need to maintain their relationship, but not in the same ways:

• couples with some risk can really benefit from learning new skills
• couples with less risk can benefit from unstructured discussions about intimacy and communication

Secondary prevention is probably more viable than primary prevention
-because things like S-PREP are very expensive and not everyone benefits from it - we can save money by using a secondary prevention

Question 18

Video Clip developed by people with a program like S-PREP

Answer 18

showing bad communication through video taped conversation:
it’s not how similar you are in general, how much sex you’re having
what predicts divorce in a marriage is how destructive communication in relationship is

the major complaint of women is that my husband won’t communicate with me

• in research they find he is communicating but they are having destructive conversations
• men tend to withdraw or make facial expressions showing that he isn’t getting his point across
• when discussion turns very negative is when physical abuse is likely to occur
• we tend to see what we expect to see and we can influence the other person to behave the way we expect them to behave
• need to validate what your partner is saying and doing - if a partner doesn’t get this (or gets the opposite) it could be deadly to the relationship

they have these couples watch a video in a group setting of an example of poor communication and then bring them into private room with a coach to be videotaped communicating. After the fact they are asked “how did that feel?” they would respond “that was terrible” the coach asks “what could you do differently” then they brainstorm better ways they could communicate

first Couple in Video:

• she pursues more when he pulls away (withdraw/demand)
• their kids are in turmoil with going to a new school
• one partner says something and the other interprets it as negative and responds with something negative
• she says that she cleans and the next min the kids come in and it’s not clean anymore - he responds with the fact that when she cleans there are still crumbs (she does a poor job of cleaning) but should say “that must be so hard for you, what can I do to help?”
• Instead of hearing what she just said, he was developing a defensive response (motivated reasoning - how can I be right)
• instead of looking for harmony in relationship and trying to do things together (how can we work together to keep our house clean?) they are doing “you’re on your side and I’m on my side”
• there’s no lightness, no humor, there is just hostility and contempt in which he feels she is always right and has the power over him - there is a moment where they could have a good laugh but it falls flat (he says, you’re right, you’re always right your highness)

second couple in video:
they are fighting over TV time, she wants to watch her primetime shows and he wants to watch his football but she CAN’T watch TV when football is on