Ch. 12: Preventing Distress Flashcards
Metaphoric view of Therapy and Prevention
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
Why intervene Early?
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
couples wait before seeking therapy
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
few divorcing couples try therapy first
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
therapy may not work (or last)
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
Collateral damage can be avoided
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…
Happy couples might be motivated to keep their relationship strong
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”
prevention: ‘easier’ than treatment?
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
many couples can be reached
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)
Enrichment Interventions: some quick observations
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)
Obama Quote
“…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
prevention programs : beware
“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?
What do we know about prevention programs
“pre to post” improvements: easy
Durability of effects is unknown
benefits deteriorate (huge problem)
risk matters
“pre to post” improvements: easy
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)
risk matters
people from different backgrounds respond in different ways to prevention programs
S-Prep
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
should we have universal prevention programs where everyone gets it (primary prevention) or should only people at high risk get it (secondary prevention)?
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
Video Clip developed by people with a program like S-PREP
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
