Lecture 21: Therapeutic Approaches to Relationship Maintenance & Repair Flashcards
1
Q
what is couple’s therapy
A
- Therapy with two people
- Historically, a married couple
- Nowadays, couples therapy methods have been applied to many close relationships, such as unmarried dating couples, central couples in a polyamourous network, and
friends/ workplace relationships
2
Q
clinical considerations in couple’s therapy
A
- Agreeing on goals
- Keeping secrets: confidentiality agreement with two individuals
- Involving other family members
3
Q
why go to couple’s therapy?
A
- Feeling stuck in a harmful relationship dynamic
- Could be new or a pattern across relationships
- Wanting support navigating a transition or difficult conversation
- Sexual dysfunction
- Individual mental helath concerns (most often used for PTSD)
- Positive psychology reasons
- Build insight, strengthen the relationship
4
Q
why deny couple’s therapy to specific clients?
A
- Individual concerns
- Intimate partner violence
5
Q
cultural considerations in couple’s therapy
A
Western ideals of love and heteronormative definitions of love, are not the basis of every committed relationship
6
Q
three theoretical approaches to couple’s therapy
A
- the gottman method
- solution-focused couple’s therapy
- emotion-focused couple’s therapy
7
Q
development of Gottman’s couple’s therapy
A
- Dr. John Gottman & Dr, Robert Levenson
- Filmed live interactions and measured physiological changes (ex. skin conductance, blood velocity, gross motor activity, heart rate) to assess emotionality
- Longitudinal studies with replications
- Followed couples for up to 20 years
- Many types of dyad studies
- Repeated measurements of both subjective and objective outcomes (ex. marital satisfaction, happiness, conflict behaviours, emotionality, and relationship status in couples)
8
Q
gottman research findings
A
- Couples are very stable: 80% stability in conflict behaviours and marital satisfaction
- Most relationship problems did not get solved without intervention: 69% were perpetual problems based on personality differences
- Lots of fun stats: couples that stay together have 5 positive interactions for every negative interaction
- Defined meta-emotion: the way people feel about emotions
- Found that differences in meta-emotion drove a lot of conflict
- Defined several common relationship dynamics and conflict behaviours, and identified which were related to outcomes of interest
9
Q
antidotes to the four horsemen
A
- Criticism: “I” statements
- Contempt: be respectful! Deliberately integrate more statements of appreciation and care into conversation
- Defensiveness: take responsibility, even for just a small part of an ongoing problem
- Stonewalling: take breaks of at least 20 minutes during conflicts when one partner feels overwhelmed, and then return to continue problem-solving
10
Q
components of Gottman’s couple’s therapy
A
- Based on observational findings (not an overarching theory)
- Consists of:
1. Assessment: couple + therapist
2. Individual sessions + questionnaires
3. Build a sound relationship house
11
Q
the sound relationship house
A
- build love maps
- share fondness and admiration
- turn towards instead of away
- the positive perspective
- manage conflict (accept your parnter’s influence, dialogue about problems, practice self-soothing)
- make life dreams come true
- create shared meaning
12
Q
Gottman therapy is best used for:
A
- Couples who want to increase relationship skills
- Couples who want to fix relationship issues
- People who are “psychologically minded”: want to learn psychological constructs and tools
13
Q
Gottman therapy is not suited for:
A
- Treating individual issues/understanding either individual better
- Mental health issues, domestic violence
14
Q
takeaways from Gottman therapy
A
- Huge evidence-basis for types of conflict
- Specific, evidence-based replacement behaviours
- Not theory-driven
- Therapy materials are hidden behind a paywall
15
Q
solution-focused couple’s therapy (SFCT)
A
- Developed by Steve de Shazer & Insoo Kim Berg (marreied couple)
- Goal-oriented (solution-focused)
- Based on positive psychology and behavioural interventions
- Strength-based
- Action-oriented
- Little to no focus on the problem/mechanisms of the problem
- Focus on identifying resources clients have and using them
- Collaborative therapy with no expert in the room
- Patients are the experts themselves
- The therapist provides or identifies concrete interventions/solutions
- Socratic questioning is used to keep conversation concrete and measurable as much as possible
- Firmly grounded in behaviourism, positive psychology orientation
16
Q
SFCT interventions
A
- Pre-session change question
- Miracle-10 question
- Look for previous solutions
- Look for exceptions to the problem
- Use present- and future-focused questions
- Give compliments
- Invite the couple to experiment with doing more of what works
- Scaling questions
- Coping questions
17
Q
SFCT is best used for
A
- Findings solutions to specific couple problems (frequent conflict, difficulty compromising)
- Emergency responses to active couple problems (no explicit refusal with domestic violence, although this likely varies between clinicians)
18
Q
SFCT is not suited for
A
- People who want to understand the “whys”
19
Q
SFCT takeaways
A
- Not all therapies focus on the past, sometimes the most effective approach is to focus on possibilities for the future
- Complex problems might not require complex solutions
20
Q
emotionally-focused couple’s therapy (EFCT)
A
- Developed by Dr. Susan Jognson & Dr. Leslie Greenberg
- Brief, structured, collaborative couple therapy
- Grounded in attachment theory
- Developed from clinical work and qualitative research with couples
21
Q
EFCT view of adult love
A
- Adult relationships are conceptualized as two-way attachment bonds
- Bonds come with associated schemas regarding one partner’s and one’s own dependability for comfort
- The partner should be a safe-haven
- Attachment needs are a huge motivator for individual change and growth
22
Q
EFCT interventions
A
- Reflection
- Validation
- Evocative reflections & questions
- Tracking & reflecting on interactions
- Reframing
23
Q
what does EFCT look like?
A
- identify the clients’ current dance (observation & de-escalation)
- help the clients be clearer about what they ar emissing (ex. care, validation, and understanding)
- enactments in session to help clients practice caring responses
24
Q
EFCT is best used for
A
- Fixing problems (ex. Trust breach, fear or anger, mental illness in one or both members)
- Strengthening a relationship
25
EFCT is not suited for
- Couples with intimate partner violence
- Couples who are separating
26
EFCT takeaways
- The one therapy that explicitly focuses on love/connection as the desired outcome
- Requires that the therapist be a secure base for both partners and then help the partners become that for one another
27
historically measuring success in couple's therapy
- Historically: did couples stay together?
- Evidence isn’t perfect:
- 30% relapse in 2 years
- 38% divorce in 4 years
- Trouble with internal validity: Selection bias: people come for couple’s therapy when things are already going wrong and have been for awhile
28
modern measurements of success in couple's therapy
- There are many contemporary uses of couple’s therapy
- Build relationship-relevant tools for the individuals in their existing relationship
- Facilitate a more amicable/smooth life transition
- Parenthood conversations
- Major decisions
- End of relationship
- Improve their understanding of one another
- Makes it hard to measure success
- Lots of discrete studies with specific outcomes -> meta-analyses and narrative and systemic reviews
29
constructing a control group
- It’s not ethical to deny people care outright
- Several common options in clinical care:
1. Waitlist control group
2. Psychoeducation-only group
3. Non-treamtent seeking couples
4. Compare sample stats to known population stats
30
relative efficacy
- It’s hard to find recent comparison research
- Most work suggests that all the schools of couple’s therapy are equally helpful
- Suggests that the most important aspects are common factors (ex. Relationship with the therapist, getting the therapy you want, collaboration, etc)
31
an integrative stance to couple's therapy
- This does not necessarily mean you can switch completely between solution-focused and EFCT with patients
- Trained in many forms of practice and adapt an individual client’s care to their mindset/goals/presenting problems
- May integrate specific tools or elements of a perspective between schools
32
couple's therapy efficacy (Carr, 2019) methods
- Narrative review
- “Current evidence base”
- Summarizes meta-analyses when available
- Summarizes efficacy of different treatment modalities for relationship distress, psychosexual problems, intimate partner violence, anxiety disorders, mood disorders, substance abuse, psychosis, and adjustment to chronic physical illness
33
couple's therapy efficacy (Carr, 2019) findings
- 40% of couples report that they benefit a great deal from coupleès therapy and 30% benefit somewhat
- 84% of couples fared better than controls
- For mildly distressed couples, EFCT has better outcomes
- Couple therapy overall (not EFCT): couples with mild-to-moderate IPV had better outcomes than 80% of controls, but it was not appropriate for severe IPV
- EFCT and other behavioural therapies are evidence-based for anxiety disorders (especially PTSD)
- Most couple’s therapies are evidence-based for depression and other mood disorders
- Most couple’s therapies improved health outcomes for patients with a range of chronic health conditions
- Meta-analysis across 52 studies, includes HIV, stroke, cancer, cardiovascular disease, and chronic pain
- Longer treatments with ill patients and their spouses were the most effective
34
why is Gottman therapy not mentioned in many efficacy studies?
- Everyone integrates psychoeducation andinterventions from Gottman
- Gottmans have a lot of control of their materials (paywall)
- There are lots of efficacy studies comparing GCT to a control condition, but not to other therapies
35
common factors for treating relationship distress
1. Alter couple’s view of problem to be more objective and dyadic
2. Decrease emotion-driven, dysfunctional behaviour
3. Elicit emotion-based, vulnerable behaviours
4. Increase constructive communication
5. Promotes strength & reinforce gains
