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PSYC 474 > Lecture 21: Therapeutic Approaches to Relationship Maintenance & Repair > Flashcards

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
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2
Q

clinical considerations in couple’s therapy

A
  • Agreeing on goals
  • Keeping secrets: confidentiality agreement with two individuals
  • Involving other family members
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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
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4
Q

why deny couple’s therapy to specific clients?

A
  • Individual concerns
  • Intimate partner violence
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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

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6
Q

three theoretical approaches to couple’s therapy

A
  • the gottman method
  • solution-focused couple’s therapy
  • emotion-focused couple’s therapy
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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)
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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
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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
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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
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11
Q

the sound relationship house

A
  1. build love maps
  2. share fondness and admiration
  3. turn towards instead of away
  4. the positive perspective
  5. manage conflict (accept your parnter’s influence, dialogue about problems, practice self-soothing)
  6. make life dreams come true
  7. create shared meaning
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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
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13
Q

Gottman therapy is not suited for:

A
  • Treating individual issues/understanding either individual better
  • Mental health issues, domestic violence
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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
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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
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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
  1. identify the clients’ current dance (observation & de-escalation)
  2. help the clients be clearer about what they ar emissing (ex. care, validation, and understanding)
  3. 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
Q

EFCT is not suited for

A
  • Couples with intimate partner violence
  • Couples who are separating
26
Q

EFCT takeaways

A
  • 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
Q

historically measuring success in couple’s therapy

A
  • 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
Q

modern measurements of success in couple’s therapy

A
  • 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
Q

constructing a control group

A
  • 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
Q

relative efficacy

A
  • 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
Q

an integrative stance to couple’s therapy

A
  • 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
Q

couple’s therapy efficacy (Carr, 2019) methods

A
  • 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
Q

couple’s therapy efficacy (Carr, 2019) findings

A
  • 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
Q

why is Gottman therapy not mentioned in many efficacy studies?

A
  • 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
Q

common factors for treating relationship distress

A
  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

PSYC 474 (39 decks)

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