Couples Therapy

Couples Therapy

Günce HazmanSeradil Eylül Uyal

Couples Therapy

20% of couples have marital distressHalf of marriages end in divorce10-15% separate in 4 years70% last a decade

Couples Therapy

Couples therapy is the only evidence-based treatment.

Aimed at marital difficulties but also preventive and enrichment work.

Couples Therapy Marital distress brings

work difficulty, health problems, problems with children.

Marital difficulty Psychopathology

Couples Therapy

Various DSM-IV disorders double in people experiencing marital distress.

Whissman (1999); 15% mood disorders, 28% anxiety disorders, 15% alcohol and substance use disorders. Couples therapy is seen to be effective in

individual disorders of depression, anxiety, substance use.

History of Couples Therapy

Gurman and Fraenkel (2002) describe it in 4 phases:

Phase I, atheoretical marriage counseling formation.

Phase II, psychoanalytic experimentation. Phase III, theoretical expansion Phase IV, development of empirical

treatments.

Couple Processes

John Gottman says that “first understand the characteristics of unsatisfied couples, then prevent and treat dissatisfaction”.

Several differences between satisfied and unsatisfied couples;

* Satisfied couples show higher rates of positive behavior than negative (5/1). Unsatisfied couples (0.8/1).

*Distressed couples show high rates of “The Four Horsemen”: defensiveness, criticism, contempt, stonewalling.

Couple Processes

Not only our behaviors but also our cognitions contribute to dissatisfaction.

Positive sentiment override-feeling positively about one’s partner and the relationship is crucial.

Many unhappy couples experience demand-withdrawal. One partner tries to communicate while the other one withdraws.

Assessment of Marital Distress

Couples can be assessed along behavior, cognition, affect, and internal dynamics.

Lots of assessment tools are available. Many of these are self reports filled out by couples before the therapy session.

Marital Satisfaction InventoryThe Area of Change Questionnaire....

Treatment Approaches

Behavioral Couples Therapy

The goal is to increase positive behavior demonstrated by each partner and make them realize that one’s behavior influences the other.

There are two main components: behavior exchange and communication/problem solving training.

Behavioral Couples Therapy

Behavior exchange aims to increase positive behaviors in daily life. The therapist gives homeworks such as “love day”.

Communication/problem solving training aims to teach some skills that will help them solve future problems.

Reflective listening: one partner expresses his/her a feeling or a thought and the other one restates, summarizes it before responding.

Cognitive-Behavioral Couples Therapy

Based on a belief that people evaluate their relationship and partners according to unreasonable standards.

If people’s appraisals of events are altered then there will be positive changes in behavior and emotion accordingly.

Two different stresses: primary distress and secondary distress.


Primary distress comes from one partner’s unmet needs (affiliation, intimacy, autonomy...).

Secodary distress emerges when that partner uses wrong strategies to address the conflict coming from unmet needs (ignoring, verbally or physically attacking).


Delivered within 8-25 sessions.First 2-3 sessions are for the assessment

and followed by a feedback session. The couple and the therapist define the treatment goals together.

Socratic questioning and guided discovery techniques may be used.


Socratic questioning involves asking the client a series of questions to reevaluate the logic behind his/her certain beliefs.

Guided discovery involves creating experiences (role playing, pros and cons of the relationship) to have different perspectives.

Integrative Behavioral Couples Therapy

Adds “emotional acceptance” to BCT to increase positive feelings.

Jacobson and Christensen (1996) say that in the early stages, partners tolerate the differences in personality and see it them as the source of attraction.

In time, these differences become sources of discontent and concern, and result in polarization, vilification.


This therapy is interested in the agent of behavior and the receiver together.

According to this therapy increased acceptance reduces conflict and is a catalyst for change.

Acceptance techniques’ aim is to soften the adversarial attitudes partners take toward eachother.


Gottman says that some problems cannot be solved. Instead of aiming to solve them the sources of conflict can be turned into sources of intimacy.

IBCT therapists determine a central theme which summarizes the central issue.

They believe that as partners try to change eachother, polarization occurs. This is called the mutual trap.


The effort to change eachother creates a defense, therefore the partner who want to change the other experiences a frustration and hopelessness.

The theme+polarization+mutual trap= the formulation.

Interested in the history of the relationship, the individual’s family, and individual’s previous relationships.

Emotionally Focused Couples Therapy

Susan Johnson Focuses on couple emotion and attachment Recreating bonds in couples by restructing and

expanding their emotional responses Three main tasks1. Create safe, collaborative alliance2. Access and expand emotional responses3. Restructure interactions Humanistic techniques

Object Relations Couples Therapy

Infant primarily driven by the desire to have a relationship with a nurturin figure.

This theory holds that couples seek lost parts of themselves in their spouses, and through marriage unacceptable parts of self can be expressed vicariously.

Therapist provides safe holding environment.

Affective Reconstruction

Couple difficulties often stem from injuries sustained in previous relationships that cause partners to develop defensive strategies that interfere with intimacy.

“ the interpretation of persistent maladaptive relationship patterns as having their source in previous developmental experiences”

Six fundamental tasks

Affective Reconstruction

1. Developing a collaborative alliance2. Containing disabling relationship crises3. Strenghtening the marital dyad4. Promoting relevant relationship skills 5. Challenging the cognitive components of

relationship distress6. Examining developmental sources of

relationship distress

Brief Integrative Marital Therapy

Focus on present İnterpersonal and intrapersonal world

together Three central goals1. Teach relationship skills2. Challenge dysfunctional relationship

rules3. Inculcate systematic thinking

Narrative Couples Therapy

Change happens when couples modify their views of themselves and others

Integrative Problem-Centered Therapy

Problem solving by integrating individual, family, biological therapies.

Hierarchical approach that employes specific psychotherapeutic techniques

Begins from the simpliest to complex.“Problem maintenance structure”

Feminist Couple Therapy

Intimacy achieved with equality

Special Problems

Sex therapyInfidelity problemsviolence

Ethical Issues

Confidentiality and record keeping

Research Assesing Effectiveness of Couple TherapyCouple therapy is as effective as individual

therapy.High return problems

Couples Therapy

Günce HazmanSeradil Eylül Uyal

Documents

Couples Therapy