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Relationship Dysfunction Lecture Overview. Overview of the problem Theories of relationship dysfunction Empirically-supported treatments Traditional BMT Integrative couple therapy Efficacy data Class discussion. Significance of Marital Discord. Between 50-67% of married adults divorce

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relationship dysfunction lecture overview
Relationship DysfunctionLecture Overview
  • Overview of the problem
  • Theories of relationship dysfunction
  • Empirically-supported treatments
    • Traditional BMT
    • Integrative couple therapy
  • Efficacy data
  • Class discussion

Treatments of Relationship problems

significance of marital discord
Significance of Marital Discord
  • Between 50-67% of married adults divorce
  • Marital problems represent the single most frequent problem for which people seek out mental health services
  • Divorce and marital separations rank as one of the most significant stressors and has also been shown to increase people’s risk for physical and mental illness

Treatments of Relationship problems

significance of marital discord3
Significance of Marital Discord
  • Admission to mental hospitals are the lowest among the married, and highest among the divorced
  • Motor vehicle accident rates among those undergoing divorce double during the six months before and after divorce
  • Marital distress, conflict, and disruption are associated with a wide range of deleterious effects on children

Treatments of Relationship problems

significance of marital discord4
Significance of Marital Discord
  • Adults who experienced a divorce as children experience significantly more emotional problems in their adult life

Treatments of Relationship problems

what predicts marriages to end in divorce

What Predicts Marriages to End in Divorce?

Treatments of Relationship problems

factors associated with marital discord
Factors Associated with Marital Discord
  • Reinforcement loss (behavioral)
  • Positive affect loss (emotional)
  • Dysfunctional beliefs (cognitive)
  • Situational factors (environmental)

Treatments of Relationship problems

factors that predict separation and divorce
Factors that Predict Separation and Divorce
  • Parental disagreement about child rearing practices (Block, 1981)
  • Emotional stability (Kelly & Conley, 1987)

Treatments of Relationship problems

gottman s balance theory

Gottman’s Balance Theory

Gottman (1993)

Treatments of Relationship problems

gottman theory major assumptions
Gottman Theory: Major Assumptions
  • The cascade toward marital dissolution can be predicted with just two variables

Treatments of Relationship problems

gottman theory major assumptions10
Gottman Theory: Major Assumptions
  • Not all negativity is equally corrosive

Treatments of Relationship problems

gottman theory major assumptions11
Gottman Theory: Major Assumptions
  • There is a process cascade that relates to the couple's perception of the relationship and that also predicts dissolution

Treatments of Relationship problems

process cascade
Process Cascade

Treatments of Relationship problems

gottman theory major assumptions13
Gottman Theory: Major Assumptions
  • During marital conflict, the perception of positive affect is one dimensional, whereas the perception of negative affect is two dimensional

Treatments of Relationship problems

gottman theory major assumptions14
Gottman Theory: Major Assumptions
  • Flooding leads to emotional (escape) conditioning, which causes a state of hypervigilance to the cues conditioned to the flooding.

Treatments of Relationship problems

gottman theory major assumptions15
Gottman Theory: Major Assumptions
  • Physiological reactivity and chronically high levels of physiological arousal are related to separation and divorce

Treatments of Relationship problems

gottman model
Gottman Model

Treatments of Relationship problems

incompatibility as a causal factor in relationship discord

Incompatibility As a Causal Factor in Relationship Discord

Jacobson & Christensen (1996)

Treatments of Relationship problems

development of incompatibilities
Development of Incompatibilities
  • Longitudinal research suggests that the likelihood of a person finding a mate whose preferences were compatible on just three separate dimensions was low (17%)

Treatments of Relationship problems

development of incompatibilities19
Development of Incompatibilities
  • Potentially conflictual differences and similarities are not likely to create problems early on in the relationship
  • Similarities and differences that were once a source of attraction may become a source of incompatibility

Treatments of Relationship problems

development of incompatibilities20
Development of Incompatibilities
  • Shared and individual life experiences may exacerbate existing incompatibilities or even create new ones

Treatments of Relationship problems

incompatibility as a causal agent in relationship discord
Incompatibility As a Causal Agent in Relationship Discord
  • Areas of incompatibility
    • Level of closeness
    • Extent of asymmetry

Treatments of Relationship problems

incompatibility as a causal agent in relationship discord22
Incompatibility As a Causal Agent in Relationship Discord
  • Consequences of incompatibility
    • Coercion

Treatments of Relationship problems

incompatibility as a causal agent in relationship discord23
Incompatibility As a Causal Agent in Relationship Discord
  • Consequences of incompatibility
    • Coercion
    • Vilification

Treatments of Relationship problems

incompatibility as a causal agent in relationship discord24
Incompatibility As a Causal Agent in Relationship Discord
  • Consequences of incompatibility
    • Coercion
    • Vilification
    • Polarization

Treatments of Relationship problems

incompatibility as a causal agent in relationship discord25
Incompatibility As a Causal Agent in Relationship Discord
  • Factors affecting how couples manage incompatibilities
    • Level of incompatibility
    • Attractions
    • Personality
    • Conflict resolution skills
    • Stressful circumstances

Treatments of Relationship problems

assessment of relationship dysfunction
Assessment of Relationship Dysfunction
  • Partner’s beliefs that each hold about the relationship (marital satisfaction)
    • Lock-Wallace Marital Satisfaction Scale
    • Dyadic Adjustment Scale

Treatments of Relationship problems

assessment of relationship dysfunction27
Assessment of Relationship Dysfunction
  • What are the day-to-day interactions of the couple
    • Spouse Observational Checklist

Treatments of Relationship problems

assessment of relationship dysfunction28
Assessment of Relationship Dysfunction
  • What are the factors contributing to the central relationship problems?
    • Clinical interview with each partner
    • Self-monitoring

Treatments of Relationship problems

assessment of relationship dysfunction29
Assessment of Relationship Dysfunction
  • How do partners bring about change in their relationship e.g., conflict resolution skills)?
    • MICS (Marital Interaction Coding System)

Treatments of Relationship problems

treatment of relationship problems

Treatment of Relationship Problems

Early Behavioral Marital Therapy

Treatments of Relationship problems

behavioral marital therapy
Behavioral Marital Therapy
  • History

Treatments of Relationship problems

procedural components of bmt
Procedural Components of BMT
  • Increasing couples’ positive exchanges

Treatments of Relationship problems

why start with increasing couples positive exchanges
Why Start with Increasing Couples Positive Exchanges
  • Changes in problems do not automatically increase positive exchanges
  • Negative spouse behaviors tend to diminish even if they are not the focus
  • May increases receptivity to tackle more demanding marital changes
  • The focus on the positive serves to reduce the spouses’ deprivation and thus may increase the perception that the relationship is worth the effort
  • Comparatively easy to implement

Treatments of Relationship problems

strategies for increasing positive exchanges
Strategies for Increasing Positive Exchanges
  • Giver-initiated positive exchanges
    • Have each spouse generate hypotheses about increasing partner’s daily satisfaction
    • Set target goals for increasing pleasing behaviors
    • Use of “love days”

Treatments of Relationship problems

strategies for increasing positive exchanges35
Strategies for Increasing Positive Exchanges
  • Receiver-initiated positive exchanges
    • Teaching spouses to make specificrequests for pleasing behaviors
    • Exchange contracts
    • “Cookie jar”

Treatments of Relationship problems

strategies for increasing positive exchanges36
Strategies for Increasing Positive Exchanges
  • Specification of mutual positive exchanges
    • Couple pleases
    • Companionship activities
    • Shared avocations

Treatments of Relationship problems

procedural components of bmt37
Procedural Components of BMT
  • Increasing couples’ positive exchanges
  • Communication training

Treatments of Relationship problems

targets for communication training
Targets for Communication Training
  • Empathy and listening skills
  • Validation
  • Learning to talk about feelings
  • Learning to express negative feelings appropriately
  • Expression of positive feelings

Treatments of Relationship problems

strategic steps in communication training
Strategic Steps in Communication Training
  • Feedback
  • Coaching and modeling
  • Behavioral rehearsal

Treatments of Relationship problems

cognitive approaches to communication training
Cognitive Approaches to Communication Training
  • Teaching partners about sex differences in conversational style
  • Teaching partners about sex differences in the meaning of talk
  • Identifying dysfunctional beliefs
  • Correcting dysfunctional beliefs through communication

Treatments of Relationship problems

considerations in the choice of positive exchange strategies
Considerations in the Choice of Positive Exchange Strategies
  • Have partners slacked off in their attempts to please one another?
  • Does one or both partners have difficulties with making requests from the other?
  • Are the partners ineffective in reinforcing each other even though positive behaviors are being emitted?

Treatments of Relationship problems

procedural components of bmt42
Procedural Components of BMT
  • Increasing couples’ positive exchanges
  • Communication training
  • Problem-solving training

Treatments of Relationship problems

factors contributing to effective problem solving
Factors Contributing to Effective Problem-Solving
  • Setting
  • Attitude
  • Distinguishing between problem definition vs. problem solution

Treatments of Relationship problems

guidelines for defining problems
Guidelines for Defining Problems
  • Begin with something positive
  • Be specific
  • Express your feelings
  • Admit to your role in the problem
  • Be brief when defining problems
  • Discuss only one problem at a time
  • Paraphrase

Treatments of Relationship problems

guidelines for solution phase
Guidelines for Solution Phase
  • Focus on solutions that will work in the future
  • Brainstorm solutions
  • Solution should involve mutuality and compromise
  • Final change agreements should be specific
  • Final agreement should include cues reminding each of the changes they are to make
  • Final agreement should be recorded in writing

Treatments of Relationship problems

therapist behaviors associated with a positive outcome
Therapist Behaviors Associated With a Positive Outcome
  • Structuring skills
  • Instigation skills
  • Teaching skills
  • Fostering positive expectancies
  • Provide emotional nurturance

Treatments of Relationship problems

efficacy data for bmt hahlweg markman 1988
Efficacy Data for BMT(Hahlweg & Markman, 1988)
  • Meta-analysis
    • 17 studies comparing BMT to either a wait-list group or placebo control group
    • Average effects size was .95 (83% of the BMT patients were better off than controls)
    • Chance of improving was 72% for BMT versus 28% for controls
    • Rate of improvement attributable to BMT is about 40%

Treatments of Relationship problems

efficacy data for bmt hahlweg markman 198848
Efficacy Data for BMT(Hahlweg & Markman, 1988)
  • Meta-analysis cont.
    • Trend toward a lower effect size for newer studies (.8 vs. 1.09)
    • Comparisons with other approaches showed no significant advantage of BMT
    • Measure of clinical significance revealed that few couples moved into the normal range

Treatments of Relationship problems

meta analytic review dunn schwebel 1995
Meta-Analytic Review(Dunn & Schwebel, 1995)
  • Meta-analysis
    • 15 studies (558 couples) investigating effect sizes of three different treatments: (1) BMT (n = 13), (2) CBMT (n = 3), and (3) IOMT (n = 5) .
    • Each of the three treatment classes were compared to control couples
    • Behavior Change: Average effects size was .79 (BMT), .54 (CBMT), and .87 (IOMT)
    • Only CBMT led to significant change in cognitions
    • IOMT had largest effect size on general measures of the quality of the relationship

Treatments of Relationship problems

moderators of treatment outcome for bmt
Moderators of Treatment Outcome for BMT
  • Commitment
  • Younger age (after controlling for duration of marriage)
  • Emotional engagement
  • Non-traditionality (peer marriage)
  • Convergent goals for the marriage

Treatments of Relationship problems

treatment of relationship problems51

Treatment of Relationship Problems

Integrative Couple Therapy (Jacobson & Christensen, 1996)

Treatments of Relationship problems

problems with bmt
Problems with BMT
  • Neither intervention strategies nor intervention targets stem from a functional analysis of couple interaction at the individual couple level of analysis
  • Rather than letting natural reinforcers establish and strengthen couple interaction, BMT created new "rules” for the couple to use to reduce distress

Treatments of Relationship problems

problems with bmt cont
Problems With BMT Cont.
  • TBCT is based on two critical assumptions that are probably misguided:
    • Therapy should promote couple compromise and accommodation
    • Marital distress is caused by interaction skill deficits

Treatments of Relationship problems

basic assumption of ibct
Basic Assumption of IBCT
  • Some relationship conflicts cannot be resolved and thus the intervention focus needs to be on helping couples foster acceptance

Treatments of Relationship problems

goals of ibct
Goals of IBCT
  • Get the couple to adopt a formulation of their difficulties based on a careful evaluation that will help allow them stop blaming their partner and open themselves up to both acceptance and change

Treatments of Relationship problems

components of the formulation
Components of the Formulation
  • Theme

Treatments of Relationship problems

common themes in ibct
Common Themes in IBCT
  • Closeness-Distance
  • Control and responsibility
  • You don’t love me. Yes I do
  • Artist and the scientist
  • Conventionality-unconventionality

Treatments of Relationship problems

components of the formulation58
Components of the Formulation
  • Theme
  • Polarization process

Treatments of Relationship problems

components of the formulation59
Components of the Formulation
  • Theme
  • Polarization process
  • Mutual trap

Treatments of Relationship problems

stages of ibct
Stages of IBCT
  • Assessment stage
  • Feedback stage
  • Therapy stage

Treatments of Relationship problems

goals of the initial interview
Goals of the Initial Interview
  • Validate their experience of hopelessness
  • Honor and respect their ambivalence about therapy
  • Collect info on how the couples came together
  • What was the relationship like before the problems began?
  • How is the relationship different now on days that they are getting along
  • Socialize them to the twin process of therapy and assessment

Treatments of Relationship problems

assessment of problem areas
Assessment of Problem Areas
  • How distressed is the couple?
  • How committed is the couple to the relationship?
  • What are the issues that divide them?
  • Why are these issues such a problem for them?
  • What are the strengths holding them together?

Treatments of Relationship problems

strategies for promoting acceptance
Strategies for Promoting Acceptance
  • Teach couple a different method for discussing a problem
  • Teach partner’s to increase their tolerance of the other’s negative behaviors
  • Assist each partner in self-care

Treatments of Relationship problems

change techniques in icbt
Change Techniques in ICBT
  • Behavior exchange techniques
  • Communication training
  • Conflict resolution training

Treatments of Relationship problems

adherence data
Adherence Data

Data from Jacobson & Christensen (2000). Journal of Consulting and Clinical Psychology, Vol. 68, No. 2, 351-355

Treatments of Relationship problems

pilot study on efficacy of ibct
Pilot Study on Efficacy of IBCT

Data from Jacobson & Christensen (2000). Journal of Consulting and Clinical Psychology, Vol. 68, No. 2, 351-355

Treatments of Relationship problems