Problems in marriage and other close relationships are widespread. For example, the divorce rate in the United States is approximately 50%. Relationship problems are also among the most common reasons for people seeking mental health services. There is good evidence that marriage counseling is effective in treating relationship problems and a variety of emotional and behavioral disorders.
The most widely researched approach to marriage counseling is cognitive-behavioral couple therapy (CBCT; Epstein & Baucom, 2002). This approach focuses on making positive changes in each partner so that couples have more rewarding and less punishing interactions. The goals of CBCT are (1) to identify and increase the frequency of positive behaviors that each person does to make the partner happier (“caring behaviors”), (2) to teach verbal and nonverbal expressive and receptive communication skills to help couples improve their communication around sharing thoughts and feelings, (3) to teach conflict resolution and problem-solving skills, and (4) to educate partners in the use of various techniques that allow them to identify and modify their negative or maladaptive cognitions about their partner or the relationship.
Another approach to marriage counseling that has been widely studied is emotion-focused therapy (EFT; Johnson, 2004). This approach is based on adult attachment theory, and the model integrates techniques from the experiential and family systems approaches to primarily target attachment insecurity rather than couple discord per se. The goals of EFT are (1) to identify repetitive negative interaction cycles that are the manifestation of attachment insecurities; (2) to reframe these cycles in terms of the underlying attachment needs; and (3) to facilitate the expression and the acceptance of one another’s attachment needs. When specific attachment injuries are identified, the therapist attempts to use emotional processing of these injuries to allow the injured partner to move toward a more secure bond.
The effectiveness of these two approaches to marriage counseling has been evaluated in several clinical trials. To summarize the results across studies, researchers have used meta-analysis, which is a summary of previous research that uses quantitative methods to compare outcomes across studies and provide a measure of the magnitude or degree of the impact of the intervention (i.e., an effect size). A meta-analysis of clinical trials comparing CBCT with waiting list control groups in treating couple discord yielded a mean effect size (d) of 0.95, which can be interpreted as indicating that the average couple who received CBCT was better off at the end of treatment than 83% of untreated couples. A meta-analysis of clinical trials comparing EFT with a waiting list control group indicated that it also has a positive impact on couple discord, with a mean effect size of 1.27, which can be interpreted as indicating that the average couple who received EFT was better off at the end of treatment than 89% of untreated couples (Byrne, Carr, & Clark, 2004).
In addition to these two approaches to marriage counseling that have been evaluated in multiple clinical trials, there are several approaches that have demonstrated positive outcomes in treating couple discord in only one trial. For example, an insight-oriented approach to marriage counseling, which emphasized the interpretation and resolution of conflictual emotional processes related to developmental issues and maladaptive relationship patterns, demonstrated significant gains in couple discord compared to a wait-list control group. The most recently studied approach to marriage counseling is integrative behavioral couple therapy (IBCT), which combines traditional behavioral techniques for promoting change with strategies aimed at fostering emotional acceptance. Interventions aimed at increasing acceptance include encouraging empathic joining around or unified detachment from ongoing relationship problems, building tolerance to responses that problems elicit, and encouraging acceptance of differences. In the largest randomized clinical trial of couple therapy ever conducted, IBCT was compared with CBCT, and results indicated that, although the treatments demonstrated different patterns of change over the course of treatment, the two treatments were equally effective at the end of treatment (Christensen et al., 2004).
In addition to treating couple discord, marriage counseling has also been shown to be effective in the treatment of a variety of psychiatric disorders. Research has shown that relationship discord is higher among people with mental-health problems versus those without such problems (see Whisman, 2006). Mental-health problems may negatively affect a person’s role functioning, resulting in greater discord in close relationships. Alternatively, relationship problems may act as social stressors, increasing the likelihood of mental health problems. Whether they are the cause or consequence of a disorder, relationship problems are likely to complicate the course of an emotional or behavioral problem, suggesting that marriage counseling, singly or in combination with other treatments, may be effective in the treatment of a range of disorders.
The co-occurrence of couple discord with psychiatric disorders has led to three couple-based treatment strategies for addressing these comorbid difficulties. The first uses marriage counseling to reduce overall couple discord based on the premise that such discord serves as a broad stressor that contributes to the development, exacerbation, or maintenance of mental-health problems. The second strategy involves developing disorder-specific couple interventions that focus on particular relationship processes presumed to directly influence either the co-occurring problems or their treatment. The third couple-based strategy involves partner-assisted interventions in which one partner serves as a “surrogate therapist” or coach in assisting the other partner with individual problems.
Research has documented the effectiveness of couple- based interventions for a broad range of mental-health problems, including alcohol and drug-use disorders, mood disorders, anxiety disorders, and physical aggression (see Snyder, Castellani, & Whisman, 2006). Promising couple-based interventions have also been developed for a variety of other emotional and behavioral problems, including sexual dysfunctions, post-traumatic stress disorder, and borderline personality disorder. For many of these conditions, marriage counseling not only improves the mental health problem, but also reduces couple discord, which may result in lower rates of relapse of psychiatric disorders. Finally, the cost effectiveness of marriage counseling has been shown to compare favorably with individual-based treatments of several disorders.
Counseling; Couples Therapy; Marital Discord.
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