Marital Therapy Outcome Research Articles

Are waiting-list control groups needed in future marital therapy outcome research?

Behavioral couple therapy (BCT) is an efficacious treatment for maritally distressed couples. The current article includes a meta-analysis of BCT and waiting-list control groups from BCT outcome investigations. The findings indicate that, on average, distressed couples who are placed on waiting lists make no improvement during the waiting period. These results are consistent across 17 controlled investigations conducted in different countries. Given the consistency of these findings, the current investigators propose that marital therapy outcome investigators consider employing these effect-size estimates rather than using scarce resources to place distressed couples in waiting-list control conditions. Such a strategy circumvents the ethical dilemma of withholding efficacious treatment from clients and encourages effectiveness studies in real-world conditions.

Marriage Doctor or Dr. Death?

In response to Doherty's theses that married people who seek therapy are at risk today from incompetent therapists who hold individualistic values and thereby undermine marital commitment and marital therapy outcome, two extensions are offered. First, that even though the message espoused by Doherty is not new, this may be a better time for therapists and clients to hear and respond to it. Second, a clinical approach is suggested for therapists which can provide a methodology during the initial stages of couple therapy that enhances the likelihood that the therapist will focus more on systemic and interaction aspects of the relationship. Even with such methodology available, therapists must examine core values about marriage and decide if they can ethically hold themselves out as marital therapists when their intended outcome for couples is individualism over the marital relationship.

The Marriage Clinic: A Scientifically Based Marital Therapy

Back to table of contents Previous article Next article Book Forum: PsychotherapiesFull AccessThe Marriage Clinic: A Scientifically Based Marital TherapyMICHAEL F. MYERS, M.D., MICHAEL F. MYERSSearch for more papers by this author, M.D., Vancouver, B.C., CanadaPublished Online:1 Feb 2001https://doi.org/10.1176/appi.ajp.158.2.334AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Well into The Marriage Clinic, Dr. Gottman, clarifying his philosophical approach to marriage and the promise of marital therapy, makes two statements that grabbed my attention: “I am a ‘plumber,’ not an idealist or a theologian” (p. 184) and “I like to think of myself as a kind of quantitative Studs Terkel” (p. 185). It is sentences like these, and their humanistic underpinnings, that make this superb book so enjoyable.Humility aside, Dr. Gottman is a prolific and world-renowned researcher and clinician in the field of marital therapy. The Marriage Clinic is the latest of more than two dozen books, videotapes, and audiotapes that he has produced for mental health professionals and couples. This book is the product of his prospective and ongoing research with more than 700 couples whom he has studied at the University of Washington in Seattle, where he is William Mifflin Professor of Psychology.The book is divided into three sections. Part 1, Research and Theory, begins with a frank exposition of the myths of what marital therapy can and cannot do. Citing high relapse rates in couples within a year or two of treatment, Dr. Gottman calls for a more scientific and rigorous approach to marital therapy outcome research and decries reliance on therapist ratings and customer satisfaction alone. He explains his theory of the core triad of balance in marriage, which includes interactive behavior, perception, and physiology. Of his so-called Four Horsemen of the Apocalypse—criticism, defensiveness, contempt, and stonewalling—contempt is a significant predictor of divorce and is essentially zero in stable and happy marriages. In this section, Dr. Gottman also describes what he means by the sound marital house: marital friendship and its ability to create positive affect in nonconflict contexts; positive sentiment override, which facilitates repair during conflict discussions; conflict regulation, i.e., the ability to establish dialogue with perpetual problems, to use basic skills, and to offer physiological soothing; and the ability to create a shared meaning system.In part 2, Assessment, Dr. Gottman builds on this introduction and infrastructure and explains in great detail how he assesses couples when they come for therapy. In addition to interviews (both conjoint and individual), he uses a number of questionnaires, which are all included in the appendixes to the book. This second section is particularly rich. There is a chapter dedicated to illustrating the particulars of the sound marital house theory and the ways in which couples handle their challenges masterfully or disastrously.Part 3, Intervention, makes up the second half of the book. There are several chapters covering important clinical aspects: setting realistic goals with couples; promoting dyadic interaction and monitoring one’s own activity as a therapist; striving for a largely positive affective experience in therapy; recreating and reinforcing the marital friendship; assisting couples with problem-solving; explaining and helping couples to understand and work with perpetual conflict; dealing with resistance and eschewing diagnostic labels of personality pathology; helping couples to avoid relapse (which includes establishing rituals of emotional connection and a follow-up appointment 3 to 6 months after treatment ends); working with emotion, emotional discrepancy, and myths about gender differences in couples; and helping parents to reach out to their children in the face of marital conflict.There is much here for practicing psychiatrists wishing to enrich their couples’ therapy. Each chapter begins with a synopsis, and there are many interesting case vignettes (both descriptive and prescriptive), a bounty of questionnaires and checklists, and a comprehensive reference list. Most important, Dr. Gottman’s writing is both scholarly and engaging. This book is highly recommended.By John M. Gottman. New York, W.W. Norton & Co., 1999, 480 pp., $49.00. FiguresReferencesCited byDetailsCited BySSRN Electronic Journal Volume 158Issue 2 February 2001Pages 334-334 Metrics History Published online 1 February 2001 Published in print 1 February 2001

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

THERAPIST DEFENSIVENESS AND MARITAL THERAPY PROCESS AND OUTCOME

This study examined the effect of couple socioeconomic status (SES); pretherapy marital adjustment; and therapist, husband, and wife defensiveness during the third session of marital therapy on posttherapy marital adjustment. Participants were 22 therapists and 88 couples. Each therapist treated 4 couples, 2 from the middle SES level and 2 from the lower SES level. Path analyses revealed that for husbands higher marital satisfaction before therapy was associated with higher adjustment at the end of therapy, but defensive therapist behavior during therapy was associated with lower posttherapy adjustment. A similar pattern was found for wives, but this should be interpreted with caution owing to potential dependencies in the wives' posttherapy adjustment scores. Neither SES nor pretherapy adjustment predicted therapist defensive behavior in therapy, and SES did not predict marital therapy outcome variance. Results suggest that therapist defensive behavior may reflect a style or characteristic of some marital therapists.

Literature update: A critical review

There are two recent meta-analytical reviews looking at the efficacy and the effectiveness of marital and family therapy (Shadish W. R., Ragsdale, K, Glaser, R. R. & Montgomery, L. M. (1995) The efficacy and effectiveness of marital and family therapy: a perspective from meta-analysis, Journal of Marital and Family Therapy, 21, pp. 345–360; DUNN, K. L. & SCHWEBEL, A. I. (1995) Meta-analytic review of marital therapy outcome research, Journal of Family Psychology, 9, pp. 58–68). Shadish et al. have attempted to make their earlier analysis of this area more reader friendly and the paper is certainly an easier read than the original. These two papers constitute the main reviews of marital therapy over the last five years, although, regrettably, most of the papers published this decade are not included in the reviews. For example, the Shadish et al. review includes 163 randomized studies, but only through to 1988. The findings clearly show that the marital therapy group (when they excluded the family therapy group) had a significant positive effect size, although this was not universal. The authors report that marital therapy produced a significant improvement in 41% of the treatment conditions studied. The review excluded those studies where the problem was a sexual dysfunction and where only traditional sex therapy was given.

The Generalisation of Cognitive Behavioural Marital Therapy in Behavioural, Cognitive and Physiological Domains

The limited effectiveness of cognitive behavioural marital therapy (CBMT) for some couples may be due to a failure to achieve generalized changes in behavioural, cognitive or physiological responses during marital interaction. In the present study an intra-subject replication design across five maritally distressed couples assessed changes associated with CMBT in behaviour, cognitions, and physiological arousal during marital communication. These response domains were assessed weekly in both clinic and home settings. Introduction of CBMT was associated with clear reductions in behavioural negativity in both settings for all couples, some variable cognitive changes across couples and settings, but no consistent change in physiological arousal across couples or settings. Physiological responding was asynchronous with behaviour and cognition. Further research is needed on the significance of physiological arousal in marital distress, and the importance of changes in physiological responding during marital interaction to marital therapy outcome.

Meta-analytic review of marital therapy outcome research.

This meta-analytic review examines the findings of 15 methodologically rigorous marital therapy outcome studies reported in 19 journal articles. These findings were used to assess the efficacy of three treatment approaches in fostering change in spouses' relationshiprelated behavior, cognitions, affect, and general assessment of their relationship. Behavioral marital therapy (BMT), cognitive—behavioral marital therapy (CBMT), and insightoriented marital therapy (IOMT) were all found to be more effective than no treatment in bringing change in spouses' behavior and in the general assessment of their relationship. IOMT was more effective than BMT or CBMT in bringing change in spouses' general relationship assessment, while CBMT was the only approach that induced significant change in spouses' posttherapy relationship-related cognitions. The role of meta-analytic reviews of marital therapy approaches is also discussed.

Meta-analytic review of marital therapy outcome research.

Meta-analytic review of marital therapy outcome research.

Behavioral martial therapy outcomes: Alternate interpretations of the data

The data from a behavioral marital therapy outcome study were analyzed in order to better understand the phenomena involved when spouses improve in their communication skills but do not improve in marital satisfaction. Three possible patterns of marital therapy outcome for the subset of subjects who improved in communication skills but not in marital satisfaction were proposed: (a) spouses who denied their distress at pretest, obscuring any subsequent improvement in marital adjustment ratings; (b) spouses who did not effectively apply their acquired skills to problem content areas in the marriage; and (c) spouses who made a thoughtful, positive decision to end the marriage. The first two of these three proposed patterns were present among the distressed couples being studied.

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors associated with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process rating forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed.

Relationship between behavioral marital therapy outcome and process variables.

This study was conducted to identify therapist and client behaviors associated with a positive response to social learning-based behavioral marital therapy. A sample of 32 couples receiving treatment was examined. Immediately after each therapy session, the therapist, husband, and wife independently completed process rating forms that measured therapist and client behaviors during the session. Composite scales, derived from these ratings, were entered into multiple regression equations to examine their relationship with posttherapy marital satisfaction. After controlling for pretherapy marital satisfaction and the other predictor variables, therapists', husbands', and wives' ratings of positive client behavior (i.e., collaboration, active participation, and homework compliance) were positively associated with therapy outcome. Implications for marital therapy and suggestions for future research are discussed.

Marital therapy outcome measured by therapist, client, and behavior change.

The present research examined marital therapy outcome, in a sample of 88 couples and 22 therapists, through the use of multidimensional criteria from multiple perspectives. Three paper-and-pencil patient self-report instruments were used to measure different aspects of the couple relationship. In addition, therapist post-therapy ratings and objective observer ratings of the couple behavior during therapy were obtained. Past debates about what the "right" criteria might be for measuring therapeutic change prompted our strategy. Special attention was focused on those criteria that could be classified as "inside" or "outside" of the couple relationship. Data analysis revealed a significant relationship between the couples' and therapists' ratings of improvement in therapy. Additionally, husband and wife negative acts (behaviors) in therapy were also significantly correlated with therapists' ratings of improvement. Both statistically significant and clinically significant criteria were employed to evaluate the therapy outcome. Improvement due to therapy as measured by the three self-report instruments varied from 38% to 58%. These differences appeared to stem from the different kinds of information yielded by the specific tests.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data.

Evaluating Marital Therapy1

Outcome studies of marital therapy indicating a trend towards more rigorous research are reviewed. The complexities of evaluation require consideration of spontaneous remission, deterioration, values, control groups, duration and type of treatment. Multiple measures of outcome are advocated and it is suggested that, in Australia, marital therapy outcome studies have made a promising beginning.

Brief marital therapy outcome: personality correlates.

The purpose of the study was to investigate with regression analyses the relationship between personality and background variables and outcome of brief marital therapy. Twenty personality dimensions from the Personality Research Form and data on age, education, number of previous unions, number of children and number of sessions were used as independent variables. The dependent variable was provided by ratings of over-all improvement in affective communication: sexual, verbal, and social, provided by clinical records of 30 couples. The main result was that only the husband's traits were found to be important correlates of improvement in affective communication of both husbands and wives. The important traits involved husband's cognitive efficiency in the area of reflection and accurate judgement of situations, submissiveness, and sensitivity to social approval of his behaviour. The number of individual therapy sessions given to wives was also a notable predictor of improvement. Other personality and background variables were not significantly related to outcome.

Marital adjustment and sex therapy outcome

Abstract The hypothesis that an initially severe level of marital dissatisfaction limits responsiveness to sex therapy was tested. As part of a larger investigation of the predictive utility of certain patient characteristics for sex therapy outcome, 15 married couples who underwent an average of 15 sessions of conjoint treatment for sexual dysfunction completed a marital adjustment scale and a constellation of outcome measures. Support for the hypothesis was mixed. Individuals reporting milder and more severe levels of marital distress manifested equivalent levels of relationship enhancement on the Sexual Interaction Inventory. However, therapists' and, to a lesser extent, patients' posttreatment ratings indicated that more satisfied spouses of both sexes registered greater improvement on both sex‐specific and more generic outcome criteria. Although the results leave open the overall question of a linkage between initial level of marital satisfaction and responsiveness to sex therapy, they suggest the potential fruitfulness of more definitive inquiry.

Couples' Facilitative Communication Skill as a Dimension of Marital Therapy Outcome*

This study examined the relationships between three dimensions of patients' perceptions of their spouses' empathic understanding, warmth, and genuineness, and marital co‐therapy outcome. The relationships between selected therapist and treatment factors and couples' communication skill was also investigated. Results indicated (a) a positive relationship between patient‐rated outcome and final levels of rated Total Facilitative Conditions (TFC), but not initial levels; (b) a near‐zero relationship between pre‐ and post‐therapy TFC similarity and outcome; (c) positive relationships between changes in perceived TFC and outcome, but no relationship between outcome and symmetry of TFC change; (d) no relationship between treatment length and either outcome or TFC change; and (e) a significant negative relationship between co‐therapists' experience level differences and two dimensions of rated TFC change. Discussion of these findings focused on implications for the clinical practice of conjoint couples' therapy.