Article summary with Research on the treatment of couple distress by Lebow a.o. - 2012

Research on the treatment of couple distress
Lebow, J. L., Chambers, A. L., Christensen, A., Johnson, S. M. (2012)
Journal of Marital & Family Therapy, 38, 145-68

Epidemiology

Couple distress continues to number along the most frequently encountered difficulties.

Couple distress has a strong relation to an individual’s level of mental and physical problems. It may have a causal role in the generation and maintenance of individual psychopathology. The presence of diagnoses and relationship distress is circular, each begets the other.

The effects of relationship distress are also salient throughout the family system. It also leads to poorer treatment outcome in the treatment of disorders.

Advances in assessment

There have emerged a number of well-validated measures of couple functioning.

Meta-analytic and effectiveness studies

Studies show that most couple therapy has an impact, with about 70% of cases showing positive change.

Integrative behavioural couple therapy

Integrative behavioural couple therapy (IBCT) includes aspects of private experience (such as emotions) and emphasizes concepts such as acceptance and mindfulness in addition to the typical cognitive-behavioural strategies. It focuses on broad themes in partners’ concerns and puts a renewed emphasis on a functional analysis of behaviour. IBCT emphasizes emotional acceptance as well as behavioural change and creates joint awareness of the difficult patterns couples get into and an emotional distance from those patterns so that couples can look at them more objectively. It emphasizes contingency-shaped change, in which change occurs by exposing partners to new experiences that create contingencies that shape new behaviour.

In IBCT, there is no delay in focusing on long-standing issues. This may account for the slow, but continual increase in satisfaction.

Behavioural couple therapies produce substantial improvements in even seriously and chronically distressed couples. Those improvements are maintained for a substantial portion of the couples for 5 years after treatment termination. Potentially important variables that may predict response to treatment are arousal and language during difficult problem-solving discussions.

Emotion-focused therapy

Emotionally focused couple therapy (EFT) is a couple intervention that is based on a humanistic, experiential perspective that values emotion as an agent of change and on an attachment orientation to adult love relationships.

The active ingredients in EFT are depth of emotional experience in key sessions and the shaping of new interactions where partners are able to clearly express attachment fears and needs and be emotionally responsive to the other’s needs. The empirical base of attachment is the model of intimate relationships that is the foundation of EFT.

Emotion-focused couple therapy focuses on affect regulation and the creation of a secure connection that fosters resilience. This is particularly applicable to couples whose relationship is impacted by traumatic stress and the symptoms of PTSD.

Therapist interventions associated with change are evocative questioning, heightening emotional engagement, and shaping enactments.

Couple therapy for specific couple difficulties

Treatment for couple experiencing infidelity has three phases. These are: 1) coping with the initial emotional and behavioural disruption, 2) exploring factors contributing to the onset or maintenance of the affair 3) reaching an informed decision about how to resolve the issues.

Couples group therapy is the most effective in decreasing violence.

Treatment of DSM axis I and axis II disorders with couple therapy

Couples therapy is helpful in the treatment of disorders conceived of through the lens of individual diagnosis. The proximate goal of improving the couple relationship is a step toward improving individual problems.

A couple’s relationship is characterized by elevated levels of relationship dissatisfaction and dysfunction when there is one partner in the couple who has a substance use disorder. Relationship discord is often a precursor to relapse. Behavioural couples therapy (BCT) for alcohol and substance use disorders has an alcohol-focused component, and a relationship-focused component. These treatments are efficacious in treating alcohol and drug substance use disorders. BCT has also been found to have an effect in reducing marital violence.

Couples therapy has been established as an evidence-based treatment for depression. It has also been shown useful in the treatment of anxiety, and  borderline personality disorder.

Process studies

A good couple-therapist alliance needs to be formed within the first few sessions of therapy to prevent premature termination of the therapy. It predicts improvement in marital distress. Split alliances, especially when the male’s alliance is lower, present special challenges for couple therapy.

Principles of couple therapy

Five principles of couple therapy that transcend approach are: 1) dyadic conceptualization challenging the individual orientation view that partners tend to manifest, 2) modifying emotion-driven maladaptive behaviour by finding constructive ways to deal with emotions, 3) eliciting avoided, emotion-based, private behaviour so that this behaviour becomes public to the partners, making them aware of each other’s internal experience, 4) fostering productive communication, attending to both problems in speaking and listening, 5) emphasizing strengths and positive behaviours.

Common factors in couple therapy are: the expanded relationship system, the generation of new hope in the context of demoralization, a systemic viewpoint, adapting to client state of change and intervention strategies that work with emotion, cognition and behaviour.

Transcendent aspects of relationships need to be addressed in an effective couple therapy. These are: attachment, exchanges, skill building, attributions, biology, and personal histories.

Conclusion

A taxon of distressed marriages can be separated from the broad ever-changing continuum of levels of marital satisfaction. There are two populations that seek out marital therapy that can be treated as distinct. Those that are beyond the threshold for distressed marriages with all the factors that accompany distressed marriages and everyone else.

There are circular and pernicious cycles that occur between marital distress and individual psychopathology.