Download - Couples Therapy
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Couples Therapy
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Couples Therapy
20% of couples have marital distressHalf of marriages end in divorce10-15% separate in 4 years70% last a decade
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Couples Therapy
Couples therapy is the only evidence-based treatment.
Aimed at marital difficulties but also preventive and enrichment work.
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Couples Therapy Marital distress brings
work difficulty, health problems, problems with children.
Marital difficulty Psychopathology
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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.
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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.
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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.
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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.
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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....
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Treatment Approaches
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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.
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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.
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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.
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Cognitive-Behavioral Couples Therapy
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).
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Cognitive-Behavioral Couples Therapy
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.
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Cognitive-Behavioral Couples Therapy
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.
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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.
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Integrative Behavioral Couples Therapy
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.
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Integrative Behavioral Couples Therapy
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.
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Integrative Behavioral Couples Therapy
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.
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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
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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.
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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
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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
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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
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Narrative Couples Therapy
Change happens when couples modify their views of themselves and others
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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”
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Feminist Couple Therapy
Intimacy achieved with equality
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Special Problems
Sex therapyInfidelity problemsviolence
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Ethical Issues
Confidentiality and record keeping
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Research Assesing Effectiveness of Couple TherapyCouple therapy is as effective as individual
therapy.High return problems
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Couples Therapy
Günce HazmanSeradil Eylül Uyal