Academic journal article Journal of Marital and Family Therapy

The "Coming of Age" of Couple Therapy: A Decade Review

Academic journal article Journal of Marital and Family Therapy

The "Coming of Age" of Couple Therapy: A Decade Review

Article excerpt

The article overviews significant developments in couple therapy over the last decade. Key trends include: (1) couple therapy becoming firmly established as the accepted treatment of choice for couple problems, (2) the blossoming of the science of relationships, (3) strong evidence supporting the effectiveness of couple therapy both for relationship problems and DSM disorders, (4) greater understanding of the ramifications of gender, (5) new respect for the diversity of family forms, (6) increased accent on the role of emotion, (7) the influence of postmodernism, (8) greater recognition of couple violence, and (9) the move toward integration across models of treatment.

The acceptance and utilization of couple therapy has increased enormously during the last decade. Whereas it was once the treatment of last resort, couple therapy is now the preferred mode of treatment for relationships in significant distress in much of our culture. There is no doubt that there is an increasing demand for this kind of therapy. Distress in an intimate relationship is recognized as the single most frequent presenting problem in psychotherapy. Nearly 50% of first marriages and an even higher proportion of remarriages are ending in divorce. A growing number of practitioners are trained to do couple therapy. The American Association of Marriage and Family Therapy (AAMFT) now has more than 20,000 members, almost all of whom see couples regularly. Marital and Family Therapy has advanced substantially in obtaining licensure, and more professionals in related fields such as psychology and social work are specializing in couple therapy. Over the last decade, an understanding has also clearly emerged that couple therapy requires distinct training and a specific set of skills.

Has couple therapy now come of age as commentators such as Gurman and Jacobson (1995) suggest? We would suggest that a treatment modality requires a clear description of the problems it addresses and a way to predict adjustment and distress to be considered mature. It also needs some unifying theoretical frameworks for the phenomena addressed-in this case, adult love relationships-and interventions that are documented to be effective. In this review, we consider developments in our understanding of relationships and relationship problems. We also address interventions and how empirical research has contributed to the growth of the field. In the final section, we summarize some of the main issues and themes that have arisen in the last decade and comment on whether the field of couple therapy has, in fact, come of age. Such a review necessarily reflects the viewpoints of its authors. Because of the importance that we assign to scientific investigation and the remarkable developments in the science of relationships over the last decade, we particularly accent therapies and aspects of relating that have been investigated empirically. However, in our view, couple therapy remains both an art and a science.


Before the emergence of a systemic paradigm, views of couple process and methods of couple intervention were principally extrapolated from abstract theories of individual adaptation and change. The systemic perspective radically changed this, bringing into focus the need to understand couple process as an entity. Building on research of the previous two decades, the 1990s have seen the maturation of a coherent science of the basic elements of relationship distress and satisfaction.

The work of John Gottman (1994) and his colleagues (Heavey, Christensen, & Malamuth, 1995) is seminal in this area. Their research underlines the power of negative emotions and highly structured interaction patterns, for example, criticism and contempt responded to with distancing and stonewalling, to predict the future of a relationship. As such patterns become pervasive in a relationship, emotional engagement becomes impossible to sustain and polarization and distance accelerate the process of relationship dissolution. …

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