Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Therapy with Couples: Empirical Status

Academic journal article Journal of Cognitive Psychotherapy

Cognitive-Behavioral Therapy with Couples: Empirical Status

Article excerpt

This article briefly summarizes the behavioral, cognitive, and affective factors that have been implicated in couples' relationship problems, describes representative interventions for those factors, and reviews the current status of outcome research on cognitive-behavioral therapy for couples. Although the initial studies have provided encouraging findings concerning the effectiveness of cognitive-behavioral treatment for distressed couples, limitations in the number and scope of the studies leave many unanswered questions. In particular, studies have not assessed the impact of cognitive-behavioral couple therapy as it is conducted in clinical practice. Additional research is needed to address issues such as the relative efficacy of different cognitive restructuring interventions and the impact of integrating interventions targeting cognitive, affective, and behavioral aspects of relationship problems.

Although cognitive therapy principles and procedures initially were developed for the individual treatment of various forms of psychopathology, the past two decades have seen a rapid growth in conjoint interventions with couples and families. Cognitive restructuring strategies have been combined with interventions that were developed by behavioral marital therapists to modify destructive interaction patterns that are common in distressed relationships. The resulting cognitivebehavioral approaches focus on identifying and modifying problematic aspects of the moment-to-moment processes that occur as members of a couple interact.

COGNITIVE-BEHAVIORAL MODELS OF RELATIONSHIP DYSFUNCTION

Cognitive-behavioral models of relationship dysfunction are based on a premise that partners' satisfaction commonly depends as much on their subjective experiences of the couple's interactions as on the actual behavior that occurs in the relationship. Theory and research have identified behavioral, cognitive, and affective factors that can contribute to the development and maintenance of distress and dissolution of intimate couple relationships. Mutual impacts among partners' behaviors, cognitions, and emotions have been postulated, and some of these links have been tested and supported empirically. Concerning behavior, social exchange theory (e.g., Thibaut & Kelley, 1959) proposes that relationship satisfaction is associated with the members perceiving that they receive a favorable ratio of benefits to costs from being with their partner. Consistent with that premise, empirical findings have indicated that members of unhappy couples behave more negatively and less positively toward each other than happy couples (Weiss & Heyman, 1990, 1997). Furthermore, once a distressed couple begins to interact negatively, they are more likely to escalate the reciprocal criticism, threats, and so forth, than are happy couples. Studies also have demonstrated that particular sequences of negative behavior (demand-withdrawal; criticism-defensiveness; contempt-withdrawal) predict deterioration in couples' relationships (Christensen & Shenk, 1991; Gottman, 1994). Satisfied couples exhibit more constructive verbal and nonverbal behavior (e.g., approval, suggested solutions, smiles) than distressed couples while discussing areas of disagreement (Weiss & Heyman, 1990, 1997).

Consequently, cognitive-behavioral couple therapy includes interventions intended to increase partners' awareness of negative interaction patterns, to decrease the negative behavior, and to increase positive acts. The major interventions include communication training focused on expressive and listening skills, training in problem-solving or decision-making skills, and formal or informal "contracts" or agreements in which each person will behave in specific ways that are desired by his or her partner (Baucom & Epstein, 1990; Jacobson & Christensen, 1996; Jacobson & Margolin, 1979; Rathus & Sanderson, 1999; Stuart, 1980). It is generally assumed that it will be difficult to develop and maintain partners' positive cognitions about each other if the couple is unsuccessful in generating more positive behavioral interactions. …

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