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Author Topic: Myths and Mistakes of Marital Therapy ~ John M. Gottman Ph.D.  (Read 748 times)
BorisAcusio
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« on: July 28, 2016, 12:35:03 PM »

Marital therapy effects: little or nothing with high relapse
Chapter 1, Myths and Mistakes of Marital Therapy
Excerpts from: The Marriage Clinic: A Scientifically Based Marital Therapy (Norton Professional Books) 1st Edition
by John M. Gottman Ph.D.
W. W. Norton & Company; 1 edition (August 17, 1999)
ISBN-13: 978-0393702828


Pages 4-5
More people seek therapy for marital problems than a any other type of problem (Veroff, Kulka, & Douvan, 1981). But how effective is the most sought after form of help? The largest effect sizes found in meta-analysis were those for behavioral marital therapy (for a review of those meta-analyses, see Bray and Gerald 1995). There are two ways to get a large effect in such a meta-analysis. One is by having a large experimental group effects. The other is by having a large deterioration in no-treatment control groups.

Indeed, when Jacobson (1984) reanalyzed data from four of his behavioral marital studies (which had among largest defects), he reported that, although 55% of the couples improved after treatment, only 35% were in the nondistressed range at the end of therapy. He concluded the significant effect sizes in controlled marital therapy studies may exist largely because people tend to deteriorate in the waiting list control groups. Jacobson Addis (1993) wrote, "success that investigators have had establishing these effects for their preferred treatments is not impressive as first thought. Improvement rate in the absence of treatment is so low that even small changes in the experimental treatment are likely to be statistically significant.”

Furthermore, a pervasive problem exists for almost all marital therapies that have been systematically evaluated using a long-term follow-up (as a minority of studies): a ubiquitous relapse effect. Of the couples that make some initial gains in therapy, a sizable percentage of these couples, about 30 to 50%, relapse in two years (Jacobson and Addis, 1993). Something like the second law of thermodynamics seems to function in marriage - that is, marital distress exist, things usually deteriorate (entropy increases). Therapeutic effects of the therapies that have been scientifically evaluated are generally weak, and there is a very high relapse rate.

What affects, in general, does marital therapy have? In our longitudinal study we have typically found a strong positive correlation (about .50) between having been in marital therapy and getting divorced. Is our result representative? The best study we have available on what therapy is "out there" that is, non-university based therapy, was done by Cookerly in 1980. Cookerly conducted a five year follow-up of 326 clients treated by a wide variety of marriage therapies in the US. The separation/divorce rate was 43.6% after five years. The highest separation/divorce rate occurred in the first year after therapy. These rates are considerably higher than base rates would lead one to predict. So marital therapy appears to be a reliable vehicle towards divorce!

To summarize, after taking a hard look at relapse rates, our current best estimate is that for about 35% of couples, marital therapy is effective in terms of clinically significant, immediate changes, but that after year about 30 to 50% of lucky couples who made the initial games relapse. This means that we all can claim is that in the best studies, conducted in universities with careful supervision, only between 11-18% of couples maintain clinically meaningful initial gains when treated with our best marital therapies. What must the actual success rate be in real clinical practice, with standards of training, treatment adherence, and supervision are generally lower, if not absent altogether? I think that we must conclude that it is likely that we have intervention method all to that nets relatively small effects, and we have a huge relapse problem.

Pages 8-9
Perhaps the most influential theory of marital therapy is the "active listing model". This model forms the basis most marital treatments (see Gottman, Coan, Carrere, and Swanson, 1998; Jacobson and Margolin, 1979). Hypothesis is that stable, happy marriages are characterized by active, empathetic listening during conflict resolution, and that Italy marriages are characterized by the absence of this quality. That is, in order to have a happy, lasting marriage, partners need to be able to be nondefensive and empathetic listeners, even when they feel they are being attacked by their spouse. In most marital therapies this assumption is translated into some form of listener-speaker exercise…

There is a superbly conducted study by the Munich group, Hahlweg, Schindler, Ravensdorf, and Brengelmann (1984). They followed gurneys method precisely, comparing his active listening with the behavioral treatment that combined behavior exchange plus problem solving training. To their credit they also used observational methods, and they had follow-ups at six months and a year. They reported that in the short term:

  • Active listening show decreases negative interactions with no increases in positive interactions

  • Behavioral intervention showed both decreases negativity and increases in positivity.

In the long term, Hahlweg et al wrote, couples in the behavioral group reported significant and stable increases of quarreling behavior compared to couples in the active listening group, who return to pretreatment levels. On their communication self-report scale couples in a group remained stable, whereas couples in the active listening group relapsed to pretreatment levels. In assessing the clinics sick significance (not just statistical significant, of results, the typical couple in the behavior group scored within the “happy” ranges of marital quality whereas a typical couple in the active listening group was within the “unhappy” range.
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« Reply #1 on: January 22, 2017, 11:57:56 AM »

Part of the difficulty with this is that I did not see it discuss at what point people come to marital counseling.  

The biggest issue my MC had with MC effective rate is the high likelyhood that most couples were coming as a "last ditch effort" to see if there was any point in trying any longer.  So basically people were coming to see her, wanting to split up, but wanting reassurance that there was nothing left to save and they could leave "guilt free."  They only took initiative to seek counseling AFTER they were already worn down and pretty much had given up.

That is a huge difference if folks actually come early on in their relationships BEFORE resentments build and set in.

She had told me that once resentments set in, that it was hard (close to impossible) to overcome.  Yet, this is the stage folks seek counseling, after dysfunctional patterns have set in and they have a set "poor" way of "working together."

They often seek counseling AFTER one has turned away from the marriage via cheating and the non cheating spouse wants to blame, or overcome the affects or such.

Now, how about measuring the affective rate of couples who enter counseling to cope with minor conflicts BEFORE any huge life events have happened such as kids, death, or such.  Couples who feel they are not doing their best connecting to their partner and want to support one another but feel like they are simply sometimes missing it.  Couples who harbor no resentments of any indiscretions?
I think this would be worth my read.  Cause I am the type to seek help before patterns of disrespect set in.

Sadly, my past MC have told me, couples counseling really turns into her helping both couples seperate as peacefully as possible.  Which, yes, this is a devastating time and certainly worth its time and resources in session often.  Yet, if that is the case, then imo, the MC I got with my ex was very effective, even though we did not stay together.  So maybe change the measure of the effectiveness so it is NOT dependent on the outcome of the couple staying paired.  Even when my partner and I were splitting, we attended sessions, and they were quite effective in descalating what could have been abusive and dangerous times.  I was leaving with my son.  Preventing domestic violence and giving us both ways to manage stress, resolve in our mind some things, and disagree in the most peaceful way a couple can during such a time, to me, was quite valuable.
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How wrong it is for a woman to expect the man to build the world she wants, rather than to create it herself.~Anais Nin
MzAnneThrope

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« Reply #2 on: February 07, 2017, 11:22:35 AM »

There also seems to be an underlying assumption here that all (or even many) marital unions indeed should be salvaged, when that is by no means always the case.

If both parties share a certain level of willingness to honestly examine and address their own issues and work toward achieving a healthier relationship (provided that no safety issues exist regarding emotional or physical abuse or intimidation by either party), couples' counseling can potentially prove very helpful, but that does not necessarily mean that both people will ultimately choose to remain together.

That isn't an indictment of marital counseling, but merely a reflection of the fact that not all marital relationships are destined to be equally beneficial to both members of the couple in the long term.

We are drawn to intimate relationships for various reasons (mainly having to do with our early histories, I believe), and what initially attracts two people to form an emotional bond is most certainly not always healthy, or desirable to maintain indefinitely.
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« Reply #3 on: February 12, 2017, 06:43:00 PM »

Sadly, my past MC have told me, couples counseling really turns into her helping both couples separate as peacefully as possible.  

I'm not sure this is universally true or true in most cases as you r past counselor presented. The study above cites the separation/divorce rate was 43.6% within five years.

She had told me that once resentments set in, that it was hard (close to impossible) to overcome.  Yet, this is the stage folks seek counseling, after dysfunctional patterns have set in and they have a set "poor" way of "working together."

This is Gottman's theory (the author above).

  • Active listening show decreases negative interactions with no increases in positive interactions

  • Behavioral intervention showed both decreases negativity and increases in positivity.

The central point of this book excerpt is to point out that teaching active listening skills (which is what most therapists do) is not enough to recover most conflicted relationships - that also needed in change in the behavior of one or both parties to truly improve relationships.
 
Gottman's suggests that to so would increase the initial success rate which he pegs at 35% and reduce the relapse rate (50%).

And yes, earlier therapy would help our members. And therapy is not a panacea - its a "hail Mary". It's success rate is low (35%), but at the same time much higher that alcohol abuse recovery.
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« Reply #4 on: February 12, 2017, 08:59:49 PM »

Excerpt
I'm not sure this is universally true or true in most cases as you r past counselor presented. The study above cites the separation/divorce rate was 43.6% within five years.

She was speaking in terms of "couples counseling" (sorry for the use of MC prior, as is because that seems to be an understood abbrev.) so the couples are not needing to be legally married, hence there would be no divorce or "legal separation" statistic tied to that? Unless your 43.6% includes non married couples who break up? (Idk, not being sassy, just clarifying)

I was in couples counseling twice.  (Actually three times, but with two different partners)
Neither time was it for someone who I was married to.  (Yet both times, in my head, the person and I were as committed as any married couple)
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How wrong it is for a woman to expect the man to build the world she wants, rather than to create it herself.~Anais Nin
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