How Couple Relationships Shape our World

Clinical Practice, Research, and Policy Perspectives

Andrew Balfour, Mary Morgan, Christopher Vincent, Andrew Balfour, Mary Morgan, Christopher Vincent

• Publisher: Routledge
• Year: 2018
• Print ISBN:
  9781855758377
• eBook ISBN:
  9780429914591
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is about the importance of the couple relationship in the broadest terms. It draws on clinical researches into the inner lived world of adult couples, empirical developmental research into children and parenting, as well as the legal setting when relationships break down. It aims to bridge the inner and outer worlds, showing how our most intimate relationships have vital importance at all levels, from the individual and the family, to the social setting - and explores the implications for practice and policy. Above all, it is a book about applications of clinical thinking linked with research knowledge, as tools for front line workers and policy makers alike. It draws on the tradition of applied clinical thinking and research of the Tavistock Centre for Couple Relationships, linking current thinking with the history of ideas in each area it covers, as well as considering implications for the future.

CHAPTER ONE

Prevention: intervening with couples at challenging family transition points

Carolyn Pape Cowan and Philip A. Cowan

Couples come to TCCR, to other clinics, and to private therapists when aspects of their relationship have broken down so that one or both partners are unhappy and at a loss for how to make things better. In recent decades, theories about how to help troubled couples have become more complex and detailed as they have attempted to match the complexity and specificity of problems that therapists and clients confront. As the field of couple therapy made significant gains over the past six decades, an alternative pathway for troubled couples emerged. This path, involving preventive strategies for helping couples, was guided by the strong belief that it is both possible and desirable to intervene early as relationship processes are unfolding, to prevent severe relationship distress from taking hold, or to reduce the severity and aftermath of couple dysfunction when it occurs. The preventive intervention pathway is the main focus of this chapter.

From the current high incidence of couple dissatisfaction and divorce and the increasing tendency of couples not to marry (Cherlin, 2009; ONS, 2009), it is clear that couples face a daunting challenge in their attempts to maintain an intimate romantic relationship over a lifetime. While clinicians and marital researchers know that peaks and valleys in distress levels are to be expected, most partners who begin relationships in a rosy glow are caught off guard when their satisfaction drops and their relationship feels tenuous. We argue here that it makes sense to help couples to deal with troubling relationship issues before a cumulative downward spiral leads to even more serious problems that feel intractable and impossible to resolve.

We begin by describing what we mean by preventive intervention. Next, we define the concept of family transitions in an attempt to rescue the term from its vague current usage in which any change in an individual is described in transitional terms. To provide empirical weight to our argument, we present evidence from studies of preventive interventions designed to help partners who are approaching marriage, making the transition to parenthood, shepherding a first child into primary school, or sorting out their decision to divorce. We use these accounts of empirically validated interventions as a basis for speculation about other family transitions in which interventions with couples might produce beneficial results for parents, children, and the relationships between them. Finally, we present several examples of ways in which our perspective on preventive interventions for couples might have implications for the way governments and foundations allocate funds to support and strengthen couples and families.

Defining prevention

The concept of prevention emerged first in the field of public health and then in the fields of community psychology and community psychiatry. The public health example that provides a core definition of prevention harks back to the time when attempts to treat widespread outbreaks of yellow fever were based on two discoveries—(1) the elimination of polluted wells and marshlands after it was established that they were breeding grounds for mosquitoes (i.e., reducing risk), and (2) the development and distribution of a vaccine that substantially reduced the likelihood of an individual contracting yellow fever (i.e., enhancing personal resources to ward off risk). In the field of public health, prevention was initially defined in absolute terms—whether or not the actions taken resulted in the occurrence or elimination of the disease. In the fields of community psychiatry and community psychology, the criteria for whether a preventive intervention could be deemed successful were, and still are, less clear cut. A preventive intervention does not necessarily eliminate individual or relationship distress, but it does reduce the probability that the distress will occur in a specified population and/or reduces the severity of the problem when it does occur.

Based on the fact that interventions can occur at various points in the unfolding of a problem, theorists have identified three levels of prevention.

Primary prevention refers to interventions that inhibit the development of a problem, disorder, or disease before it occurs. This level draws heavily on the medical metaphor of vaccinations in which one injection may be adequate to ward off a specific disease. In reality, we are unlikely to find such a potent substance in the field of couples work. It is probable that “booster shots” will be needed along the life course, and that new interventions will be required as family members face the new challenges associated with expectable and unexpected life changes.

Secondary prevention involves detection and treatment of a problem early in its occurrence. Couples who have a solid relationship but experience a stormy period while their children are young might enrol in a course or workshop, hoping to learn some strategies to help resolve their current disequilibrium or lower their level of distress.

Tertiary preventions such as psychotherapy or couples counselling by mental health professionals or religious leaders are designed to reduce the debilitating outcomes of already existing problems and restore adequate functioning to the individual partners or the relationship—for the health and well-being of the parents, the children, and the family.

The definition of what constitutes primary, secondary, and tertiary prevention depends on how wide a lens we apply to the desired outcomes. For example, we would have no trouble describing the process of therapy with a couple on the brink of divorce as tertiary prevention. The therapist and the couple are working together to mitigate the severity of the marital problems and to restore some degree of positive couple interaction, if only to work collaboratively on parenting their children. But from the vantage point of children’s well-being (not often considered in the couple therapy literature), the couples therapist may be engaging in primary prevention by helping the parents establish a collaborative co-parenting relationship, regardless of whether their marital relationship remains intact. The distinctions among primary, secondary, and tertiary prevention become relevant when planners are considering how wide a net to cast for a new programme or how narrowly defined and targeted the intervention should be.

Why, when so many couples are already in distress, should we be thinking about devoting scarce resources to prevention? We propose that the need for an approach that offers help to couples at times of major family transitions can be justified by a set of well-established research findings. More than thirty studies in a number of Western industrialised countries reveal that, on average, couples begin their marital or cohabiting relationships high in marital satisfaction, but their satisfaction declines over the next fifteen years (Hirschberger, Srivastava, Marsh, Cowan & Cowan, 2009). By that time almost half of the couples’ descriptions of their relationship are comparable to those of partners enrolled in couple therapy—they feel disappointed, unhappy, angry, misunderstood, and so on. The point here is that studies in the US, Canada, the UK, Germany, and Israel indicate that it is normative for couples to fight more or be silent more and to evaluate their relationship more negatively after being together for some years. We think of preventive intervention because almost half of the couples with these kinds of relationship difficulties ultimately dissolve their marriages.

The normative slide in couple relationship satisfaction is debilitating for the partners, of course, but it also poses a risk for the couples’ children. In the last three decades, a growing body of research indicates that dysregulated conflict between the parents (arguments out of control or long-standing patterns of not expressing emotion) is likely to have negative effects on the quality of each parent’s relationship with the children and on children’s social skills, academic competence, and emotional well-being (e.g., Shelton & Harold, 2008). That is, whether partners stay together or separate, failure to resolve their difficulties increases the probability that their children will also suffer the consequences.

In sum, given the prevalence of couple conflict and distress, the negative effects on both partners and their children, and resulting costs for the family and society, it makes sense to provide services earlier in the life of a couple (primary prevention) or earlier in the course of relationship breakdown (secondary prevention).

Defining family transitions

Some of the early work on transitions emerged in England. Rhona and Robert Rapaport (1977), pioneers of community psychiatry, attempted to apply Erik Erikson’s theory of normative intrapsychic crisis as necessary for growth to non-normative catastrophic events (natural disasters, personal losses). Like Gerald Caplan in the United States (1964), the Rapaports argued that the disequilibrium associated with these events produced crises, but that crisis embodies both danger and opportunity for growth, as in the Chinese ideograph. In his explorations of grief and mourning, Colin Murray Parkes (1971) argued that transitions are not so much defined by events as by changes in one’s “assumptive world”. Previously held premises about how the world works no longer apply. Expectations about how roles should be defined and relationships operate are questioned. Not every aspect of one’s view of the world is reorganised during what Parkes called “psycho-social transitions”, but rather, seeing the world through new eyes can result in both positive and negative short-term and long-term outcomes. Others’ work on transitions in the United States looked to stress and coping models to examine how individuals reacted to stressful life events (Lazarus & Folkman, 1984) and whether these reactions were adequate to meet the external challenges.

Elsewhere, one of us (P. A. Cowan, 1991) attempted to provide an integrative definition of individual and family life transitions as long-term processes that result in a qualitative reorganisation of both inner life and external behaviour. Passing a life marker (entering school), or completing a life milestone (getting married) does not in itself signify that a transition has been completed. The inner view refers to changes in one’s sense of self or identity, one’s assumptive world and affect regulation system. The complementary view from outside focuses on a reorganisation of life roles, a restructuring of coping systems to meet new challenges, and a reorganisation of central relationships. For example, a man who takes some time off during the week his son is born and then returns to his office as planned to continue his life as before, has become a father but not necessarily made the transition to parenthood. Another new father recognises changes in his sense of himself, develops new views about his responsibilities to family and community, and initially feels somewhat out of control. He shifts his arrangement of family and work responsibilities, learns new skills, and attempts to deal with the fact that his relationship with his partner is now on the back burner. With qualitative changes in both his inner and outer life, this man is in the process of making a major life transition.

Theories about the developmental crises associated with life changes generally describe two kinds of life transitions—normative and nonnormative. Normative transitions are expectable life changes experienced by many or most within a culture. Almost all children experience developmental stage transitions (as defined by Freud, Erikson, or Piaget) and entrance to major social institutions (child care, primary school, secondary school). Transitions to adolescence, leaving home, and becoming an adult are major normative post-childhood life changes. Entering the world of higher education is normative for many, as is becoming employed, establishing an intimate relationship with a partner, moving in together, getting married, becoming a parent, and having more children (in either order). Other mid-to late-life transitions include changing jobs or careers, moving house, becoming a grandparent, caring for elderly parents, and the death of a parent or spouse. Non-normative transitions for children include moving far from friends, accidents that result in serious injuries, and the sudden illness or loss of a parent. For adults, unemployment or job loss, chronic ill health of a family member, and being the victim of violent crime or a natural disaster are nonnormative transitions. In contemporary society, divorce is on the border between normative and non-normative—frequent enough to be considered expectable, yet not expected by most couples when they marry. A central factor associated with labelling a transition as normative or non-normative—expected or not—is whether it occurs on time or out of time. Women having babies in their late teens through to early thirties are entering a normative transition. A woman becoming a mother for the first time in her late forties is entering a non-normative transition.

Although most empirical studies focus on only one life transition at a time, the definition of transitions implies that there is a generic set of processes involved in both normative and non-normative transitions. For example, having a first child (normative) and being a victim of an earthquake (non-normative) are not similar on the surface but, except for the suddenness of the latter, they can both lead to reorganisations of one’s internal and external worlds. This is the prime contribution that transition theory has made over the past decade—the idea that expectable and desired transitions may create a kind of disorder and displacement in one’s personal life and relationships, just as unexpected and unwanted transitions do.

So far we have focused on the individual in transition. Yet, individual life transitions almost always occur in a family context. In becoming parents, both partners are involved in the “same” life event, but may make the transition to parenthood in different ways at different times, with each partner’s reorganisation of self, roles, and relationships influencing the other’s. A child entering adolescence is not only making a developmental transition of his/her own but also causing waves of change in the other adult and child family members. The systemic view of transitions leads us to see that the issue is not simply that one person’s life changes have ripple effects throughout the family; there are usually also simultaneous but different transitions in the generations of the family. Parents who are getting divorced may have a child entering adolescence or heading for college. An adolescent entering the world of sexual relationships may have a parent changing careers or entering menopause and grandparents who are retiring or facing problems of ill health. No matter where in the generations transitions occur, they are likely to have effects on the relationships between adults and children, with important implications for the children’s well-being or distress.

What implications does this formulation of transitions have for thinking about preventive interventions for couples? Our definition of major life transitions indicates that whatever the life change event, individuals and couples will be attempting to cope with shifts in both their inner life (identity, emotions, worldview) and social world (roles, competencies, relationships). Although such profound qualitative changes mean that both normative and non-normative transitions have the potential to place individuals and couples at risk for mild to serious levels of distress, they also have the potential to lead to developmental growth and a sense of competence if the individuals and couples find effective ways to meet new challenges successfully. Because developmental challenges bring family coping strategies into sharp relief, the choice to study or intervene with families as they face major life transitions is an excellent strategy for identifying family processes that facilitate or impede the healthy development of children and their parents.

We are not suggesting that it is desirable or practical for couples to receive psychological help from couples therapists or counsellors as they go through every normative and non-normative transition they face in a lifetime together. Rather, taking advantage of help when a major life transition creates more disequilibrium than a couple can manage can strengthen their relationship so that they are better prepared to handle the next ones they face.

Preventive intervention for couples at five family transition points: the evidence base

The transition to marriage. There has been considerable effort since the mid-twentieth century by university-based programmes, couples counselling organisations, and religious institutions to provide pre-marital counselling/education to partners about to marry. The programmes enrol couples in small groups, classes, or weekend workshops, with a curriculum that typically focuses on teaching communication skills. The best known, most well-validated programme—Premarital Relationship Education Program (PREP) (Markman, Stanley & Blumberg, 2001)—has shown long-term positive effects on couples’ marital stability and quality. A small significant proportion of these couples do not go through with the marriage—an outcome the investigators view as a positive consequence of considering their relationship in some depth before committing to a lifetime together.

Three early childrearing transitions. Over the past three decades, the authors of this chapter have been devising and evalu...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• About The Editors and Contributors
• Foreword
• Introduction: How couple relationships shape our world: clinical practice, research, and policy perspectives
• Chapter One: Prevention: intervening with couples at challenging family transition points
• Commentary on Chapter One
• Chapter Two: Parents as partners: how the parental relationship affects children’s psychological development
• Commentary on Chapter Two
• Chapter Three: How couple therapists work with parenting issues
• Commentary on Chapter Three
• Chapter Four: The role of the family court system of England and Wales in child-related parental disputes: towards a new concept of the family justice process
• Commentary on Chapter Four
• Chapter Five: Working therapeutically with high conflict divorce
• Commentary on Chapter Five
• Chapter Six: Depression, couple therapy, research, and government policy
• Commentary on Chapter Six
• Chapter Seven: Approaches to researching the evidence: an exploration of TCCR’s research into couple relationships and couple therapy, past and present
• Commentary on Chapter Seven
• Chapter Eight: Couple therapy—social engineering or psychological treatment?
• Commentary on Chapter Eight
• Chapter Nine: Her Majesty’s department of love? The state and support for couple and family relationships
• Commentary on Chapter Nine
• Chapter Ten: Supervision: the interdependence of professional experience and organisational accountability
• Commentary on Chapter Ten
• Index