The Handbook of Systemic Family Therapy, Systemic Family Therapy with Couples

• Publisher: Wiley-Blackwell
• Year: 2020
• ISBN:
  9781119702146
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Volume III of The Handbook of Systemic Family Therapy focuses on therapy with couples. Information on the effectiveness of relational treatment is included along with consideration of the most appropriate modality for treatment. Developed in partnership with the American Association for Marriage and Family Therapy (AAMFT), it will appeal to clinicians, such as couple, marital, and family therapists, counselors, psychologists, social workers, and psychiatrists. It will also benefit researchers, educators, and graduate students involved in CMFT.

Part I
Overview

1
Current Status and Challenges in Systemic Family Therapy with Couples

Douglas K. Snyder and Christina M. Balderrama‐Durbin

Couple therapy continues to gain in stature as a vital component of mental health services. The largest international study of psychotherapists found that 70% of psychotherapists treat couples (Orlinksky & Ronnestad, 2005). A survey of expert psychotherapists' predictions about future practices in psychotherapy showed couple therapy to be the format likely to achieve the most growth in the next decade (Norcross, Pfund, & Prochaska, 2013). Three factors likely contribute to this trend: (a) the prevalence of couple distress in both community and clinic samples, (b) the impact of couple distress on both the emotional and physical well‐being of adult partners and their offspring, and (c) increased evidence for the effectiveness of couple‐based interventions, not only in treating couple distress and related relationship problems but also as a primary or adjunct treatment for a variety of individual emotional, behavioral, or physical health disorders (e.g., Fischer, Baucom, & Cohen, 2016; Snyder & Whisman, 2003).

Couple therapy has evolved through several distinct phases (Gurman & Snyder, 2011), tracing its origins to the founding of the Marriage Consultation Center in New York City in 1929 and asserting a national identity with the establishment of the American Association of Marriage Counselors in 1942—subsequently renamed the American Association for Marriage and Family Therapy in 1978. Early marriage counselors provided advice and information, largely from an atheoretical and educational perspective; the predominant format for marriage counseling was with individuals, with emergence of the conjoint format (i.e., both partners meeting simultaneously with the same therapist) rising slowly from only 5% in the 1940s to a meager 15% by 1960. Today, conjoint couple therapy is the presumptive format for treating partner relationship distress. Interventions across diverse theoretical orientations share a common emphasis on the interaction between partners' respective behaviors, thoughts, and feelings—as well as their place in the broader context of extended family, community, and culture—thereby implicitly adopting a systemic perspective.

In this chapter we first consider the importance of couple therapy in promoting couple and family well‐being—noting both the prevalence of couple distress and its impact on individuals' emotional and physical health. We describe findings regarding the effectiveness of couple‐based interventions for treating general relationship distress as well as coexisting emotional, behavioral, and physical health problems. We also consider evidence regarding potential moderators and mediators of treatment effectiveness and the implications of these findings for integrative approaches and tailoring interventions to partner and relationship characteristics. Finally, we propose enduring challenges for the field of couple therapy—including training of couple therapists, conducting clinically relevant research, and disseminating findings in an impactful manner.

The Prevalence and Impact of Couple Distress

Couple distress is prevalent in both community epidemiological studies and research involving individual treatment samples. In the United States, the most salient indicator of couple distress remains a divorce rate of approximately 40–50% among married couples (Kreider & Ellis, 2011), with about half of these occurring within the first 7 years of marriage. Independent of divorce, many, if not most, marriages experience periods of significant turmoil that place partners at risk for dissatisfaction, dissolution, or symptom development (e.g., depression or anxiety); roughly one‐third of married persons report experiencing clinically relevant levels of relationship distress (Whisman, Beach, & Snyder, 2008). Data on the effects of stigma, prejudice, and multiple stressors experienced by various socioeconomically disadvantaged groups (Raley, Sweeney, & Wondra, 2015) as well as lesbian, gay, and bisexual couples (Meyer, 2003) suggest that these groups may experience additional challenges.

Global perspectives on the prevalence of couple distress—when operationalized by rates of divorce—vary in part as a function of first age and rates of marriage, as well as remarriage. More than 85% of people marry by age 50 across almost all countries, cultures, and religions (United Nations, Department of Economic and Social Affairs, Population Division, 2015). Although rates of marriage have declined in many developed countries since the 1970s, among those who choose not to marry the vast majority of people enter “marriage‐like” cohabiting couple relationships (Organization of Economic Cooperation and Development [OECD] Social Policy Division, 2011). Across almost all nation states of the OECD, divorce rates have increased from the mid‐ to late 1970s to the period 2000–2005. However, these divorce rates understate rates of relationship dissolution because in most Western countries couple cohabitation is now a common form of committed partnership. Cohabiting couples are more likely to experience relationship distress and separate than married couples (Hayes, Weston, Lixia, & Gray, 2010) and are 25–35% more likely to divorce following marriage (Stanley, Rhoades, Amato, Markman, & Johnson, 2010).

Importantly, the common focus on divorce or other indicators of couple distress also fails to recognize other issues that couples often present as a focus of concern, including those that detract from optimal individual or relationship well‐being. These include deficits in feelings of security and closeness, shared values, trust, joy, love, physical intimacy, and similar positive emotions that individuals typically value in their intimate relationships. Not all such deficits necessarily culminate in “clinically significant” impaired functioning or emotional and behavioral symptoms as traditionally conceived; yet, frequently, these deficits are experienced as insidious and may culminate in partners' disillusion or their dissolution of the relationship.

In a previous US national survey, the most frequently cited causes of acute emotional distress in individuals were couple relationship problems, including divorce, separation, and other relationship strains (Swindle, Heller, Pescosolido, & Kikuzawa, 2000). Couple distress covaries with overall life dissatisfaction even more strongly than distress in other domains, such as health, work, or children (Fleeson, 2004). Other studies have indicated that persons in distressed couple relationships are overrepresented among individuals seeking mental health services, regardless of whether or not they report couple distress as their primary complaint (Lin, Goering, Offord, Campbell, & Boyle, 1996). In a study of 800 employee assistance program clients, 65% rated family problems as “considerable” or “extreme” (Shumway, Wampler, Dersch, & Arredondo, 2004).

Findings from various US national surveys have indicated that compared with happily married persons, maritally distressed partners are significantly more likely to have a mood disorder, anxiety disorder, or substance use disorder (McShall & Johnson, 2015; Whisman, 1999, 2007). Additional findings from an epidemiological survey in Ontario, Canada, showed that even when controlling for distress in relationships with relatives and close friends, couple distress was significantly correlated with m...