Talk:Family therapy

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Family Systems Therapy redirect vs Family Therapy

Typing "family therapy" in the Wikipidia search bar redirects you to the page "family systems therapy". This seems to mean that "family therapy" and Family Systems Therapy are unqustionably synonymous. However, the term Family Systems Therapy is used in various ways

a) as a synonym for family therapy as here, in a kontext where branches of family therapy for which the title FST would not be appropriate just are not mentioned

b) in a narrower sense for schools of family therapy which are seen as in some ways inspired by General Systems Theory

c) In a very narrow sense for the approach of Murray Bowen.

Moreover there is also "systemic family therapy" (term often used in Europe), which again maybe is synonymous with FST in the sense b), maybe not. I think it would be better to have an article named just "family therapy" as it is more general and more internationnally accepted term.

The article obviously needs expanding, epecially bringing it more up to date. It is a quite briliant summing up of family therapy or FST as it was seen 30 years ago, but there have been very important developments since then, and these would be better expalained under the heading "family therapy" rather then FST.

At this point, when the article is in the stub stage, it does not seem usefull to me to include all this terminological hairsplitting into the body of the article.

Would be glad if someone reacts to this. Georgius 13:17, 27 Nov 2004 (UTC)

There is also a redirect in place that sends "Marriage and Family Therapist" here - that is a license designation more than a practice or theory - it should have its own small article describing the licensing requirements and then it should have lots of links to articles like this one and to psychotherapist, etc. Steve 19:19, 1 January 2007 (UTC)

Cleanup Taskforce

Well, the whole paragraph about Nathan Ackerman was duplicated, for what that's worth. I'm at a loss, though. Does every theorist mentioned here deserve a separate article, or should we just break this one up into sections (and if so, what do we do with the Ackerman article?) This is too big of a decision for me (and yes, that was a cop-out). Also, since all the information on the theorists was added in large, unwikified chunks, should we suspect copyvio? JP | Tark 02:50, 30 Apr 2005 (UTC) [copied here from Wikipedia:Cleanup Taskforce/Family therapy — Knowledge Seeker দ 09:23, 30 Apr 2005 (UTC)]

Yikes! It certainly looks that way (copyvio-like). My cursory Google search only turned up WP mirrors, though—it's been in the article for a long time. I'll try some more detailed searches tomorrow. — Knowledge Seeker দ 09:23, 30 Apr 2005 (UTC)

I am the author of the "copyvio-like" article. I "copied" it (slightly edited) from a paper I wrote for a Family Therapy course (hence its academic tone). Thus, there is no copyright violation. I wrote the paper in the early 1980s, so the estimate given by Georgius is fairly accurate (and thank you, Georgius for calling it a brilliant summary--I rather liked it, too, hence my decision to share it here). If copyright concerns were the only factor in deleting it, please feel free to restore it, although of course the questions regatding detailing each theorists' theories in this one article remains. I happily offered the paper, and I'll leave it to those more involved in the structure of Wikipedia to determine how best to use it. But as to copyright issues, fear not.

Thanks for sharing your work (which I'll accept as authentic unless someone presents evidence to the contrary, though a specific name and citation would help, from either Knowwledge Seeker or 71.108.18.201)! I've reverted the revert, and we can continue to move on from there. I'd love to see more on Murray Bowen. --NealMcB July 7, 2005 04:09 (UTC)

I'm splitting this up into articles on each (there is tons of information on each of the founders out there. However I am leaving the resynthesis/comparison of all of the different approaces to someone more knowledgeable in the field. --Meawoppl 23:57, 31 July 2005 (UTC)

merge from "Couple and family therapy"

Given both articles start Couple and family therapy is there a reason they should not be merged with a redirect. Although that article is purely US in scope and would need expansion -- Paul foord 06:30, 7 February 2006 (UTC)

I concur with the above, both seem to touch on virtually the same core subject matter. Netkinetic 07:00, 7 February 2006 (UTC)

I would just like to comment that this page is inaccurate as to the scope of practice for MFT's. Currently MFT's are able to work with families, individuals and children in multiple settings including individual and group. They can however also work in agencies and many work in academia, as college and school counselors and in administration. The field is expanding on the scope of training provided to MFT students and the jobs they get after they graduate and/or become licensed.

Re removal of the majority of external links by SiobhanHansa

(1) The relevant policy WP:NOT would not appear to have clearly defined the previous list (including the most recent additions by 192.102.230.171 and 74.135.42.89 – NB, not me, and I don’t know them) as being a “directory”.

(2) The links in the list might appear to have met the following criterion in the guidelines in WP:EL

“1 Any site that does not provide a unique resource beyond what the article would contain if it became a Featured article.”

However, a very great proportion – possibly the majority – of pages containing external links would likely fail on that single criterion.

(3) The list retained by SiobhanHansa is arbitrary (with the exception of the one dead link removed), and with all due respect, reveals an unfamiliarity with the field of Family therapy. The field is highly political, ideological, and values-based – and this has very real implications for those seeking help, who can be left bewildered and demoralized by the “help” that they are offered by the mainstream of the profession. There is for example, growing disaffection with the main representative body – the AAMFT. The AACFT (that 192.102.230.171 and 74.135.42.89 attempted to link) was in part set up as a direct response to this disaffection (NB: I have no personal connection to this organization).

The article has moved some way toward a recognition of these issues via the additions and modifications by various editors over time. But to fairly and accurately convey the degree of diversity and divergence of views in the field would require a very great expansion of the article in a way that would probably not be of great interest to the general public, and would almost certainly fail to achieve a consensus amongst “insiders.”

The various organizations represented in the list of external links represented, to some degree, the diversity of views in the field, as well as cultural and geographic differences (note the WP:CSB tag). I would therefore request that most of the external links be restored, possibly with some more explicit recognition within the body of the article of the issues that I have touched on, and the reasons for the number of links. Marschalko 06:03, 10 November 2007 (UTC)

Sorry to be slow responding to your concerns, I've been away for a few days. On the links issue - I disagree that a list of associations is appropriate for this article, in large part because the area is so political, ideological, and values-based and such a listing does nothing to provide context for the reader. While I'm not familiar with this subject I am aware of some of those issues - and it was the lack of usefulness that a simple listing to the association site provided that prompted me to remove them. The links to those association pages provide virtually no information of use to a general reader. They are almost all limited to listing member therapists - and it is for that reasons that I consider the section to be becoming a directory. Having these here does not help a reader unfamiliar with the field, the focus on the USA is inappropriate for an internation encyclopedia, and with no clear criteria for inclusion it becomes a magnet for promotional additions. If there were one main professional association it would be one thing. But so many makes it too much of a jump from the main purpose of the external links section, which is to provide further information about family therapy, not links to services.

As to what I left being arbitrary - yes, it was. It was a first pass and I tried only to remove sites where I couldn't find anything for a general reader that provided information about family therapy. Links I left might have been inappropriate and, though I tried to look through them all, I may have missed information on some of the sites I removed.

Having a section in the article that discusses the diversity of views in the field and links to Wikipedia articles on the major associations or schools of thought would, I think, be excellent. I don't think linking out to websites that provide nothing beyond member listings provides any encyclopedic value. -- SiobhanHansa 22:32, 14 November 2007 (UTC)

Re removal of sentence re oxytocin by Jamespkeim

The sentence re oxytocin might not appeal to those in the current family therapy establishment, but it reflects a significant emerging area of research in the field, much of which is conducted in universities, and published in reliable sources that comply with the relevant Wikipedia guidelines for notability WP:N and reliability WP:RS. Google returns many hundreds of entries for searches of “family therapy” and oxytocin or “couples therapy” and oxytocin. The research addresses directly and critically some of the core established doctrines of family therapy, which in the respective authors’ views, have been found wanting in the light of clinical experience.

Wikipedia is meant for the general public and is intended to express a range of views on any particular topic (while maintaining neutrality overall), and not just the party line. Emerging or minority trends in particular fields – especially those that are heterodox but based on sound argument and evidence – are of particular importance and interest, as these are the places where potentially significant developments often occur; to provide the public with access to such knowledge – often suppressed by established interests - was one of the founding imperatives of Wikipedia.

Accordingly, in light of the above, and given that the single, short, offending sentence was appropriately referenced and did not threaten the overall balance of the article, I have restored it. Marschalko (talk) 16:14, 10 December 2007 (UTC)

New Section?

In the spirit of Be Bold, I'm proposing and have entered a new section: == Popularized Methodologies ==

• The Five Love Languages
• Men Are from Mars, Women Are from Venus
• Myers-Briggs Type Indicator
• Neuro-linguistic programming

Comments? Additions? Boos? Simesa (talk) 23:18, 14 February 2008 (UTC)

Perhaps "Popularized Methodologies" belongs right under "Methodologies". However, if we keep it this way, I do feel it is important that we have some kind of caveat stating that professionally-guided application is better. Wikipedia should not be seen as implying that self-help application of these methodologies will always be successful. Simesa (talk) 12:47, 15 February 2008 (UTC)

Merge proposal

The article systemic therapy actually describes "family therapy" which was a forerunner to systemic therapy. Systemic therapy does not restrict itself solely to families but instead focuses more broadly on systems which may include families but is not limited to them.

Further, the page systemic psychology is improperly titled. To my knowledge, there is no such thing as "systemic psychology", what is described there is known as "systemic therapy".

Given this I propose that

1) we merge the content of systemic therapy with this page since it is describing family therapy.

2) we take the content of the systemic psychology page and put it in the systemic therapy page.

Really, #2 would be a "move" not a merge.

--Sharktacos (talk) 18:10, 15 March 2008 (UTC)

I oppose both proposals. The first entry on this discussion page ( by Georgius 13:17, 27 Nov 2004) addresses this issue in part - and the problem has still not been properly resolved (and may never be) because it goes to the fundamental issue of the commonalities and differences between, and the justifications for, the 'individual' and 'systemic' paradigms. 'Systemic therapy' is not synonymous with 'family therapy' - despite the fact that many systemically-oriented people believe it to be so or would like others to believe it. Psychodynamic and intergenerational theorists and therapists in particular resent this conflation of 'systemic therapy' and 'family therapy'.

Admittedly the article on Systemic therapy is not very good and it could do with a great deal of expansion and refinement; but it should be kept separate (at this stage anyway) to recognize that it reflects only one subtype of family therapy (albeit admittedly probably the most influential). If the Family therapy article were ever to be expanded into a comprehensive article, then maybe it could be merged at that stage. But as has already been discussed on this talk page, that would be a mammoth and controversial task. The current unsatisfactory state of the article reflects in part the lack of any real consensus about these fundamental issues.

With regard to the proposal to eliminate the systemic psychology page, I oppose that because the page - as meager and unsatisfactory as it is - recognizes the distinction between description (ie, 'science/knowledge') and intervention (ie, 'therapy). This was a very major issue for the most influential father of 'systems psychology', Gregory Bateson. He (and Milton Erickson) were largely responsible for the introduction of ideas from systems theory and cybernetics into psychology. However, Bateson (who was not a therapist) saw systems psychology as having far broader application than just therapy. He saw it as a fundamentally new paradigm having relevance in biology, psychology, anthropology, sociology, politics, etc. Furthermore he was dismayed by the misuse that was made of his ideas by many of his 'followers' in the counter-culture, pop psychology, social work, and family therapy.

Some coverage of the issues that I have described might be warranted in the article on family therapy or elsewhere - the issues have broader application to epistemology, politics, sociology, etc.

A lot of work needs to be done on all three articles, but at this stage I think they need to be kept - and kept separate. Marschalko (talk) 03:25, 16 March 2008 (UTC)

PS: I acknowledge that Sharktacos' comments recognize that 'systemic therapy' is a broader category than 'family therapy'. However in common usage they are often described as if they were synonymous, and within the therapy culture systemic therapy is often described as a subtype of family therapy. Marschalko (talk) 03:40, 16 March 2008 (UTC)

Marschalko, I agree that family therapy and systemic therapy are not the same and did not with to suggest that we merge these concepts. My gripe here is that what is described on the systemic therapy page is not systemic therapy at all, what is described there is family therapy. Really I think we should replace the incorrect description on the systemic therapy page with the content from the systemic psychology which gives a correct description of systemic therapy.

The systemic psychology page does describe systemic therapy, but is not called systemic therapy there but systemic psychology. AFAIK systemic psychology is a term that does not exist. Are you making a case that it does? If it turns out to a legitimate term and not just a misnomer then I would suggest making the systemic therapy page redirect to it. --Sharktacos (talk) 06:46, 16 March 2008 (UTC)

I partly agree with your most recent entry Sharktacos. You say again that what is described on the systemic therapy page “is family therapy”. I agree that it does not provide an accurate or comprehensive description of systemic therapy, but I would reject any imputation that what it describes is family therapy per se or in toto (although I'm not sure that you're saying that it is saying that).

With regard to your question about whether I am making a “case” for the existence of the term “systemic psychology”: there is no “case” to make – it is an irrefutable fact that it exists. It is a well-established term, as confirmed by a number of academic articles, courses, and books – a Google search will confirm this.

I agree that the content of the systemic psychology page is better than that of the systemic therapy page. However, again I don't think that what the systemic psychology page describes is systemic therapy in that - as I suggested in my previous entry - it is addressing more the descriptive aspects, and acknowledges only in passing the therapeutic application of those ideas. (I’m guessing that you might also find it more attractive as it recognises the influence of second-order cybernetics and post-modernism - although many would question whether those developments have challenged the fundamental tenets of systems theory as much as has been made out.) I would thus also oppose a redirect from systemic therapy to systemic psychology (although internal links between the two would be a small but useful start).

For now then, I think that the points in my previous entry stand. I think the best way to proceed would be to correct and expand the systemic therapy page, possibly by incorporating some of the material from the systemic psychology page (which is clearly the better of the two articles and is reasonably OK as far as it goes). As far as I can ascertain. the next best existing pages that deal with (subtypes of) systemic therapy are systemic coaching and Systemic Constellations. You may know of others that could provide guidance in this matter. Marschalko (talk) 04:22, 18 March 2008 (UTC)

Hi Marschalko. Let me be more precise then: the systemic therapy page does not describe systemic therapy at all, it describes (rather poorly) family systems therapy which is much better described on the main family therapy page right here. Systems therapy grew out of family systems therapy, but includes other systems beyond the family (for example businesses). So I find the entire article superfluous (better described elsewhere) and misleading (describing the wrong thing). Would you agree with that, and if so how would you suggest addressing it? --Sharktacos (talk) 16:37, 19 March 2008 (UTC)

That’s what I thought you were saying Sharktacos and I do agree with you. If needs be, I suggest gutting the whole page and starting again. My main point is that the concepts of “systemic therapy” and “systems/systemic psychology” should in principle be recognized as distinct – even if this means (for the time being at least) that the systemic therapy page is retained only as a stub and a collection of links (much as the family therapy page is currently). If you have any suggestions on proposed content (apart from just the existing content of the systemic psychology page) then I'd be interested to hear them.

I think that Mdd has made a good proposal on Talk:Systemic psychology. It doesn’t fully address your concern, but I think it would be a good start. Whatever comes out of this, you have started an interesting and important discussion. Marschalko (talk) 02:48, 20 March 2008 (UTC)

OK I made a first pass at a re-write for the systemic therapy page. Still needs a lot of work, (ex: in lacks any info on praxis and methods at the moment) but it's a start.

Marschalko I will leave it to you to add any distinctions you wish to make between the systemic therapy page and the systemic psychology page since that seems to be issue of importance to you :) --Sharktacos (talk) 09:52, 20 March 2008 (UTC)

"Schools of family therapy"

Several theoretical approaches mentioned in the article are incorrectly identified as "school of family therapy." I have revised the article accordingly, and someone objected, thinking I "don't like" those schools of thought. Actually I am a mental health practitioner and use these theories every day. However, it is important to note that "psychodynamic", for instance, is NOT a "school of family therapy." The essence is to understand the individual's inner life; some branches, for instance "object relations", view real-world interactions as important, others do not, but calling it a "school of family therapy" is incorrect. "Cognitive behavioral' is also NOT a school of family therapy, although cognitive-behavior techniques can be productively used in family therapy. The same goes for "solution-focused" therapy, "contextual" therapy, "emotionally focused therapy", "expriental therapy and "narrative therapy." They can be applied within the family therapy model, but family dynamics are not an essential component of these theories.

kibi (talk) 16:12, 18 May 2009 (UTC)

I am also a mental health practitioner, and more specifically, I am an MFT. I agree with most of what you say above, but I do not agree that EFT or emotion focused therapy is not from the "school" of family therapy. EFT was created by Susan Johnson, who is an MFT, and was specfically designed to be used with couples. It is a model of therapy that has been researched through meta-analysis to be effectively used in this regard.

Additionally, I don't totally even understand what you mean above by the "family therapy" model. There really is no "family therapy" model at all... instead, family therapist use several different models to "do" family therapy.

Finally, there is A LOT of things in this article that are not correct, and some are even sited. The sentence mentioned above about oxycotton I think should be removed. This research is not specific to marriage and family therapy, and was made popular, in many ways, by Susan Johnson, the developer of EFT, when she spoke about how ridicious this research has been. I think this sentence is NOT of interest to the general reader, and is very bias to ONLY be included in this article and not other articles dealing with mental health and relationships.

The models of therapy, I think, do deserve their own articles... they can be mentioned in this article as models that family therapists use, but in many ways, many other therapists use these models too. MFT is a distinct and noble profession, but it is not really distinct in this reguard. Additionally, the section about licensure and creditials had some very, very wrong information in it, and I did my best to correct it. —Preceding unsigned comment added by 68.103.186.25 (talk) 06:42, 22 May 2009 (UTC)

Kibiusa, I agree that the other Wikipedia articles that were previously linked to this article did not deal explicitly with family therapy. But that does not support the broader point that you appear to be trying to make: namely, that there ARE NOT ‘schools’, approaches, orientations toward family therapy that go under those headings, which are distinct from the individual approaches that go under those same headings. There is almost a century’s worth of work by many family therapy theoreticians and clinicians – as set out in the extensive body of literature, including the leading texts in the field - that would disagree with you. And given that Wikipedia is meant to represent knowledge according to verifiable sources and is not meant to present original work, I would submit that your thesis would be inconsistent with WP:NOR. It may well be that the majority of clinicians nowadays - who tend to work mostly with individuals but who may also do relationship work - would agree with you. But that says more about the current state of the therapy culture (especially in the US) than about ‘family therapy’.

The issues are further confounded by the terminology: ‘schools’ has a particular historical connotation in this context, referring to a time – especially following the introduction of systems theory - when there was great enthusiasm and high expectations for what was seen as a fundamentally new paradigm for therapy, with a number of groups developing their ideas and methods in relative isolation from each other. However, the simple weight of clinical experience over time, among other things, has forced a retreat from some of the early dogmatism, and the term ‘school’ has fallen out of favour, to be replaced by ‘approach’, ‘orientation’, etc, concurrent with the incorporation of a lot of new ideas (and the revival of some old ones). So it becomes problematic nowadays to distinguish clearly between ‘schools’ and the more recent ‘approaches’ (as you appear to have done), without some discussion of the historical development of the field.

And there are still those true believers who are exclusively family therapists, who are convinced of the distinctiveness of the family/relationship versus individual modalities, and who could clearly be identified as subscribing to a school. You appear to have acknowledged this in part (implicitly at least) in stating very definitely what you consider are and are not ‘schools’ - but again, your list would be strongly disputed by many. For example, you seem to single out psychodynamics for exclusion. Yet, all of the leading texts in the field do recognize the group of approaches that fall under the broad umbrella of "psychodynamic" - whether they be predominantly psychoanalytic, object relations, self psychology, etc in their orientation - as representing a "school" of family therapy per se, whose various "sub-schools" have specific theories and methods that distinguish them from the respective theories and methods that apply in the individual modality.

It’s also worth noting that the article in its previous form with the offending links stood for more than a year without complaint. I assume that this is in part because people (at least those who cared at all) basically understood what it was getting at, even if it was not strictly correct. The fact that the links do not refer specifically to modalities of family therapy as well as individual therapy is largely a reflection of the deficiencies of Wikipedia as it stands.

This is a complex and contentious issue. To deal with it properly would require a significant expansion of the article to address, in part, the historical development of the field and a number of theoretical, epistemological, ideological, etc, issues. And as has already been discussed on this talk page, that would be a very onerous and controversial task. If you would like to discuss how to do that then I would be very interested to hear any suggestions. In the meantime, I have modified the earlier section to provide some clarification and some brief outline (although by no means adequate) of the historical context. If you disagree, then I trust that we can discuss it and come up with some solution.

Oxytocin

With regard to the sentence about oxytocin, I still think it is justified (as per my earlier comments on this talk page). I don’t agree that it would not be of interest to the general reader; in fact I think it would be of very great interest especially to those who have had disappointing experiences with the conventional approaches to counseling/therapy. However, as the cited references refer only to couples therapy and not family therapy in general, I have moved the section to the relationship counseling article, which deals (somewhat) more explicitly with couples therapy (although I suspect that someone will object to it there as well).

Marschalko (talk) 19:40, 17 June 2009 (UTC)

Let me begin by saying that I am an MFT and work in the field.

I agree 100% with all of kibiusa's comments, especially those in regard to Oxytocin. As Kibi stated, but you so easily ignored, Sue Johnson, who is an MFT, made this "research" popular NOT by endorsing it, but instead by warning clincians about how silly the research was. The research was NOT specific to the field of MFT AT ALL. Therefore, if you are so insistant about stating that it should be there, then it should be noted on the articles of all other mental health professionals as well. Therefore, I am glad you moved it, even though you weren't able to do so without you gab about why it should still be there.

Secondly, the information about creditials is wrong wrong wrong. I have corrected it twice, again, being a an MFT that has gone through this process, but yet the so called, "experts" continue to revert it back. I don't understand why Wiki says it is edited by everyone, when only a handful of folks really do the editing. You can continue to put WRONG information in the article, and that will continue to support the reason why educators continuiously do not allow students to use wikipedia for research. It seems to me that these power editors decide what they want, accurate or not, and that's pretty much it. The debates about this article on this talk page are interesting to me. Especially those about the "school" of family therapy. Did you ever think about perhaps listening to what an MFT has to say? Most likely not. I could take some time to edit it, and work on it, as I am very passionate (can you tell) about my field.... but alas, you will simply delete the revisions I make anyway. Mbakerreach (talk) 07:50, 26 August 2009 (UTC)mbakerreach

Mbakerreach, insofar as your comments are aimed at me, I respond as follows for the record: (1) I did not ignore the comment about Sue Johnson, I simply believed it to be irrelevant to the point at issue – the material in question was/is relevant to couple therapy according to the relevant criteria, and I noted that when I moved it; (2) I have had nothing to do with any reverting edits to the Licensing and degrees section – there are ways to deal with unjustified reverts; (3) your grievance(s) appear(s) to be with Wikipedia’s Policies and guidelines as much as with this article - if you don’t like them, then challenge them directly. Marschalko (talk) 14:12, 3 September 2009 (UTC)

Extensive relationship counseling research notes & links, focus on integrative and empirically validated methods & reviews

Research studies http://ibct.psych.ucla.edu/

Married With Problems? Therapy May Not Help By SUSAN GILBERT

Published: April 19, 2005 http://www.nytimes.com/2005/04/19/health/psychology/19coup.html?pagewanted=1&_r=1

...

With an experimental approach called integrative behavioral couples therapy, for example, 67 percent of couples significantly improved their relationships for two years, according to a study reported in November to the Association for the Advancement of Behavior Therapy. Instead of teaching couples how to avoid or solve arguments, as traditional counseling techniques do, the integrative therapy aims to make arguments less hurtful by helping partners accept their differences. It is based on a recent finding that it is not whether a couple fights but how they fight that can destroy a relationship. ...

Three types of couples therapy have been found to improve people's satisfaction with their marriage for at least a year after the treatment ends. The oldest approach, developed more than 20 years ago but still widely used, is behavioral marital therapy, in which partners learn to be nicer to each other, communicate better and improve their conflict-resolution skills. Another, called insight-oriented marital therapy, combines behavioral therapy with techniques for understanding the power struggles, defense mechanisms and other negative behaviors that cause strife in a relationship. With each method, about half of couples improve initially, but many of them relapse after a year. A relatively new approach that studies have found highly effective is called emotionally focused therapy, with 70 to 73 percent of couples reaching recovery - the point where their satisfaction with their relationship is within normal limits - for up to two years, the length of the studies. Dr. Johnson, who helped develop emotionally focused therapy in the 1990's, said that it enabled couples to identify and break free of the destructive emotional cycles that they fell into. "A classic one is that one person criticizes, the other withdraws," she said. "The more I push, the more you withdraw. We talk about how both partners are victims of these cycles." As the partners reveal their feelings during these cycles, they build trust and strengthen their connection to each other, she said. Surprisingly, Dr. Johnson said, until emotionally focused therapy came along, therapists were so intent on getting couples to make contracts to change their behavior that they did not delve into the emotional underpinnings of a relationship. "It was like leaving chicken out of chicken soup," she said. Dr. Johnson's latest research, completed in January, included 24 of the most at-risk couples, people who were unable to reconcile because their trust in each other had been shattered by extramarital affairs and other serious injuries to their relationship. "These injuries are like a torpedo," she said. "They take a marriage down." The study found that after 8 to 12 sessions, a majority of the couples had healed their injuries and rebuilt their trust. Most important, these gains lasted for three years. "It's very satisfying to know that we can make a difference with these couples and that it sticks," Dr. Johnson said. Alice, a library program coordinator in Honesdale, Pa., credits her couples therapy, which focused on emotional issues, with getting her and her husband to reunite after a yearlong separation. "The marriage counselor brought us back together," she said. Alice, who did not want her last name used out of privacy concerns, said an important catalyst for their reunion was the therapist's asking each to think about the ways that the other person wanted to feel appreciated and loved. Gradually, she said, she has come to see that her husband's needs were different from her own. "Going back to this exercise is one thing that has gotten us through hard times," she said. ... Researchers have begun to identify which qualities in a couple make for a lasting relationship. The findings challenge some common assumptions - that couples who fight a lot are beyond help, for example. Over more than two decades of videotaping and analyzing the behavior of happy and unhappy couples, Dr. Gottman has found that all couples fight and that most fights are never resolved. What is different between happy and unhappy couples is the way they fight.

The happy couples punctuate their arguments with positive interactions, he said, like interjecting humor or smiling in fond recognition of a partner's foibles. The unhappy couples have corrosive arguments, characterized by criticism, defensiveness and other negative words and gestures. Of course, even the happiest of couples can get nasty sometimes. But Dr. Gottman has found that as long as the ratio of positive to negative interactions remains at least five to one, the relationship is sturdy. When the ratio dips below that, he says, he can predict with 94 percent accuracy that a couple will divorce. Dr. Gottman says that couples therapists can use this information to help keep couples together. "You can't just teach a couple to avoid conflict," he said. "You have to build friendship and intimacy into the relationship. If you don't, the relationship gets crusty and mean."

J Consult Clin Psychol. 2000 Apr;68(2):351-5. Integrative behavioral couple therapy: an acceptance-based, promising new treatment for couple discord. Jacobson NS, Christensen A, Prince SE, Cordova J, Eldridge K. Department of Psychology, University of Washington, USA. Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord. PMID: 10780137 [PubMed - indexed for MEDLINE]

J Consult Clin Psychol. 2004 Apr;72(2):176-91. Traditional versus integrative behavioral couple therapy for significantly and chronically distressed married couples. Christensen A, Atkins DC, Berns S, Wheeler J, Baucom DH, Simpson LE. Department of Psychology, University of California, Los Angeles, Los Angeles, CA 90095-1563, USA. [email protected] Comment in: • Evid Based Ment Health. 2004 Nov;7(4):117. A randomized clinical trial compared the effects of traditional behavioral couple therapy (TBCT) and integrative behavioral couple therapy (IBCT) on 134 seriously and chronically distressed married couples, stratified into moderately and severely distressed groups. Couples in IBCT made steady improvements in satisfaction throughout the course of treatment, whereas TBCT couples improved more quickly than IBCT couples early in treatment but then, in contrast to the IBCT group, plateaued later in treatment. Both treatments produced similar levels of clinically significant improvement by the end of treatment (71% of IBCT couples and 59% of TBCT couples were reliably improved or recovered on the Dyadic Adjustment Scale; G. B. Spanier, 1976). Measures of communication also showed improvement for both groups. Measures of individual functioning improved as marital satisfaction improved. PMID: 15065953 [PubMed - indexed for MEDLINE]

J Consult Clin Psychol. 2005 Aug;73(4):624-33. Improving relationships: mechanisms of change in couple therapy. Doss BD, Thum YM, Sevier M, Atkins DC, Christensen A. University of California, Los Angeles, USA. [email protected] In a sample of 134 married couples randomly assigned to traditional or integrative behavioral couple therapy (TBCT vs. IBCT), a multivariate hierarchical growth curve analysis using latent variable regression revealed that measures of communication, behavior frequency, and emotional acceptance acted as mechanisms of change. TBCT led to greater changes in frequency of targeted behavior early in therapy, whereas IBCT led to greater changes in acceptance of targeted behavior both early and late in therapy. In addition, change in behavioral frequency was strongly related to improvements in satisfaction early in therapy; however, in the 2nd half of therapy, emotional acceptance was more strongly related to changes in satisfaction. Research and clinical implications are discussed. Copyright 2005 APA, all rights reserved. PMID: 16173850 [PubMed - indexed for MEDLINE]

J Consult Clin Psychol. 2006 Dec;74(6):1180-91. Couple and individual adjustment for 2 years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy. Christensen A, Atkins DC, Yi J, Baucom DH, George WH. Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA. [email protected] Follow-up data across 2 years were obtained on 130 of 134 couples who were originally part of a randomized clinical trial comparing traditional versus integrative behavioral couple therapy (TBCT vs. IBCT; A. Christensen et al., 2004). Both treatments produced similar levels of clinically significant improvement at 2 years posttreatment (69% of IBCT couples and 60% of TBCT couples). Both treatments showed a "hockey-stick" pattern of change in which satisfaction dropped immediately after treatment termination but then increased for most of follow-up. The break point when couples reversed courses and gained in satisfaction occurred sooner for IBCT than TBCT couples, and those couples who stayed together generally fared better in IBCT than in TBCT. Finally, there was evidence of greater stability during follow-up in IBCT than in TBCT couples. There was little change in individual functioning over follow-up, but when change occurred it was strongly related to change in marital satisfaction. Given that this sample was selected for its significant and chronic distress, the data are encouraging about the long-term impact of behavioral couple therapy. ((c) 2006 APA, all rights reserved). PMID: 17154747 [PubMed - indexed for MEDLINE]

BUT:

Behav Ther. 2008 Jun;39(2):137-50. Epub 2007 Nov 19. Observed communication and associations with satisfaction during traditional and integrative behavioral couple therapy. Sevier M, Eldridge K, Jones J, Doss BD, Christensen A. California State University, Fullerton, CA 92834, USA. [email protected] To investigate changes in couple communication and potential mechanisms of change during treatment, 134 distressed couples, who were randomly assigned to either traditional or integrative behavioral couple therapy (TBCT; IBCT), were observed in relationship and personal problem discussions prior to and near the end of treatment. Analyses were conducted using the Hierarchical Linear Modeling program. Over the time in therapy, during relationship problem discussions, positivity and problem solving increased while negativity decreased. Compared to IBCT, TBCT couples had the largest gains in positivity and reductions in negativity. During personal problem discussions, negativity decreased, while withdrawal increased and positivity decreased. TBCT couples had larger declines in negativity. In both discussion types, increases in marital satisfaction were associated with increases in positivity and problem solving. Declines in marital satisfaction were associated with increased negativity during relationship problem interactions and increased withdrawal during personal problem interactions. However, no treatment differences in these associations were found. Differences in rule-governed and contingency-shaped behavior change strategies between the two therapies and implications of findings are discussed. PMID: 18502247 [PubMed - indexed for MEDLINE]

J Consult Clin Psychol. 2009 Feb;77(1):160-73. Prediction of response to treatment in a randomized clinical trial of couple therapy: a 2-year follow-up. Baucom BR, Atkins DC, Simpson LE, Christensen A. Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA. Many studies have examined pretreatment predictors of immediate posttreatment outcome, but few studies have examined prediction of long-term treatment response to couple therapies. Four groups of predictors (demographic, intrapersonal, communication, and other interpersonal) and 2 moderators (pretreatment severity and type of therapy) were explored as predictors of clinically significant change measured 2 years after treatment termination. Results demonstrated that power processes and expressed emotional arousal were the strongest predictors of 2-year response to treatment. Moderation analyses showed that these variables predicted differential treatment response to traditional versus integrative behavioral couple therapy and that more variables predicted 2-year response for couples who were less distressed when beginning treatment. Findings are discussed with regard to existing work on prediction of treatment response, and directions for further study are offered. PMID: 19170462 [PubMed - indexed for MEDLINE]

J Consult Clin Psychol. 1989 Feb;57(1):39-46. Behavioral versus insight-oriented marital therapy: effects on individual and interspousal functioning. Snyder DK, Wills RM. This study compared the effects of behavioral marital therapy (BMT) and insight-oriented marital therapy (IOMT) on both interspousal and intrapersonal functioning in a controlled outcome study. A total of 79 couples seeking treatment for relationship distress were randomly assigned to BMT, IOMT, or a treatment-on-demand (TOD) waiting-list control group. Results indicated the significance in individual and relationship functioning. Both treatment approaches produced significant effects from intake to termination that were substantially maintained at the 6-month follow-up. Behavioral and insight-oriented therapies resulted in significant improvements in self-reports of global marital accord and, to a lesser extent, in the reduction of overall psychological distress and in the enhancement of self-concept, with no significant differences between treatment conditions. The magnitude of these effects in comparison with those reported in previous marital outcome studies and in more general psychotherapy research is discussed, and possible mechanisms for the equivalence of these technically divergent treatment approaches are explored. PMID: 2925973 [PubMed - indexed for MEDLINE]

http://www.psychpage.com/family/library/ibct.html Integrated Behavioral Couples Therapy Review of Jacobson and Christenson's model of Couples Therapy

Jacobson and Christenson's Integrated Behavioral Couples Therapy (IBCT) is a newer model based on traditional models of behavioral couples therapy. The traditional model is based on a few basic ideas:

• talking about how you feel and think about problems is not very helpful; rather, doing something about them is what helps • most partners can learn ways break bad patterns of behavior that cause problems • most partners can learn new ways to compromise and resolve problems, and thus make each other happier • as a result, most any couple can be happy and content When traditional models of behavioral therapy for individuals are applied to couples, therapy tends to produce significant improvements in functioning initially in just over half of couples. While in the past, this treatment appeared to be extremely effective, more recent studies have shown that it is not as effective as previously thought, and a few smaller studies may have made it appear overly effective. Further, other studies have found that at the end of therapy, only about a third of couples recover from their problems well enough to look like happily coupled partners. The rest are still distressed and unhappy. Two years later, a fourth to a third of behavioral therapy couples say they are worse off then when they went to therapy, and after four years over a third are divorced. Thus, the initial improvements do not appear to last. The addition of a "communication skills" module to traditional therapy seems to help improve the lasting effect of treatment to some extent though.

Jacobson and colleagues have done research to improve the effectiveness of behavioral therapy by adding an element of "emotional acceptance." Jacobson and colleagues argue that some problems can be resolved by compromise, but some likely can not. The greatest harm to the couple comes not from the incompatibilities; rather, the greatest harm comes from the rigid, negative, and excessive emotional responses that develop from these unresolved issues. Thus, the IBCT model is based on a few simple ideas:

• talking about how you feel and think about problems sometimes is necessary before you accept them • most partners can learn ways to alter the negative emotional responses they have to problems, responses that make them, as well as their partners, unhappy • most partners can learn new ways to resolve problems and the emotions that come with them • as a result, most any couple can be happy and content

There have been three promising studies showing the IBCT approach is better than the traditional one. Christenson and colleagues conducted a fourth study though that is especially interesting, in that for this study they purposely took the most distressed couples they could find. They treated 134 couples for an average of 23 sessions over 36 weeks, half with the IBCT approach and half with the traditional approach. They found that about two-thirds of couples reported significant improvements (slightly better than traditional behavioral therapy), half were able to recover from their problems well enough to look like happily coupled partners (again, better than traditional behavioral therapy).

Resources For more information • Christensen, A., Atkins, D. C., Berns, S., Wheeler, J., Baucom, D. H. & Simpson, L. E. (2004). Traditional versus Integrative Behavioral Couple Therapy for Significantly and Chronically Distressed Married Couples, Journal of Consulting and Clinical Psychology, 72, 176–191. • Jacobson, N. S., Christensen, A., Prince, S. E., Cordova, J., and Eldridge, K. (2000). Integrative Behavioral Couple Therapy An Acceptance-Based, Promising New Treatment for Couple Discord, Journal of Consulting and Clinical Psychology, 68, 351-355. • Wimberly, J. & Waltz, J. (1998). An outcome study of Integrative Couples Therapy delivered in a group format. Paper presented at the 32nd annual convention of the Association for Advancement of Behavior Therapy. Washington, D.C. • Shadish, W.R., & Baldwin, S.A. (2005). The effects of behavioral marital therapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 73(1), 6-14.

FROM http://christensenresearch.psych.ucla.edu/

Upcoming research presentations:

Acceptance and change in couple therapy. Andrew Christensen. Master Clinician Presentation, World Congress of Behavioral and Cognitive Therapies, Boston, Massachusetts, June, 2010.

Behavior Change in Traditional and Integrative Behavioral Couple Therapy: Examination of Changes Through 2-year Follow up. Katherine J. Williams. Association of Behavioral and Cognitive Therapies. New York, New York.

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples. Lisa Benson. Association of Behavioral and Cognitive Therapies. New York, New York.

Physical intimacy over the course of couple therapy and follow-up. Meghan McGinn. Association of Behavioral and Cognitive Therapies. New York, New York.

Integrative Behavioral Couple Therapy An Acceptance-Based, Promising New Treatment for Couple Discord

"As Table 4 indicates, 64% of the TBCT couples either improved or recovered by the end of therapy; in contrast, 80% of the IBCT couples either improved or recovered."

Journal of Consulting and Clinical Psychology © 2000 by the American Psychological Association April 2000 Vol. 68, No. 2, 351-355 For personal use only--not for distribution

Neil S. Jacobson Department of Psychology University of Washington Andrew Christensen Department of Psychology University of California, Los Angeles Stacey E. Prince Department of Psychology University of Washington James Cordova Department of Psychology University of Washington Kathleen Eldridge Department of Psychology University of California, Los Angeles ABSTRACT Although traditional behavioral couple therapy (TBCT) has garnered the most empirical support of any marital treatment, concerns have been raised about both its durability and clinical significance. Integrative behavioral couple therapy (IBCT) was designed to address some of these limitations by combining strategies for fostering emotional acceptance with the change-oriented strategies of TBCT. Results of a preliminary clinical trial, in which 21 couples were randomly assigned to TBCT or IBCT, indicated that therapists could keep the 2 treatments distinct, that both husbands and wives receiving IBCT evidenced greater increases in marital satisfaction than couples receiving TBCT, and that IBCT resulted in a greater percentage of couples who either improved or recovered on the basis of clinical significance data. Although preliminary, these findings suggest that IBCT is a promising new treatment for couple discord.

James Cordova is now at the Department of Psychology, University of Illinois at Urbana—Champaign. After the completion of this article, but prior to its revision, Neil S. Jacobson died suddenly and unexpectedly. His untimely departure is a major loss not only for his family and friends but also for the field of marital therapy, to which he contributed so much. This research project was supported by Grant 5 R01 MH499593-02 from the National Institute of Mental Health. We thank Steve Clancy, Peter Fehrenbach, Joan Fiore, Susan Price, and Debra Wilk, who served as therapists for this project. Correspondence may be addressed to Andrew Christensen, Department of Psychology, University of California, Los Angeles, California, 90095. Electronic mail may be sent to [email protected] Received: February 2, 1999 Revised: September 12, 1999 Accepted: September 17, 1999 Traditional behavioral couple therapy (TBCT; also known as behavioral marital therapy) has been the most widely studied approach to treating marital distress, and its efficacy has been repeatedly demonstrated in over 20 randomized clinical trials ( Baucom, Shoham, Meuser, Daiuto, & Stickle, 1998 ; Christensen & Heavey, 1999 ; Jacobson & Addis, 1993 ). Several of these clinical trials were conducted by Jacobson and colleagues using the version of TBCT summarized by Jacobson and Margolin (1979) . In an analysis of the clinical significance of various treatment approaches, Jacobson's version of TBCT yielded higher rates of success than the others examined ( Jacobson et al., 1984 ). This is not to say that TBCT is the only effective approach to couple therapy. In fact, as Baucom et al. (1998) have documented, other treatments, such as emotionally focused couple therapy Greenberg & Johnson, 1988 ), have shown promise. But TBCT is the only couple therapy to receive the highest designation as an "efficacious and specific intervention" ( Baucom et al., 1998 , p. 58).

At the same time, these studies have also revealed significant limitations in both the clinical significance and the durability of TBCT. First, at least one third of the couples studied in randomized clinical trials of TBCT are clear-cut treatment failures, remaining in the maritally distressed range at the conclusion of therapy ( Jacobson & Addis, 1993 ). Second, even among those couples who improve, many do not maintain their improvement over a 2-year period ( Jacobson, Schmaling, & Holtzworth-Munroe, 1987 ).

The purpose of the present study was to provide preliminary data on a new approach to treating marital distress, integrative behavioral couple therapy (IBCT), which was developed by Andrew Christensen and Neil S. Jacobson ( Christensen, Jacobson, & Babcock, 1995 ; Jacobson & Christensen, 1996 ).

Whereas TBCT focuses on helping spouses "change" in light of their partners' complaints and requires active collaboration and compromise between partners, IBCT includes strategies to help spouses accept aspects of their partners that were previously considered unacceptable. However, despite the label, the purpose of "acceptance work" is not to promote resignation to the relationship as it is or mere acceptance. Rather, it is designed to help couples use their unsolvable problems as vehicles to establish greater closeness and intimacy. For couples who have difficulty changing their behavior, acceptance provides a viable alternative for building a closer relationship. For couples who do benefit from the traditional approach, IBCT can facilitate further progress by providing an alternative way to establish a closer relationship, given that there are problems in every relationship that are impervious to change.

Paradoxically, acceptance interventions are also predicted to produce change in addition to acceptance, often more efficiently than the direct change inducing strategies that constitute TBCT, because at times the pressure to change may be the very factor that prevents it from occurring.

Method

Participating Couples and Therapists

Participants in this study were 21 couples requesting therapy for marital distress. To be eligible for the study, couples had to be legally married and living together and both spouses had to be between 21 and 60 years old. In addition, each was required to score above 58 on the Global Distress Scale (GDS) of the Marital Satisfaction Inventory (MSI; Snyder, 1979 ), indicating clinically significant levels of marital distress. Couples were excluded if either spouse was in some concurrent form of psychotherapy ( n = 8), taking psychotropic medication ( n = 8), alcohol dependent ( n = 2), engaging in moderate to severe domestic violence within the past year ( n = 2, using criteria from Jacobson, Gottman, Waltz, Babcock, & Holtzworth-Munroe, 1994 ), or if the sole presenting complaint was sexual dysfunction ( n = 2). We were also prepared to exclude couples if either spouse met the criteria for schizophrenia (current episode), drug dependence, or mania, although no such couples were encountered.

After qualifying for the study, couples were randomly assigned to either TBCT or IBCT. Table 1 presents a summary of pretreatment demographic variables for each spouse (age, education, duration of

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marriage, number of previous marriages, and number of children) as a function of treatment condition.

None of the demographic variables were significantly different in the two treatment conditions.

Cases were assigned to one of five therapists as the therapist was available and as needed to ensure that therapists saw cases in both conditions. Each therapist saw a total of two to six cases and, with the exception of one therapist who saw an extra TBCT case, saw equal numbers of cases in each condition.

The five therapists, who included four licensed psychologists and one master's-level marriage and family therapist, were trained by first attending a didactic workshop presented by Neil S. Jacobson. They were then asked to read both the IBCT ( Christensen et al., 1995 ) and TBCT ( Jacobson & Margolin, 1979 ) treatment manuals. Once they began seeing cases, half were supervised by Andrew Christensen and half were supervised by Neil S. Jacobson, who both supervised cases in each treatment condition.

All of the treatment sessions were audio- or videotaped and mailed to supervisors, and each therapist had weekly 30-min telephone conversations with each supervisor during which the supervisor provided feedback and answered questions regarding the therapist's current cases. In addition to these weekly phone contacts, Andrew Christensen and Neil S. Jacobson met monthly with therapists in Year 1 and bimonthly in Year 2. During these meetings, taped segments illustrating both treatments were viewed, difficult cases were discussed, and any violations of treatment protocol observed by the adherence raters were reviewed. These strategies were successful in preventing drift across supervisors and in revising the IBCT treatment manual so that versions could be published for therapists (Jacobson & Christensen, 1996 ) and for clients ( Christensen & Jacobson, 2000 ).

Treatment Conditions TBCT.

The version of TBCT used in the present study was an adaptation of the one used by Jacobson and Margolin (1979 ), as specified in a companion manual. 1 IBCT ( Christensen et al., 1995 ; Jacobson & Christensen, 1996 ).

This approach includes three interventions designed to promote acceptance between partners: empathic joining, unified detachment, and tolerance building. In IBCT, these acceptance strategies are integrated with the change-oriented strategies of TBCT. The relative emphasis on acceptance versus change depends to some extent on the individual characteristics and needs of the couple.

IBCT treatment began as clinically indicated for each couple in the study on the basis of the case formulation developed during the initial assessment sessions but usually began with acceptance interventions. Subsequently, change techniques were integrated with acceptance strategies as needed.

Treatment length.

All of the couples in both treatment conditions were allowed up to 26 sessions (which included 2 individual sessions during an evaluation phase) and, in fact, received between 13 and 26 sessions. The mean number of sessions for TBCT couples was 20.72 ( SD = 3.55), whereas the mean number of sessions for IBCT couples was 21.00 ( SD = 4.15); the difference between groups was not significant.

Of the 11 couples assigned to TBCT, 1 couple experienced substantial improvement early in treatment and, in agreement with their therapist, terminated after the 14th session. Of the 10 couples assigned to IBCT, 1 couple did not complete treatment, deciding to divorce after 13 sessions.

Therapist adherence and competence.

We constructed an adherence scale that included eight items reflecting change-oriented interventions

Page 3 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html Page 4 and nine items reflecting acceptance interventions. Two senior graduate students served as coding trainers and calibrators, and three additional graduate students served as coders. Eight TBCT and eight IBCT cases were coded for adherence. Nine tapes were coded per case (three early, three middle, and three late sessions); within these constraints, the exact tapes to be coded were determined randomly.

Twenty percent of the coded tapes were also coded by a calibrator. Coders were blind as to both treatment condition and which sessions were coded by the calibrator. They rated the degree to which each intervention was observed in that session on a 5-point scale ranging from 1 ( not at all ) to 5 ( extensively ). Reliabilities were calculated based on intraclass correlation coefficients and represent the agreement between each rater and the calibrator. Reliabilities for the three coders ranged from .87 to .95 for change ratings and from .74 to .88 for the acceptance ratings.

In addition, we conducted a second, completely independent manipulation check to ensure that our ratings of adherence were not influenced by rater bias. The adherence ratings described above were conducted by clinical graduate students familiar with TBCT and IBCT and who therefore were often able to discern the treatment condition. Thus, we created a second, simpler system using global codes and trained undergraduate raters who had no previous knowledge of TBCT and IBCT to use this global coding system. This system included a code for "instigate change," which consisted of any of the change interventions defined in the earlier system, and "acceptance," which consisted of any of the acceptance activities defined in the earlier system. After watching an entire session, coders rated the extent to which therapists engaged in these activities on a 9-point scale. Six sessions from each of the 21 cases (two sessions each from the early, middle, and late phases of therapy) were rated by four teams of three or four undergraduate observers who were trained in the global coding system but who were uninformed about TBCT, IBCT, and the nature of the study. In fact, they were not told that two kinds of therapy were being compared but rather that we were examining the correlates of different types of therapist activities. Ratings on these two global scales were reliable (average alpha was .86 for change and .80 for acceptance). Finally, to document that TBCT received a fair test in the present study, we had 120 TBCT tapes coded for competence by Donald H. Baucom, a recognized expert in TBCT. These manipulation checks and their results are described in greater detail below. Outcome Measures We measured pre- to posttreatment changes in marital satisfaction using the GDS of the MSI ( Snyder, 1979 ) and the Dyadic Adjustment Scale (DAS; Spanier, 1976 ). Both are well-validated instruments for assessing satisfaction in marriage.

Results

Adherence to Treatment Protocols

Table 2 compares the overall change and acceptance ratings for TBCT versus IBCT on our molecular

Adherence scale. The table shows that change-oriented interventions were significantly more likely to be used in TBCT than in IBCT, whereas acceptance interventions were significantly more likely to be used in IBCT than in TBCT. The means reported in Table 2 represent the sum of the ratings for each item in that subscale. Thus, the range for the Change subscale (eight items) is 8 to 40, and the range for the Acceptance subscale (nine items) is 9 to 45. Of particular note is that the mean for Acceptance items in TBCT is very close to the minimum, indicating that there was very little acceptance work going on in TBCT and thus very few protocol violations. On the other hand, because IBCT includes the change-oriented strategies of TBCT, some change work is appropriate. As expected, there were a moderate

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number of change interventions observed in IBCT, but not as many as in TBCT. In addition to the above, we conducted a second manipulation check using naive raters and global codes of instigate change and acceptance described earlier to ensure that our adherence data were not an artifact of the raters' biases. Primary analyses consisting of 2 (treatment group) × 6 (session) repeated measures analyses of variance revealed significant main effects of treatment group.

As predicted, average ratings of acceptance were much higher for IBCT therapists ( M = 6.47) than for TBCT therapists ( M = 4.28), F (1, 17) = 35.61, p < .001, whereas mean ratings for instigate change were much higher for TBCT therapists ( M = 6.08) than for IBCT therapists ( M = 3.32), F (1, 17) = 33.45, p < .001.

Further, when we created a ratio of acceptance to instigate change, we found no overlap in the two distributions: The lowest ratio among IBCT cases was higher than the highest ratio among TBCT cases.

In short, results indicate that these two systems for rating adherence were able to discriminate between TBCT and IBCT and, further, that therapists conducting both treatments were able to keep them distinct: They were successful in avoiding acceptance interventions in TBCT and in incorporating such interventions when conducting IBCT.

Therapist Competence in TBCT One possible explanation for promising results when testing a new treatment approach is the effect of therapist allegiance: Perhaps the therapists' greater enthusiasm for the new treatment and/or their corresponding decreased confidence in the old treatment lead them to provide a less than optimal test of the latter. Therefore, it was important to ensure that TBCT was performed with a high degree of competence and that therapist bias toward IBCT did not influence our results. To this end, we had 120 TBCT tapes coded by an expert in TBCT, Donald H. Baucom from the University of North Carolina.

Baucom had no other connection to the study beyond his role as a consultant who provided competence ratings of TBCT. In collaboration with Baucom, we designed a scale, called the Behavioral Couple Therapy Competence Rating Scale, which is designed to have a maximum score of 66. A score of 40, which indicates an average rating of "good," is considered the cutoff for competent performance of TBCT. Baucom rated up to 16 tapes per couple for 8 couples assigned to TBCT. The first 4 tapes (1st conjoint session, individual assessment sessions with both husband and wife, and feedback session) were viewed for case conceptualization purposes only; competence ratings were completed for Sessions 5—16. Results indicated that TBCT was conducted with a high level of competence. Ratings for individual sessions ranged from 43 to 66, with an overall mean rating of 61.1. These ratings consistently exceeded our established minimum standards of competence and indicated that the TBCT performed in this study was state of the art.

Treatment Outcome Because of the small sample size and inadequate statistical power of the present study, we made a decision to confine our analyses to descriptive statistics reflecting both effect size and clinical significance of the group differences but not to use statistical analyses for hypotheses-testing purposes.

Table 3 presents the results of our primary outcome analyses. The table shows pre- and posttest scores for husbands and wives on the GDS and the DAS, our two primary outcome measures. Results are presented for all 21 couples who participated in the study, including the 1 IBCT couple who did not complete treatment. For the latter couple, because we were unable to obtain posttest scores, their pretest scores on each outcome measure served as the termination score. As the table shows, both husbands and wives experienced greater improvements in their satisfaction following IBCT than they did following TBCT. The effect sizes indicate moderate (based on the DAS) to large (based on the GDS) group differences favoring IBCT.

Finally, we assessed the clinical significance of the observed group differences using the criteria for

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improvement and recovery derived by Jacobson and colleagues (e.g., Jacobson & Truax, 1991 ). Table 4 shows the number and proportion of couples whose increases in marital satisfaction were both statistically and clinically significant using the GDS. Clinical significance referred to both spouses scoring in the nondistressed range at the conclusion of therapy, whereas improvement referred to scores that indicated increased marital satisfaction but were still in the distressed range for 1 or both spouses posttreatment. To ensure that the magnitude of change exceeded that which could reasonably be explained by measurement error, we also required that each partner's magnitude of change had to be statistically reliable on the basis of the modified reliable change index ( Jacobson & Truax, 1991 ). As Table 4 indicates, 64% of the TBCT couples either improved or recovered by the end of therapy; in contrast, 80% of the IBCT couples either improved or recovered.

Discussion The results of our treatment development study suggest that IBCT may be a promising alternative to TBCT. First, through our adherence ratings, we demonstrated that IBCT was a distinct treatment from TBCT. Second, we showed that the therapists in this study were able to successfully implement our independent variable by confining acceptance-focused interventions to IBCT and by providing an intensive, state-of-the-art test of change-oriented interventions in TBCT. Third, and most importantly, IBCT, performed by therapists with no prior experience with the treatment, obtained results that were impressive both in an absolute sense and relative to TBCT. Besides these outcome results, there are several additional findings that support the future study of IBCT. Christensen and Jacobson (1996) reported that IBCT produced as much or more change in some areas of the relationship than TBCT, despite the emphasis on acceptance, rather than change, in IBCT. Consistent with the theory of change underlying IBCT ( Jacobson & Christensen, 1996 ), the contextual shifts following successful acceptance work can be a more effective way of shifting the contingencies of reinforcement in a way that supports spontaneous change. Acceptance may not only be conducive to an improved relationship in its own right but may also at times be a more efficient way of producing behavior change than the direct attempts to induce it, which characterize TBCT. Furthermore, evidence of differential processes occurring in the two treatments was found in an examination of couples' in-session verbal behavior ( Cordova, Jacobson, & Christensen, 1998 ). Using a system designed to rate husband—wife interaction, coders were trained to rate early, middle, and late therapy sessions on the occurrence of spouse behaviors expected to discriminate between the two treatments. Results indicated different kinds of interactional changes in the two treatments that were in accord with the theories of change underlying the two treatments. For example, two categories of spouse behavior, empathic joining and unified detachment, behaviors that are encouraged in IBCT but not in TBCT, were indeed more common in IBCT sessions, especially toward the end of therapy. This study provides further evidence that the types of interactional change targeted by the two treatments are actually reflected in couples' in-session behavior, especially in middle and later sessions. Since we conducted this original trial, two additional unpublished studies, summarized by Christensen and Heavey (1999) , have provided further preliminary evidence as to the scope of IBCT. Not only does it appear to be possible to successfully apply IBCT in a couples—group format, but the treatment may also be a viable alternative to individual therapy when depression in 1 spouse coexists with marital discord. Although these results, taken together, warrant further exploration, they must be interpreted in the preliminary spirit in which the data were collected. The next step is a randomized clinical trial with sufficient statistical power to establish both the replicability and the reliability of group differences Page 6 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html

Page 7 between IBCT and TBCT. In fact, we have begun such a trial at two sites–the University of California, Los Angeles, and the University of Washington–where 150 couples are being randomly assigned to IBCT or TBCT in what will be the largest study of marital therapy efficacy ever undertaken. Only after such a trial has been completed will we know if the early promise demonstrated in the present study can be confirmed. The study currently under way will also address a question that is crucial to the value of a marital treatment but beyond the scope of the present treatment development study: the durability of acceptance and change produced by the two treatments under study. Not only do we need to know about the immediate benefits of IBCT, but a major reason for its development was also the hope that an integrative treatment would lead to permanent improvement, a goal that has not yet been tested, even in a preliminary way. References Baucom, D. H., Shoham, V., Meuser, K. T., Daiuto, A. D. & Stickle, T. R. (1998). Empirically supported couple and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology, 66, 53-88. Christensen, A. & Heavey, C. L. (1999). Interventions for couples. Annual Review of Psychology, 50, 165-190. Christensen, A. & Jacobson, N. S. (1996, November). The measurement of acceptance and change in integrative versus traditional behavioral couple therapy. (Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy, New York, NY) Christensen, A. & Jacobson, N. S. (2000). Reconcilable differences. (New York: Guilford Press) Christensen, A., Jacobson, N. S. & Babcock, J. C. (1995). Integrative behavioral couple therapy.(In N. S. Jacobson, & A. S. Gurman (Eds.), Clinical handbook of couples therapy (pp. 31—64). New York: Guilford Press.) Cordova, J. V., Jacobson, N. S. & Christensen, A. (1998). Acceptance versus change interventions in behavioral couples therapy: Impact on couples' in-session communication. Journal of Marriage and Family Counseling, 24, 437-455. Greenberg, L. S. & Johnson, S. M. (1988). Emotionally focused couples therapy. (New York: Guilford Press) Jacobson, N. S. & Addis, M. E. (1993). Research on couples and couple therapy: What do we know? Where are we going? Journal of Consulting and Clinical Psychology, 61, 85-93. Jacobson, N. S. & Christensen, A. (1996). Acceptance and change in couple therapy: A therapist's guide to transforming relationships. (New York: Norton) Jacobson, N. S., Follette, W. C., Revenstorf, D., Baucom, D. H., Hahlweg, K. & Margolin, G. (1984). Variability in outcome and clinical significance of behavioral marital therapy: A reanalysis of outcome data. Journal of Consulting and Clinical Psychology, 52, 497-504. Jacobson, N. S., Gottman, J. M., Waltz, J., Babcock, J. & Holtzworth-Munroe, A. (1994). Affect, verbal content and psychophysiology in the arguments of couples with a violent husband. Journal of Consulting and Clinical Psychology, 62, 982-988. Jacobson, N. S. & Margolin, G. (1979). Marital therapy: Strategies based on social learning and behavior exchange principles. (New York: Brunner/Mazel) Jacobson, N. S., Schmaling, K. B. & Holtzworth-Munroe, A. (1987). A component analysis of behavioral marital therapy: Two-year follow-up and prediction of relapse. Journal of Marital and Family Therapy, 13, 187-195. Jacobson, N. S. & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19. Snyder, D. K. (1979). Multidimensional assessment of marital satisfaction. Journal of Marriage and the Family, 11, 813-823. Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage Page 7 of 8 11/27/2000 http://spider.apa.org/ftdocs/ccp/2000/april/ccp682351.html

Page 8 and similar dyads. Journal of Marriage and the Family, 38, 15-28. 1 The TBCT manual can be obtained from Andrew Christensen by written request. Pretreatment Demographic Variables Overall Adherence Ratings Pre- to Posttreatment Improvement by Treatment Condition Clinical Significance Data Page 8 of 8 11/27/2000

The history of couple therapy: a millennial review. Family Process, 07/22/2002, Vol. 41 No. 2 Pg. 199 By: Alan S. Gurman; Peter Fraenkel

In this article, we review the major conceptual and clinical influences and trends in the history of couple therapy to date, and also chronicle the history of research on couple therapy. The evolving patterns in theory and practice are reviewed as having progressed through four distinctive phases: Phase I—A theoretical Marriage Counseling Formation (1930-1963); Phase II--Psychoanalytic Experimentation (1931-1966); Phase III--Family Therapy Incorporation (1963-1985); and Phase IV--Refinement, Extension, Diversification, and Integration (1986-present). The history of research in the field is described as having passed through three phases: Phase I--A Technique in Search of Some Data (1930-1974), Phase II--Irrational(?) Exuberance (1975-1992), and Phase III-- Caution and Extension (1993-present). The article concludes with the identification of Four Great Historical Ironies in the History of Couple Therapy.

...

What is the relative effectiveness of different couple therapies? To borrow a borrowed phrase from Luborsky, Singer, and Luborsky's (1975) discussion of the comparative efficacy of individual psychotherapies, "Everybody has won, and all must have prizes" (p. 995). More accurately, all those couple therapies that have been reasonably well put to the empirical test to data have won, i.e., have proven superior to no treatment. These methods are Behavioral (including cognitive-behavioral) Therapy, Emotionally Focused Therapy, and Insight-Oriented Marital Therapy. Thus far, there is no strong evidence that any one of these approaches is more effective than the others, or any other. To date, there have been very few head-to-head comparative studies in clinical trials, so that the occasional differences that have been found may be quite unreliable, and, in any case, have not been replicated.

At the same time, not all influential approaches to systems-oriented therapy even deserve consideration for "prizes" to date for their treatment of couples, e.g., Structural, Strategic, Bowen Family Systems, Solution-Focused, and Narrative methods with couples have essentially never been tested empirically. This fact should certainly not lead us to dismiss outright treatments that have not yet been tested empirically. Nonetheless, the proponents of such untested methods have a collective obligation to provide more than anecdotal evidence of their efficacy and effectiveness. —Preceding unsigned comment added by 64.105.0.102 (talk) 00:33, 7 December 2009 (UTC)

Edit re Behavioral couple therapy/Behavioral family therapy

There are several issues with this edit:

1. It purports to relate to BFT, but its content and the cited sources relate to BCT - the two cannot properly be conflated.

2. The issues of research, evidence, and comparative effectiveness of models in FT form a highly contentious and problematic area in the field – all of the general textbooks in the field attest to this. The article as it stands obviously lacks adequate coverage of this area. (An unsigned contributor made some suggestions about this, albeit limited in scope and highly partial, in the entry Extensive relationship counseling research notes & links, focus on integrative and empirically validated methods & reviews on the Talk page, which, coincidentally (?), is highly consistent with the most recent addition to the article.) However, the bold assertion made about BFT being ‘’the most researched model of family therapy’’ is unjustified, unverified, (and, I would suggest, unverifiable), and unbalanced. The entry conflicts with WP:V and WP:NPOV.

3. The material is not appropriate for the article as it currently stands, since it gives significantly more coverage to BCT/”BFT” than is given to the other approaches. This material would be more appropriate to (1) a page of its own with appropriate links to the FT page, or (2) the Relationship counseling page, or (3) a new section in the FT page devoted to research and effectiveness (which, I suspect, would be difficult to create because of the problematic nature of research in this field, and on which it would be difficult to achieve an appropriate consensus).

Marschalko (talk) 07:49, 15 May 2010 (UTC)

Is FT necessarily a single-patient modality?

This section is in response to the recent edit by Bernalano which I have reverted. I felt that I should offer some brief justification for the revert, since Bernalano has touched on an important issue.

The date of the cited source by Hales et al, 1999, partly reveals the problem: it reflects an out-dated and, even at that time, a minority view of the scope of FT. Note as well that it is a textbook of psychiatry, not FT per se. The majority of the more recent sources cited in the article acknowledge that while FT may be applicable in the case of a single identified patient, this is not a sine qua non of FT. As the introductory section says, it is now widely acknowledged that FT is also appropriate where there is no clear individual problem or where, even if there is, there is simply a desire to improve family relationships and functioning generally.Marschalko (talk) 21:17, 3 December 2010 (UTC)

Experiential Therapy

Can someone explain why Experiential Therapy redirects to Family Therapy? It's a model of therapy, but is clearly a subset, as is Strategic Therapy (Which has its own page). — Preceding unsigned comment added by 128.223.223.73 (talk) 22:52, 22 November 2011 (UTC)

Evidence base/Evaluation of effectiveness

There are two serious problems with a recent edit of the section Evidence base by CartoonDiablo, which prompted me to partially revert it: 1) the edit completely removed – without acknowledgment, explanation or justification - the existing content of the section and the associated link to a relevant evidence resource; 2) the table that was inserted misrepresents the contents of the cited source and the relevant table in that source; in particular, by its incorrect and misleading addition of the term “no effect” in relation to various disorders and treatments. Marschalko (talk) 18:56, 11 September 2012 (UTC)

My bad with the revert but how is the image misleading? Its based on the specific table from the study. CartoonDiablo (talk) 16:43, 13 September 2012 (UTC)

The image contains assertions with very significant implications that are not contained in the original table or article, ie, the addition of "No effect". The misleading effect of that addition is highlighted when the content of the article as a whole - and in particular, another table in the article, "Effects of family therapies depending on disorder" - are considered.

Further, this is only one study - albeit a meta-analysis - and in a field like family therapy, where issues of evidence and research are so vexed and contentious, it is arguably not prudent to present a single table like that (even without additional errors) as being definitive or representative of the state of evidence overall. And in any case, the article is getting a bit old, and, as the first sentence in the section says, the evidence base is evolving. Marschalko (talk) 18:46, 13 September 2012 (UTC)

Well it's not just a review, it's a tertiary source meaning it reviewed 100+ reviews. That aside the "no effect" is what the study says, it looked at the therapy and if no significant improvement was found it was seen as ineffective (and therefore not listed on the table). CartoonDiablo (talk) 02:33, 14 September 2012 (UTC)

The article does not say anywhere that family therapy - or any intervention - has "no effect" in relation to any disorder. The closest it comes is in saying that psychodynamic treatment for schizophrenia has "Little or no effect". And it does not say or imply that any treatment is "ineffective" for anything. I think your interpretation of the article is not correct. The article is useful and it should be cited; but it certainly does not support the interpretation that you have proposed. And it has its own limitations and, given the state of evidence for the field as a whole, it should not be accorded the prominence that you seek to give it (even without incorrect interpretations).

Further, I have just checked and have discovered that you have already had a similar dispute re the same issue on the Psychoanalysis page. Evidently you have some personal investment in that table and I don't intend to go through all those same arguments again. For the reasons stated previously, the table is an inappropriate addition to this (and arguably, any) article. Marschalko (talk) 08:42, 14 September 2012 (UTC)

That study would be in the article meaning the article did in fact say that family therapy is ineffective at xyz disease. And in the former we reached a dispute resolution (although the other editor didn't abide by it resulting in two subsequent blocks). As far as I can tell you haven't given an actual reason for excluding the image, its an exact reflection of the study which is rather good seeing as how it looked at 100+ reviews. I'll reinstate it for now and if it becomes an issue we can go to dispute resolution. CartoonDiablo (talk) 16:56, 16 September 2012 (UTC)

Dispute resolution noticeboard request lodged. Marschalko (talk) 10:47, 17 September 2012 (UTC)

The prose CartoonDiabolo added to the article contains fatal errors. A detailed description can be found at [1]. In your position I would insist that these prose will delate or corrected. --WSC ^® 18:57, 18 September 2012 (UTC)

NPOV August 2012

Famaly therapy is an well evaluated treatment for several disorders. You can find several studies and meta-studies and overviews in google-scholar and at google books, if you want to.

There is no need to overstate one single controversy study as it was made in the chapter evaluation. That destroys the balance of the article.

Futher I have to say, that this is a part of the campain of user CartoonDiablo to deny the efficacy of other treatments than Cognitiv-behavioral. I think for this POV-contributions and editwarring, CartoonDiablo should be blocked. --WSC ^® 10:02, 16 October 2012 (UTC)

Keep. Please make a specific suggestion in one short sentence, then defend your suggestion. Otherwise I can't understand what you are contesting. The section sounds neutral to me, as a family therapist. Markewilliams (talk) 18:29, 5 April 2013 (UTC)

Assessment comment

The comment(s) below were originally left at Talk:Family therapy/Comments, and are posted here for posterity. Following several discussions in past years, these subpages are now deprecated. The comments may be irrelevant or outdated; if so, please feel free to remove this section.

This article is in need of many corrections and additions. There is no mention of any of the roots of family therapy [Philadelphia Child Guidance Clinic, Hahnemann University, schizophrogenic mothers, etc.] or the basis of cybernetics/systems theory. Recent edits have addressed these problems somewhat (I hope), though not fully. Marschalko (talk) 13:00, 22 July 2009 (UTC)

Last edited at 13:00, 22 July 2009 (UTC). Substituted at 14:57, 29 April 2016 (UTC)

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Cut Frank Pittman quote

This quote was tagged for a possibly unreliable source. However that wasn’t why I cut it. The actual article is very clearly on buying therapy in general and not just family therapy. It is not entirely clear in the article whether at that point being quoted Pittman is talking about family therapy or individualised psychoanalysis. It actually sounds more like the latter. In any case, since it’s not clearly about the article’s subject I believe it shouldn’t be included. Dakinijones (talk) 21:26, 10 August 2020 (UTC)

Wiki Education assignment: Adult Development Spring 2022

This article was the subject of a Wiki Education Foundation-supported course assignment, between 18 April 2022 and 18 July 2022. Further details are available on the course page. Student editor(s): AriannaLarson (article contribs).

— Assignment last updated by AriannaLarson (talk) 08:48, 19 July 2022 (UTC)

Family Therapy is the most popular pornographic channel

Their content has billions of views and is very notable. There should be a in pop culture section of this page to address it, or something similar. It is notable. — Preceding unsigned comment added by 115.72.16.83 (talk) 21:34, 18 August 2022 (UTC)

Statistics in the matter

Can we include some statistics on the different types of therapies? I think this will help readers get an idea of what works for couples and families. They can decide if it's working or not. Numbers always help get an idea of the topic! Focus less on the history of the information and more on the statistics side of the information. How does it also affect households of different races or socioeconomic statuses? Any underlying factors that seem to be the cause of coming to therapy would also be a interesting thing for readers to look at. Birmaniahern (talk) 19:58, 31 August 2022 (UTC)