A summary of new information provided by Dr John Gottman at the Wellington, NZ Level 1 training, April 2016
Current Status of Couples Therapy Research.
The research literature on couples’ therapy has now validated five treatments for couples’ distress. As a great guide to these treatments Clinical Handbook of Couple Therapy, Fifth Edition (2015), edited by Alan Gurman, Jay Lebow and Douglas Snyder (New York: Guilford Press) is recommended. The validated treatments described in this book include:
1. Behaviorial Marital Couples Therapy, either traditional, or acceptance-based, described by Donald Baucom (Chapter 2). This therapy has had the most outcome studies done.
2. Insight-Oriented Marital Therapy. Chapter 2 also includes references to the “insiht-oriented” marital therapy developed by Snyder and Wills. Their therapy was influenced by analytic thinking about relationships.
3. Acceptance-based Couples therapy (Chapter 3). The late Neil Jacobson and Andrew Christensen developed this “accept your partner as he or she is” therapy as a contract to behavioral marital therapy, in which asking for change was central to the therapy. The new thrapy actually includes asking for change as well as acceptance-based interventions; it also uses Johnson’s ‘softening’ anger intervention.
4. Emotionally Focused Couples Therapy (Chapter 4) as described by Susan Johnson. Johnson brought extensions of attachment theory for adults into the couples’ domain.
5. Gottman Method Couples Therapy (Chapter 5) as described by John and Julie Gottman.
Gottman highlights two limitations to the research literature – Relapse, and limited populations studies.
Relapse – The problem of people not doing what is beneficial for them is ubiquitous in medicine. The World Health Organisation and the Centers for Disease Control have documented that, regardless of medical access, 50% of patients with chronic diabetes, hypertension, and asthma do not take their medicine, and 70% do not make the life-style changes recommended by physicians . This is just one example of what we are calling the Relapse problem. These numbers are found to be similar in Mental health and relationship therapy longitudinal outcome studies – Neil Jacobson found a 30 to 50% relapse problem in behavioral marital therapy in the 1970’s and 1980’s. Gottman believes we have not yet solved this problem. He advises that relapse be discussed openly with couples, normalized and planned for.
Limited populations – The current research literature does not reflect clients seen in clinics. The most commonly used outcome measures of relationship satisfaction is the Locke-Wallace marital Adjustment Test, or its slightly modified form called the Spanier Dyadic Adjustment Scale. In clinics we typically see couples with relationship satisfaction scores 5 or 6 standard deviations below the mean. Our presenting couples also typically have co-morbidities. The research literature has primarily served couples with relationship satisfaction scores within on e standard deviation from the mean and generally screens out couples with co-morbidities.