What Works with Families & Couples

Want your Family Therapy Clients to Drop Out of Treatment? Name and Blame . . .
Finding the "cause" of the problem has long been considered the key to effective treatment. Of course, how else would a therapist know what to do or where to intervene. And yet, a recent study shows that the "name and blame" approach to therapy may increase the likelihood that families will drop out of treatment. In this study, researcher Walpert found that 75% of the cases which eventually dropped out of treatment contained a "double-dose" of blaming. Specifically, parents attributed the cause of the problem to the child and the therapist to the parents. In contrast, no families that continued in treatment experienced this combination.

Wolpert, M. (2000). Is anyone to blame? Clinical Child Psychology and Psychiatry, 5, 115-131.

Is Dr. Laura right? When it comes to living together before marriage, the answer is . . .
For years, couples have lived together prior to marriage. The common argument for the arrangement is that it not only helps with paying the bills but actually improves the chances of a successful marriage. At present, about 50% of couples in America live together prior to being married. A study presented at a recent conference finds, however, that such couples display more negative and fewer problems solving and support behaviors than couples who do not cohabitate–a predictor of divorce according to research conducted by other researchers (e.g., Gottman and colleagues). Perhaps this may explain why cohabitating couples have higher rates of separation and divorce?

Gorell, C. (2000). Live-in and Learn. Psychology Today, 33(6), 16.

Forgiveness versus Communication Training in Saving Relationships
For years, difficulties in marital relationships have been attributed to poor communication. In response, therapists have focused their efforts on improving communication between partners–especially about problems and expression of emotion. While effective communication has been linked to marital satisfaction in the research literature, a recent study suggests a more effective alternative: teaching tolerance. In particular, helping partners adjust their expectations to the type of communication pattern the couple does have. In the study, for example, avoidance of discussing problems and sharing emotions had less relation to marital satisfaction and happiness in couples that preferred more emotional and psychological space and less conjoint decision making. Well, duh. One size does not fit all.

Gordon, K.C. et al. (1999). The interaction between marital standards and communication patterns. Journal of Marital and Family Therapy, 25, 211-223.

Couples Therapy versus Anti-Depressants for Depression
So what works better for depression: (1) anti-depressants; or (2) couples therapy? Well, if you listen to the mental health professional organizations, you'd think it was anti-depressants. Indeed, practicing therapists seem to believe that anti-depressants are the "treatment of choice" for people who are depressed. The data, of course, suggest something else entirely. In this most recent study, researchers compared couples therapy with an anti-depressant and found that: (1) those in the anti-depressant group had significantly higher drop out rates; and (2) significantly greater improvement in the couples group which were maintained at one-year follow up. The results, interestingly enough, are not all that suprising. Most studies show higher drop out rates for those taking drugs. Similarly, most studies favor psychotherapy over drugs in terms of outcome. What is perhaps most surprising about these results is how non-drug prescribing mental health professional organizations continue to tout the "drug-em Dano" line even though the research clearly favors talk therapy . . .

Leff, J. et al. The london depression intervention trial (June 2000). British Journal of Psychiatry, 177, 95-100.

Husbands and Wives: Who Gets/Gives More Empathy?
Clinical and cultural wisdom holds that women have been conditioned to be more nurturing, more empathic. And yet, recent research on depression in marital partners appears to show that husbands may be more empathic or positive and receive less support when trying to lift marital gloom. Researchers Johnson and Jacob found that positive comments made by depressed husbands were met with negative comments from their wives. When women were depressed no such pattern was found. While the researchers suggest that the pattern may be due to compassion fatigue on the part of the ordinarily more nurturing wives, it makes more sense to interpret the findings as evidence that women want their husbands to assume their culturally-stereotyped role as strong and emotionally stilted.

When depressed husbands stumble into marital bear traps. Family Therapy Networker, 24(3), 19.