Volume I Issue 2

THE PULSE

The Science of Intimacy: The Evolution of Couple Therapy

by Paul David, PhD

* Many of the ideas in this article are based on John and Julie’s Gottman’s “Lessons from the Love Lab” in Psychotherapy Networker (November/December, 2015), pp. 37.52

The evolution of couple therapy as a scientific enterprise is a work in progress. Like other fields in mental health, couple therapy is in a continual process of refining its theory and practice by means of empirical investigation. However, as a relative newcomer, couple therapy has lagged behind other mental health fields as a scientific endeavor (Gurman, 2015). This article first discusses the ways in which some of the initial relational models in couple therapy were informed by these empirical investigations and then discusses how the field was particularly advanced by the research of John Gottman and his associates.

Initial Relational Models

Prior to the 1960’s, the mental health field was largely dominated by individually oriented models of treatment. Fueled by the groundbreaking research in communications and relationships, the field of family therapy played a major role in advancing more interpersonally oriented treatment approaches in the early sixties (Gurman, 2015). Pioneering clinicians such as Virginia Satir, Murray Bowen, Carl Whitaker, and Don Jackson developed a wide range of therapeutic approaches designed to correct the dysfunctional patterns of interaction that they hypothesized are responsible for symptoms of psychopathology (Goldenberg & Goldenberg, 2013).

One influential publication about couple therapy that advanced this new relationship perspective was The Mirages of Marriage. In this book, Lederer and Jackson (1968) posited that healthy marriages are characterized by reciprocal interactions wherein one spouse responds to the others’ good behavior with his or her own good behavior. They argued that couples who practiced this reciprocity would succeed and the ones who didn’t would fail. They called this approach quid pro quo and proposed that couple therapy should focus on helping partners establish a contingency contract in which they would agree to “give to get.”

The quid pro quo approach fit well into the new relational thinking and was widely accepted as a basic axiom by many couple therapists. However, later research demonstrated that contingency contracting didn’t really work. For instance, Murstein, Cerreto, and MacDonald (1977) found that partners operating on quid pro quo principles tended to become preoccupied with keeping track of their exchanges and, as a result, became more dissatisfied with their relationships. These researchers discovered that partners who did not become preoccupied with reciprocity were much more satisfied with their relationships because they wanted to express their caring feelings without necessarily getting something in return.

Another influential publication advancing this new interpersonal perspective was The Intimate Enemy. In this book, George Bach (1969) emphasized that marital partners should be able to openly express their resentment and anger toward one another. He argued that if they could actively air these emotions, instead of letting them accumulate, it would clear the air and improve the communication between them. Based on this rationale, Bach focused his treatment on helping partners take turns voicing their hostilities.  He even encouraged them to hit one another with foam bats called batakas.

Outcome studies in couple therapy demonstrated the beneficial effects of partners expressing their emotional insecurities and nurturing their emotional dependence with one another.

Like the quid pro quo approach, Bach’s cathartic approach had little or no beneficial effect.  As it turned out, these cathartic methods were not that cathartic after all.  In fact, they had the reverse effect in that they were more likely to leave partners with more resentment and anger than when they began therapy.  Later clinical research showed that facilitating the unregulated expression of resentment and anger leads to the expression of more—not less—of these negative emotions (Tavris, 1989; Tavris & Aronson, 2015).

Despite these findings, Bach makes an important point regarding the suppression of resentment and anger.  It is well established that bottled up resentment and anger can lead to depression, withdrawal, and bitterness in relationships (Tavris & Aronson, 2015).  However, as researchers like Gottman (2011) point out, these negative emotions are not the basic problem because they are hard-wired responses to perceptions of being unfairly treated or being thwarted from achieving a goal.  The more central problem is the dysregulation of these feelings.  As later research showed, Bach’s mistake was to focus on getting partners to express their resentment and anger without helping them better regulate these emotions (Gottman, 2011).

Just as Bach held that the suppression of resentment and anger is one of the central problems, other clinicians took the opposite position that the expression of these emotions is the primary difficulty in marital relationships. A particularly influential family systems theorist taking this position was Murray Bowen.  Bowen (1978) held that emotional reactivity interferes with the problem-solving capacities of couples.  He advocated that partners should strive to remain as calm and rational as possible in their conflicts with one another.  Bowen also took the position that partners need to be sufficiently differentiated to maintain a healthy relationship.  By this he meant that they need to be comfortable with their own independent sense of themselves and be able to express this part of themselves without getting entangled in the anxieties of other people—particularly other family members.

Later research in neuroscience brought into question Bowen’s emphasis on the paramount importance of rational functioning in maintaining healthy relationships.  This research showed that emotions play a key role in facilitating effective human interaction and problem solving (Kahneman and Tversky, 1996).  This research also demonstrated that humans depend on emotionally intuitive functions to effectively manage their interactions and relationships with one another (Demasio, 1994).  Subsequent outcome studies in couple therapy demonstrated the beneficial effects of partners expressing their emotional insecurities and nurturing their emotional dependence with one another.  Sue Johnson’s emotionally focused therapy proved to be particularly successful with couples in this regard (Johnson, Hunsley, Greenberg, & Schlinder, 1999).

The Science of Intimacy

Empirical research was successful in bringing into question many of the faulty conceptions about intimate relationships, but it wasn’t until a series of studies conducted by John Gottman and his associates (Gottman, 2002; Gottman & Levenson, 1984, 1988, 1992, 1999; Gottman, Coan, Carrere, & Swanson, 1998; Jacobson & Gottman, 1998; Levenson & Gottman, 1983, 1985; Levenson, Carstensen, & Gottman, 1994) that the scientific basis for improving intimate relationships became more firmly established. These researchers developed innovative observation and coding methods to record the complex ways in which marital partners interact in non-clinical settings. These studies were not focused on clinical treatment per se, but on identifying key communication and problem solving patterns of both healthy and unhealthy marital relationships.

The observational studies by Gottman and his associates produced groundbreaking findings that were influential across the theoretical spectrum in the field of couple therapy. The general approach they took in these studies was to measure any variable they thought might be likely related to how couples fare over time, then they would follow the couples over many years, tracking how the couples’ marriages would progress. These studies included newlyweds, couples in the first seven years of marriage, gay and lesbian couples, violent marriages, and long-term couples in their 40s and 60s (Atkinson, 2005).

A number of these studies were conducted in an apartment laboratory at the University of Washington. Couples lived at this special lab for 24-hour periods with video cameras recording everything that happened between them. These studies used a multi-method approach, observing the couples in three domains: (1) interactive behavior —coding partners’ behavior and emotions as they interacted in various contexts, (2) perception—studying partners’ perceptions of themselves and each other through questionnaires, video recall procedures, attributional methods, and interviews, and (3) physiology—measuring partners’ autonomic, endocrine, and immune system responses. These researchers found that variables in each of these domains predicted different marital outcomes (Atkinson, 2005).

These researchers developed interview protocols documenting the participants’ marriage histories, their parents’ marriage histories, their philosophies of marriage, and their levels of comfort with basic emotions. They also gathered qualitative data about the rituals, roles, life dreams, and goals that guided the couples in their search for meaning. When these researchers had measured everything they considered relevant, they then sent the couples back home, and followed them carefully—for, in some studies, up to 20 years (Atkinson, 2005).

Failure & Success in Intimate Relationships

Many of the findings from these studies were summarized in Gottman’s (1999) The Marriage Clinic and The Seven Principles of Making Marriage Work. From this research he established that there are four major predictors of relationship dysfunction that he called the Four Horsemen of the Apocalypse. The first Horseman is criticism. This type of dysfunction involves partners blaming their problems on one another’s character flaws. The second Horseman is defensiveness. This relational dysfunction takes place when partners react to one another’s criticisms by deflecting them back— often by becoming the victim or counterattacking. The third Horseman is contempt. Caught in a criticize-defend cycle of interaction, partners frustrations morph into feelings of superiority and disgust toward one another. The fourth Horseman is stonewalling. This dysfunction involves partners shutting down from one another. When this occurs, partners curtail their interactions and become emotionally withdrawn.

From this same research, Gottman and his associates also identified key predictors of relationship success. When their research team observed couples discussing their problems, those with the highest relationship satisfaction expressed understanding and empathy in their disagreements. Moreover, it wasn’t just that they were more positive, it was that the relationship of their positive to negative interactions maintained a ratio of at least five-to-one (5:1).

The observational studies by Gottman and his associates produced groundbreaking findings that were influential across the theoretical spectrum in the field of couple therapy.

Conversely, Gottman and his associates discovered that couples with low relationship satisfaction and high divorce rates had much lower ratios at a level of one positive interaction for every negative one (1:1). These researchers also found that this ratio for successful couples was on the average much higher at a level of twenty-to-one (20:1). Based on these findings, they concluded that successful couples have relational bank accounts of positive interaction that they draw upon to help them get through the rough times when they are in conflict.

Building on an impressive body of evidence from his research about what predicts marital success, Gottman (2002) developed his Sound Marital House model of intimate relationships. In this model, Gottman organized his findings into seven different levels of effectiveness. The first three levels form the foundation of this relationship house and the other four levels constitute its superstructure. Brief descriptions of these levels of relational effectiveness are as follows:

Level #1: Developing Love Maps. At the most basic level, successful partners develop a working knowledge of each other’s internal and external worlds. As a result, they know each other’s likes and dislikes, friends and enemies, aspirations and insecurities, etc. In effect, they have a detailed road map of each other’s lives and the make sure they continually update it as their lives change.

Level #2: Promoting Fondness & Admiration. Making use of their knowledge of each other, successful partners regularly express caring behavior toward one another. In doing so, they are particularly mindful about expressing their respect and affection toward one another in small and everyday ways.

Level #3: Turning Toward. Successful partners make sure to pay attention to each other’s bids for connection. These bids may be for attention, affection, conversation, humor, emotional support, and so on; but these partners make an effort to be responsive to these requests for acknowledgement.

Level #4: Generating Positive Sentiment Override. This level is achieved when the first three levels have been firmly established. Positive sentiment override is a state of perception in which successful partners perceive neutral and negative events as positive. When this phenomenon takes place, partners are more likely to experience their relationship in a positive light and are less likely to find fault with one another.

Level #5: Managing Solvable Problems. Successful partners focus their problem solving efforts on issues that are subject to negotiation and don’t get bogged down in problems that are embedded in their personality, coping, and lifestyle differences. When conflicts arise, these partners apply effective communication and problem solving strategies such as using soft startups, complaining constructively, soothing tension, making repairs, accepting influence, and finding compromise.

Level #6: Honoring Dreams. Successful partners make efforts to know and make room for one another’s life dreams. This effort helps make their relationship secure enough for the partners to more fully be themselves and to find ways to realize their aspirations.

Level #7: Creating Shared Meaning. Successful partners work at building common meaning in their relationship. As a result, they carry out formal and informal rituals of connection, supporting each other’s life roles, emphasize shared values, and identify common life goals.

Together, these seven levels comprise the essential building blocks for achieving success in intimate relationships. In referring to the scientific relevance of these building blocks, Atkinson (2005) points out that “for the first time, we now have… compelling empirical evidence that there are personal prerequisites for succeeding in intimate relationships. Those who want to succeed in love must have specific interpersonal abilities, and we now know exactly what these abilities are” (p. 2).

Summary

Many of the early interpersonally oriented couple therapies benefited from the empirical investigations that revealed the faulty assumptions and limitations of their approaches. However, much of the research on couple therapy focused on the efficacy of different treatment approaches rather than on the efficacy of different communication and problem solving approaches in intimate relationships (Gurman, 2015). It was not until the research of Gottman and his associates that clear empirical evidence emerged about how healthy and unhealthy couples function differently.

Gottman’s research also provided compelling evidence that there is a critical set of relational capabilities that intimate partners need to employ if they are going to maintain a healthy relationship. While Gottman (2011) went on to develop his own therapeutic method of enhancing these capabilities, his findings provided a sound scientific basis for the clinical significance of enhancing these relational capabilities in couple therapy. This achievement constituted a major breakthrough that enabled the field of couple therapy to become a more advanced science of intimacy.

References

Atkinson, B. J. (2005). Emotional intelligence in couples therapy. New York, NY: W. W. Norton.

Bach, G. (1965). The Intimate Enemy. New York, NY: Basic Books.

Bowen, M. (1978). Family therapy in clinical practice. Northvale, NJ: Janson Aronson.

Demasio, A. (1994). Descartes’ error: Emotion, reason, and the human brain. New York, NY: Putnam.

Goldenberg, H., & Goldenberg, I. (2013). Family therapy: An overview (8th ed.). Belmont, CA: Brook/Cole.

Gottman,. J. M., Coan, J., Carrere, S., & Swanson, C. (1998). Predicting marital happiness and stability from newlywed interactions. Journal of Marriage and the Family, 60, 5-22.

Gottman, J. M. & Levenson, R. W. (1984). Why marriages fail: Affective and physiological patterns in marital interaction. In J. Masters (Ed.) Boundary areas in social and developmental psychology (pp. 110-136). New York, NY: Academic Press.

Gottman, J. M. & Levenson, R. W. (1988). The social psychophysiology of marriage. In P. Noller and M. A. Fitzpatrick (Eds.), Perspectives on marital interaction (pp. 182- 200). Clevedon, UK: Multilingual Matters.

Gottman, J. M. & Levenson, R. W. (1992). Marital processes predictive of later dissolution: Behavior, physiology, and health. Journal of Personality and Social Psychology, 63, 221-233.

Gottman, J. M., & Levenson, R. W. (1999). Rebound from marital conflict and divorce prediction. Family Process, 38, 237-292.

Gottman, J. M., & Silver, N. (1999). The seven principles of making marriage work. New York, NY: Crown Publishers.

Gottman, J. M. (1999). The marriage clinic. New York, NY: W. W. Norton.

Gottman, J. M. (2011). The science of trust. New York, NY: W. W. Norton.

Gottman, J. M. (2002). Building the sound marital house: An empirically derived couple therapy. In A. Gurman & N. Jacobson (Ed.), Clinical handbook of couple therapy (3rd ed.) (pp. 373-399). New York: Guilford Press.

Gurman, A. S. (2015). The theory and practice of couple therapy. In A. S. Gurman, J. L. Lebow, & D. K. Snyder (Eds.), Clinical handbook of couple therapy (5th ed.) (pp. 1- 18). New York, NY: Guilford Press.

Jacobson, N. L., & Gottman, J. M. (1998). When men batter women: New insights into ending abusive relationships. New York, NY: Simon & Schuster.

Johnson, S. M., Hunsley, J., Greenberg, L., & Schlinder, D. (1999). Emotionally focused couple therapy: Status and changes. Journal of Clinical Psychology: Science and Practice, 6, 67-79.

Kahneman, D., & Tversky, A. (1996). On the reality of cognitive illusions. Psychological Review, 103, 582-591.

Lederer, W., Jackson, D. (1968). The Mirages of Marriage. New York, NY: W. W. Norton.

Levenson, R. W., Carstensen, L. L., & Gottman, J. M. (1994). The influence of age and gender on affect, physiology, and then interrelations: A study of long-term marriages. Journal of Personality and Social Psychology, 67, 56-68.

Levenson, R. W., & Gottman, J. M. (1983). Marital interaction: Physiological linkage and affective exchange. Journal of Personality and Social Psychology, 67, 56-68.

Levenson, R. W., & Gottman, J. M. (1985). Physiological and affective predictors of change in relationship satisfaction. Journal of Personality and Social Psychology, 49, 85-94.

Murstein, B.I., Cerreto, M., & MacDonald, M. G. (1977). A theory and investigation of the effect of exchange orientation on married and friendship. Journal of Marriage and the Family, 39, 543-548.

Tavris, C. (1989). Anger: The misunderstood emotion. New York, NY: Simon & Schuster.

Tavris, C. & Aronson, E. (2015). Mistakes were made, but not by me. New York, NY: Houghton Mifflin Harcourt.

Paul David, PhD, is chair of Couple and Family Therapy, in the School of Applied Psychology, Counseling and Family Therapy, at Antioch University in Seattle, Washington. His professional interests include marital conflict, family of origin therapy, infidelity, family systems theory, attachment styles and couples therapy training.

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