Couple and marital therapy: The complement and expansion provided by multicultural approaches.

Abstract

This chapter assesses and critiques how current approaches to couple therapy apply to diverse couples and provides a new framework as well as specific steps for culturally competent understanding and treatment of diverse couples. The chapter covers the theory, interventions, and cross-cultural applications of cognitive-behavioral, systems, and psychodynamic models of couple therapy, as they represent the three major theoretical orientations that are applied to couple therapy, and also covers emotionally focused therapy (EFT) and the Gottman method of couple therapy, which are the best-known data-supported approaches developed specifically for couples. It considers the empirical support for these five approaches as well as the notable limitations related to their shared Eurocentric orientation. To overcome these limitations, the chapter identifies specific examples of cultural competence involving knowledge, dynamic sizing, skills, and awareness. A case example demonstrates the application of a new model of the four mechanisms by which cultural competence may operate, including worldviews and values, experiences and contexts, power differences, and felt distance between both members of the couple with each other and the therapist. This framework is likely to yield a more focused and useful application of cultural competence in couple therapy that counters the limitations of traditional treatments. THEORETICALLY DRIVEN APPROACHES TO COUPLE THERAPYThe sections that follow review approaches to couples therapy derived from dominant theories of psychotherapeutic intervention (cognitivebehavioral, systems, and psychodynamic) and their cross-cultural application. Cognitive-Behavioral Approaches to CouplesTheory, background, and interventions. Cognitivebehavioral couple therapy is rooted in a convergence of Mowrer' s two-factor theory of classical and operant conditioning, cognitive theory, and social learning principles. All cognitive-behavioral theories emphasize functional analysis, which refers to cognitive, behavioral, and affective contingencies that shape behavior across repeating positive and negative couple interactions (Baucom, Epstein, LaTaillade, & Kirby, 2008). A common behavioral pattern with distressed couples is negative reciprocity, in which one person perceives the other' s behavior as negative and thus reciprocates with a negative behavior, beginning a continuous cycle (Baucom et al., 2008). During these interactions, cognitive and emotional problems also occur. For example, one partner might attribute the other' s negative behavior to immutable personality characteristics, which is a cognitive distortion, and the other may be unable to adaptively identify, express, and cope with emotions experienced in the relationship (Baucom et al., 2008).Traditional cognitive-behavioral interventions include skill building related to behavioral exchange, communication, problem solving, cognitive restructuring, and affect regulation (e.g., Baucom et al., 2008). Newer cognitive-behavioral approaches, such as

Cognitive‐Behavioral Couple Therapies: Review of the Evidence for the Treatment of Relationship Distress, Psychopathology, and Chronic Health Conditions

“…For example, while relationship distress for a same‐sex couple may well be driven by factors commonly found in different‐sex couples, specific challenges related to their sexual minority status such as lack of support by families of origin and minority stress are important to explore (Green & Mitchell, ). The contextual focus of CBCT allows the clinician to identify unique themes that may characterize conflict in diverse couple relationships and help couples build on their particular strengths and resources (Kelly, Bhagwat, Maynigo, & Moses, ; LaTaillade, ).…”

Principle‐Based Integrative Therapy with Couples: Theory and a Case Example

“…For Kiara, only a MC model automatically respects and utilizes a variety of cultural values, and bridges differences involving them. These differences can be between partners and between the couple and therapist, such as differences in their worldviews and values, experiences and lived contexts, power, and felt distance within the therapy session (Kelly, ; Kelly, Bhagwat, Maynigo, & Moses, ).…”

“…Each theoretical model has ways to approach couples over time at different points in the change process. For example, the MC approach starts early with joining, then a cultural genogram to uncover key diversity factors that may differ across partners and the therapist and need to be bridged in treatment (e.g., Boyd‐Franklin, ; Kelly et al., ). That bridging often occurs with the therapist acting as a cultural interpreter who translates the differences to each, or as a cultural broker who helps to label and negotiate the differences at a later point in the treatment process (Boyd‐Franklin, ; Kelly, ; Kelly et al., ).…”

“…For example, the MC approach starts early with joining, then a cultural genogram to uncover key diversity factors that may differ across partners and the therapist and need to be bridged in treatment (e.g., Boyd‐Franklin, ; Kelly et al., ). That bridging often occurs with the therapist acting as a cultural interpreter who translates the differences to each, or as a cultural broker who helps to label and negotiate the differences at a later point in the treatment process (Boyd‐Franklin, ; Kelly, ; Kelly et al., ). Traditional CB for couples starts with a collaborative alliance and assessment, then builds a couple bond with positive behavior exchange, then improves the couple's communication, and then it uses a variety of interventions tailored to the couple's needs (e.g., Epstein & Baucom, ).…”

“…Data show that research funding is allocated disproportionately to researchers from dominant groups (e.g., Ginther et al., ), and couple therapy studies disproportionately include White middle‐class couples (e.g., Karney et al., ). Empirical examination within and across diverse groups is key, because for many years, important multicultural research and practice were not conducted due to skepticism about multicultural principles (e.g., Plante, ), while findings on White middle‐class populations were inappropriately generalized to minority groups (Kelly et al., ).…”