Couple‐Responsible Therapy Process: Positive Proximal Outcomes

Abstract

Therapist-couple struggle vs. cooperation is linked to clinical outcome. This research conceptualizes and investigates treatment process as it relates to the occurrence of struggle versus cooperation. Models of couple-responsible and therapist-responsible process in couple therapy were developed. Couple-responsible process consists of enactments, accommodation, and inductive process. Therapist-responsible process consists of primary therapist-couple interaction, therapist interpretation, and direct instruction. In counterbalanced order, 25 couples were exposed to couple-responsible and therapist-responsible episodes during one therapy session. Couples reviewed videotapes of the episodes and completed measures of responsibility, struggle, and cooperation. Perceived responsibility was higher and struggle was lower during couple-responsible episodes. No difference in cooperation was found. Presence or absence of a contrast condition, where couples reported on one therapist process after already experiencing its opposite, led to main effects for responsibility and struggle, and mediated effects of struggle and cooperation. Generally speaking, responsibility was even higher during couple-responsible episodes and even lower during therapist-responsible episodes when contrast was present. Similarly, struggle was even lower during couple-responsible episodes and even higher during therapist-responsible episodes when contrast was present. For both couple-responsible and therapist-responsible episodes, cooperation was negatively affected by a shift from the prior, opposite therapist process. Significant proportions of the variance in responsibility, struggle, and cooperation, however, were not accounted for by therapist process alone.

A Primer on the Evolution of Therapeutic Engagement in MFT: Understanding and Resolving the Dialectic Tension of Alliance and Neutrality. Part 1—Retrospective: The Evolution of Neutrality

“…Instead, therapists have the demanding task of building and using alliances with both spouses while not condoning the harmful interactions of any person (Knobloch-Fedders, Pinsof, & Mann, 2007), but facilitating couples' and families' own relationships as the engine of change (Butler & Gardner, 2003;Butler & Wampler, 1999). Therefore, we see that while the detachment of Bowenian neutrality has its alliance problems, abandoning neutrality in favor of active alignment brought entirely new and equally problematic alliance complications in relational therapies.…”

Reconceptualizing Strategic Family Therapy: Insights from a Dynamic Systems Perspective

“…Such concerns should not be taken lightly or dismissed as invalid, as some research suggests clients may prefer a clinical process that is more inductive and accommodative and less directive (e.g., Butler & Bird, 2000;Butler & Wampler, 1999). Haley (1977) himself engaged in a lengthy discussion of the ethical ramifications of therapist behaviors perceived as untruthful or manipulative, and seemed to believe that such concerns had more to do with individual therapists rather than specific models or approaches to therapy.…”

Enhancing Change Process in Solution-Focused Brief Therapy by Utilizing Couple Enactments

“…Conversely, therapist-responsible process exemplified by therapist-couple interaction, therapist interpretation, and direct instruction was found to decrease the perception of couple responsibility and increase therapist-client struggle, thereby contributing to less positive clinical outcomes. Thus, enactments may decrease therapist-client struggle and foster greater cooperation and collaboration, increased interactional autonomy, and more positive therapeutic outcomes by centralizing couple interaction and engagement in therapy and privileging the couple relationship as the primary agent of change (Butler & Bird, 2000;Butler & Wampler, 1999).…”

“…Enactment utility is measured by contributing to positive therapeutic outcomes. Empirical research has found that couple-responsible process characterized by enactments, therapist accommodation, and inductive process decreases struggle and increases couple responsibility, ultimately leading to more positive clinical outcomes (Butler & Wampler, 1999). Conversely, therapist-responsible process exemplified by therapist-couple interaction, therapist interpretation, and direct instruction was found to decrease the perception of couple responsibility and increase therapist-client struggle, thereby contributing to less positive clinical outcomes.…”