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Emotionally Focused CoupleThis is a picture that describes today’s modern marriage. What do you see in this picture? ( View uploaded file) 2. Can you imagine what would happen in this picture if these two people could suddenly turn and reach for each other the whole picture would change to EFT. What changes would you see in this couple?Gottman Couple TherapyIt shows Gottman can predict relationship failure with over 90% accuracy and has researched relationships for over 40 years. Based on Gottman’s Therapy process, do you think his divorce or relationship prediction is accurate?
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CLINICAL HANDBOOK OF COUPLE THERAPY
Also from Jay L. Lebow and Douglas K. Snyder
FOR PROFESSIONALS
Common Factors in Couple and Family Therapy:
The Overlooked Foundation for Effective Practice
Douglas H. Sprenkle, Sean D. Davis, and Jay L. Lebow
Couple-Based Interventions for Military and Veteran Families:
A Practitioner’s Guide
Edited by Douglas K. Snyder and Candice M. Monson
Helping Couples Get Past the Affair: A Clinician’s Guide
Donald H. Baucom, Douglas K. Snyder, and Kristina Coop Gordon
Treating Difficult Couples: Helping Clients
with Coexisting Mental and Relationship Disorders
Edited by Douglas K. Snyder and Mark A. Whisman
FOR GENERAL READERS
Getting Past the Affair: A Program to Help You Cope,
Heal, and Move On—Together or Apart
Douglas K. Snyder, Donald H. Baucom, and Kristina Coop Gordon
CLINICAL
HANDBOOK OF
COUPLE
THERAPY
SIXTH EDITION
edited by
Jay L. Lebow
Douglas K. Snyder
THE GUILFORD PRESS
New York London
Copyright © 2023 The Guilford Press
A Division of Guilford Publications, Inc.
370 Seventh Avenue, Suite 1200, New York, NY 10001
www.guilford.com
All rights reserved
No part of this book may be reproduced, translated, stored in a
retrieval system, or transmitted, in any form or by any means,
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or otherwise, without written permission from the publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
The authors have checked with sources believed to be reliable in their efforts to provide
information that is complete and generally in accord with the standards of practice that
are accepted at the time of publication. However, in view of the possibility of human error
or changes in behavioral, mental health, or medical sciences, neither the authors, nor
the editors and publisher, nor any other party who has been involved in the preparation
or publication of this work warrants that the information contained herein is in every
respect accurate or complete, and they are not responsible for any errors or omissions or
the results obtained from the use of such information. Readers are encouraged to confirm
the information contained in this book with other sources.
Library of Congress Cataloging-in-Publication Data
Names: Lebow, Jay, editor. | Snyder, Douglas K., editor.
Title: Clinical handbook of couple therapy / edited by Jay L. Lebow,
Douglas K. Snyder.
Description: Sixth edition. | New York, NY : The Guilford Press, [2023] |
Includes bibliographical references and index.
Identifiers: LCCN 2022001583 | ISBN 9781462550128 (cloth)
Subjects: LCSH: Marital psychotherapy—Handbooks, manuals, etc.
Classification: LCC RC488.5 .C584 2022 | DDC 616.89/1562—dc23
LC record available at https://lccn.loc.gov/2022001583
Editors’ note. The case illustrations in this book are based on the authors’ research
and clinical practice. In all instances, names and identifying information have been
changed.
To our friends, colleagues, and precious loved ones
who have encouraged and sustained us over the years.
From the depth of our hearts—we thank you.
About the Editors
Jay L. Lebow, PhD, ABPP, LMFT, is Clinical Professor of Psychology at Northwestern University and
Senior Scholar at The Family Institute at Northwestern. He is also editor-in-chief of the journal Family
Process. Dr. Lebow has engaged in clinical practice, supervision, and research on couple and family
therapy since the 1970s, and is board certified in family psychology and an approved supervisor and
clinical fellow of the American Association for Marriage and Family Therapy (AAMFT). His numerous publications focus on the practice of couple and family therapy, the relationship of research and
practice, integrative practice, and intervention strategies with divorcing families. Dr. Lebow served as
president of Division 43 (Society for Couple and Family Psychology) of the American Psychological
Association (APA) and on the board of directors of the American Family Therapy Academy (AFTA).
He is a recipient of the Lifetime Achievement Award from AFTA and the Family Psychologist of the
Year Award from Division 43 of APA.
Douglas K. Snyder, PhD, is Professor of Psychological and Brain Sciences at Texas A&M University,
where he also served as Director of Clinical Training for 20 years. Dr. Snyder has engaged in clinical
practice and training of couple therapists since the 1970s, and is a clinical member of AAMFT. He
is coauthor or coeditor of several books, including Helping Couples Get Past the Affair and CoupleBased Interventions for Military and Veteran Families. Dr. Snyder has served as editor of the Clinician’s Research Digest and as associate editor of the Journal of Consulting and Clinical Psychology
and the Journal of Family Psychology. He is a recipient of the Distinguished Contribution to Research
in Family Therapy Award from AAMFT, the Distinguished Contribution to Family Psychology Award
from Division 43 of APA, and the Distinguished Psychologist Award from Division 29 (Society for the
Advancement of Psychotherapy) of APA.
vii
Contributors
Robert Allan, PhD, School of Education and Human Development, University of Colorado Denver,
Denver, Colorado
Samuel H. Allen, PhD, The Family Institute at Northwestern, Northwestern University, Evanston, Illinois
Christina Balderrama-Durbin, PhD, Department of Psychology, Binghamton University, State University
of New York, Binghamton, New York
Donald H. Baucom, PhD, Department of Psychology and Neuroscience, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina
Steven R. H. Beach, PhD, Center for Family Research and Department of Psychology, University of
Georgia, Athens, Georgia
Efrain Bleiberg, MD, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College
of Medicine, Houston, Texas
Kristin Bolton, PhD, School of Social Work, University of North Carolina Wilmington,
Wilmington, North Carolina
Douglas C. Breunlin, MSSA, The Family Institute at Northwestern, Northwestern University,
Evanston, Illinois
Will H. Canu, PhD, Department of Psychology, Appalachian State University, Boone, North Carolina
Ryan G. Carlson, PhD, Department of Educational Studies, University of South Carolina, Columbia,
South Carolina
Anthony L. Chambers, PhD, The Family Institute at Northwestern, Northwestern University,
Evanston, Illinois
Andrew Christensen, PhD, Department of Psychology, University of California, Los Angeles,
Los Angeles, California
Aaron Samuel Cohn, PhD, The Family Institute at Northwestern, Northwestern University,
Evanston, Illinois
Gene Combs, MD, Evanston Family Therapy Center, Evanston, Illinois
Deb Coolhart, PhD, Marriage and Family Therapy Department, Syracuse University, Syracuse, New York
Joanne Davila, PhD, Department of Psychology, Stony Brook University, Stony Brook, New York
Sean Davis, PhD, California School of Professional Psychology, Alliant International University,
Sacramento, California
ix
x
Contributors
Sona Dimidjian, PhD, Crown Institute and Department of Psychology and Neuroscience,
University of Colorado Boulder, Boulder, Colorado
Brian D. Doss, PhD, Department of Psychology, University of Miami, Miami, Florida
Elizabeth E. Epstein, PhD, Department of Psychiatry, University of Massachusetts Chan Medical School,
Worcester, Massachusetts
Norman B. Epstein, PhD, Department of Family Science, School of Public Health, University of Maryland,
College Park, Maryland
Melanie S. Fischer, PhD, Department of Psychology, Philipps-Universität Marburg, Marburg, Germany
Mona DeKoven Fishbane, PhD, Chicago Center for Family Health, Chicago, Illinois
Peter Fonagy, PhD, Research Department of Clinical, Educational, and Health Psychology,
University College London, London, United Kingdom
Peter Fraenkel, PhD, Department of Psychology, The City College of New York, New York, New York
Cynthia Franklin, PhD, Steve Hicks School of Social Work, The University of Texas at Austin,
Austin, Texas
Steffany J. Fredman, PhD, Department of Human Development and Family Studies, The Pennsylvania
State University, University Park, Pennsylvania
Jill Freedman, MSW, Evanston Family Therapy Center, Evanston, Illinois
Elana B. Gordis, PhD, Department of Psychology, University at Albany, State University of New York,
Albany, New York
Kristina Coop Gordon, PhD, Department of Psychology, University of Tennessee, Knoxville, Tennessee
John Mordechai Gottman, PhD, The Gottman Institute, Seattle, Washington
Julie Schwartz Gottman, PhD, The Gottman Institute, Seattle, Washington
Kathryn S. K. Hall, PhD, private practice, Princeton, New Jersey
Cathryn Glanton Holzhauer, PhD, VA Central Western Massachusetts Healthcare System and Department
of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts
Sabrina Johnson, EdS, Department of Educational Studies, University of South Carolina, Columbia,
South Carolina
Susan M. Johnson, EdD, International Centre for Excellence in Emotionally Focused Therapy,
University of Ottawa, Ottawa, Ontario, Canada
Lana Kim, PhD, Graduate School of Education and Counseling, Lewis & Clark College, Portland, Oregon
Jennifer S. Kirby, PhD, Department of Psychology and Neuroscience, University of North Carolina
at Chapel Hill, Chapel Hill, North Carolina
Bob G. Knight, PhD, School of Psychology and Counselling, University of Southern Queensland,
Toowoomba, Queensland, Australia
Kayla C. Knopp, PhD, VA San Diego Healthcare System and Department of Psychiatry,
University of California, San Diego, La Jolla, California
Carmen Knudson-Martin, PhD, Graduate School of Education and Counseling, Lewis & Clark College,
Portland, Oregon
Jaslean J. LaTaillade, PhD, JBS International, Inc., North Bethesda, Maryland
Erika Lawrence, PhD, The Family Institute at Northwestern, Northwestern University, Evanston, Illinois
Jay L. Lebow, PhD, ABPP, LMFT, The Family Institute at Northwestern, Northwestern University,
Evanston, Illinois
Gayla Margolin, PhD, Department of Psychology, University of Southern California, Los Angeles,
California
Howard J. Markman, PhD, Department of Psychology, University of Denver, Denver, Colorado
Christopher R. Martell, PhD, Psychological Services Center, University of Massachusetts Amherst,
Amherst, Massachusetts
Barbara S. McCrady, PhD, Center on Alcohol, Substance Use, and Addictions
and Department of Psychology, University of New Mexico, Albuquerque, New Mexico
Contributors
Susan H. McDaniel, PhD, Departments of Psychiatry and Family Medicine, University of Rochester,
Rochester, New York
Erica A. Mitchell, PhD, College of Education, Health, and Human Sciences, University of Tennessee,
Knoxville, Tennessee
Candice M. Monson, PhD, Department of Psychology, Toronto Metropolitan University, Toronto,
Ontario, Canada
Leslie A. Morland, PsyD, VA San Diego Healthcare System and Department of Psychiatry,
University of California, San Diego, La Jolla, California
Patricia L. Papernow, EdD, Institute for Stepfamily Education, Hudson, Massachusetts
Hannah F. Rasmussen, MA, Department of Psychology, University of Southern California, Los Angeles,
California
Galena K. Rhoades, PhD, Department of Psychology, University of Denver, Denver, Colorado
Nancy Breen Ruddy, PhD, Department of Clinical Psychology, Antioch University New England,
Keene, New Hampshire
William P. Russell, MSW, The Family Institute at Northwestern, Northwestern University, Evanston,
Illinois
Ellen Safier, LCSW, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College
of Medicine, Houston, Texas
Judith P. Siegel, PhD (retired), Silver School of Social Work, New York University, New York, New York
Douglas K. Snyder, PhD, Department of Psychological and Brain Sciences, Texas A&M University,
College Station, Texas
Alexandra H. Solomon, PhD, The Family Institute at Northwestern, Northwestern University,
Evanston, Illinois
Scott M. Stanley, PhD, Department of Psychology, University of Denver, Denver, Colorado
Daniel N. Watter, EdD, Morris Psychological Group, Parsippany, New Jersey
Carol A. Werlinich, PhD, private practice, Dayton, Maryland
Mark A. Whisman, PhD, Department of Psychology and Neuroscience, University of Colorado Boulder,
Boulder, Colorado
Stephanie A. Wiebe, PhD, School of Counselling, Psychotherapy, and Spirituality, Saint Paul University,
Ottawa, Ontario, Canada
Elizabeth R. Wrape, PhD, VA San Diego Healthcare System and Department of Psychiatry,
University of California, San Diego, La Jolla, California
Brian T. Wymbs, PhD, Department of Psychology, Ohio University, Athens, Ohio
Frances A. Wymbs, PhD, Department of Primary Care, Ohio University, Athens, Ohio
Helen Taylor Yates, PhD, School of Social Work, University of North Carolina Wilmington,
Wilmington, North Carolina
Anao Zhang, PhD, School of Social Work, University of Michigan, Ann Arbor, Michigan
xi
Contents
PART I. OVERVIEW AND GUIDING PRINCIPLES
CHAPTER 1
Couple Therapy in the 21st Century
3
Jay L. Lebow and Douglas K. Snyder
CHAPTER 2
Couple Assessment
22
Douglas K. Snyder and Christina Balderrama-Durbin
PART II. MODELS OF COUPLE THERAPY
BEHAVIORAL APPROACHES
CHAPTER 3
Cognitive-Behavioral Couple Therapy
53
Donald H. Baucom, Norman B. Epstein, Melanie S. Fischer,
Jennifer S. Kirby, and Jaslean J. LaTaillade
CHAPTER 4
Integrative Behavioral Couple Therapy
79
Andrew Christensen, Sona Dimidjian,
Christopher R. Martell, and Brian D. Doss
CHAPTER 5
Acceptance and Commitment Therapy for Couples
104
Erika Lawrence, Aaron Samuel Cohn, and Samuel H. Allen
EMOTION-CENTERED, PSYCHODYNAMIC, AND MULTIGENERATIONAL APPROACHES
CHAPTER 6
Emotionally Focused Couple Therapy
127
Susan M. Johnson, Stephanie A. Wiebe, and Robert Allan
CHAPTER 7
Object Relations Couple Therapy
Judith P. Siegel
xiii
151
xiv
Contents
CHAPTER 8
Mentalization-Based Couple Therapy
175
Efrain Bleiberg, Ellen Safier, and Peter Fonagy
CHAPTER 9
Intergenerational Factors in Couple Therapy
199
Mona DeKoven Fishbane
POSTSTRUCTURAL APPROACHES
CHAPTER 10
Narrative Couple Therapy
227
Jill Freedman and Gene Combs
CHAPTER 11
Solution-Focused Couple Therapy
250
Cynthia Franklin, Anao Zhang, Kristin Bolton,
and Helen Taylor Yates
CHAPTER 12
Socioculturally Attuned Couple Therapy
267
Carmen Knudson-Martin and Lana Kim
INTEGRATIVE APPROACHES
CHAPTER 13
Common Factors in Couple Therapy
295
Sean Davis
CHAPTER 14
Integrative Systemic Therapy for Couples
318
Douglas C. Breunlin, William P. Russell,
Anthony L. Chambers, and Alexandra H. Solomon
CHAPTER 15
Therapeutic Palette Integrative Couple Therapy
339
Peter Fraenkel
CHAPTER 16
Gottman Method Couple Therapy
362
John Mordechai Gottman and Julie Schwartz Gottman
PART III. APPLICATIONS OF COUPLE THERAPY
SPECIFIC RELATIONAL ISSUES AND POPULATIONS
CHAPTER 17
Couple Therapy for Partner Aggression
391
Norman B. Epstein, Jaslean J. LaTaillade, and Carol A. Werlinich
CHAPTER 18
Couple Therapy for Infidelity
Kristina Coop Gordon, Erica A. Mitchell,
Donald H. Baucom, and Douglas K. Snyder
413
Contents
CHAPTER 19
Couple Therapy and Sexuality
xv
434
Kathryn S. K. Hall and Daniel N. Watter
CHAPTER 20
Therapy with Older Adult Couples
454
Bob G. Knight
CHAPTER 21
Divorce Issues in Couple Therapy
472
Jay L. Lebow
CHAPTER 22
Therapy with Stepfamily Couples
492
Patricia L. Papernow
CHAPTER 23
Therapy with Queer Couples
512
Deb Coolhart
COUPLE-BASED THERAPY FOR INDIVIDUAL PROBLEMS
CHAPTER 24
Couple Therapy for Posttraumatic Stress Disorder
533
Candice M. Monson and Steffany J. Fredman
CHAPTER 25
Couple Therapy for Alcohol Problems
554
Barbara S. McCrady, Elizabeth E. Epstein,
and Cathryn Glanton Holzhauer
CHAPTER 26
Couple Therapy for Depression or Anxiety
576
Mark A. Whisman, Steven R. H. Beach, and Joanne Davila
CHAPTER 27
Couple Therapy with Parents of Youth
with Attention-Deficit/Hyperactivity Disorder
or Disruptive Behavior Disorders
595
Frances A. Wymbs, Brian T. Wymbs, and Will H. Canu
CHAPTER 28
Couple Therapy and Medical Issues
615
Nancy Breen Ruddy and Susan H. McDaniel
SPECIAL TOPICS
CHAPTER 29
Relationship Enhancement and Distress Prevention
Ryan G. Carlson, Galena K. Rhoades, Sabrina Johnson,
Scott M. Stanley, and Howard J. Markman
639
xvi
Contents
CHAPTER 30
Telehealth and Digital Couple Interventions
656
Brian D. Doss, Kayla C. Knopp, Elizabeth R. Wrape,
and Leslie A. Morland
CHAPTER 31
Ethical Issues in Couple Therapy
677
Gayla Margolin, Elana B. Gordis, and Hannah F. Rasmussen
Index
699
PA R T I
OVERVIEW AND
GUIDING PRINCIPLES
CHAPTER 1
Couple Therapy in the 21st Century
Jay L. Lebow and Douglas K. Snyder
Couple therapy is an evolving field, and this
Handbook, now in its sixth edition, reflects this
evolution. One transcendent fact is apparent in
even a cursory examination of the contents of the
current edition: Couple therapy is now an important, widely disseminated form of therapy. There
was a time when couple therapy was treated as an
afterthought in considerations of psychotherapy
and counseling, and seen as consisting of methods derived from individual or family therapy.
Today, couple therapy has emerged as a form
of treatment that stands on its own, is widely
practiced, and has its own distinct methods. The
largest international study of psychotherapists
found that 70% of psychotherapists treat couples (Orlinsky & Ronnestad, 2005). A survey of
expert psychotherapists’ predictions about future
practices in psychotherapy showed couple therapy to be the format likely to achieve the most
growth in the next decade (Norcross, Pfund, &
Prochaska, 2013).
Two key factors have driven the development
and widespread adoption of couple therapy as a
prominent therapeutic modality: the high prevalence of couple distress, and its adverse impact
on the emotional and physical well-being of
adult partners and their offspring. In the United
States, 40–50% of first marriages end in divorce
(Kreider & Ellis, 2011). Globally, across almost
all countries for which data are available, divorce
rates increased from the 1970s to the beginning of this century (Organization of Economic
Cooperation and Development, 2011). Indepen-
dent of divorce, many couple relationships experience periods of significant turmoil that place
partners at risk for developing symptoms of various emotional or physical health disorders. In a
U.S. survey, the most frequently cited causes of
acute emotional distress were couple relationship
problems (Swindle, Heller, Pescosolido, & Kikuzawa, 2000). Partners in a distressed relationship are significantly more likely to have a mood
disorder, anxiety disorder, or substance use disorder (McShall & Johnson, 2015) and to develop
more physical health problems (Waite & Gallagher, 2000). Moreover, couple distress has been
related to a wide range of deleterious effects on
children, including mental and physical health
problems, poor academic performance, and a
variety of other concerns (Bernet, Wamboldt, &
Narrow, 2016).
Many widely embraced principles of couple
therapy have emerged that transcend theoretical orientation, as well as several widely disseminated specific approaches to couple therapy
aimed at reducing couple distress and improving
relationship quality. Additional couple-based
interventions have been developed targeting
specific couple or individual problems (e.g., infidelity, partner aggression, mental health disorders) and populations (e.g., older adults, stepfamily couples). Although there remain threads
of both theoretical and technical connection to
various methods of individual and family therapy
(Lebow, 2014), the field now features a distinct
set of prominent approaches, builds on a large
3
4
I. OVERVIEW AND GUIDING PRINCIPLES
body of basic research focused on intimate relationships, and offers a substantial body of empirical evidence supporting the efficacy and effectiveness of its methods. It has become abundantly
clear that effective intervention with couples
requires its own set of theories, approaches, and
methods anchored in relational science. Furthermore, effective intervention for any psychological problem should include couple-based methods in the therapeutic arsenal.
A BRIEF HISTORY OF COUPLE THERAPY
Gurman and Fraenkel (2002) described four
stages in the development of couple therapy.
In the early 20th century, an atheoretical marriage counseling emerged, consisting of a pragmatic mix of psychoeducation and advice giving.
During this period, most of those working with
couples did not label themselves as psychotherapists; often they did not see spouses together.
The second phase that began in the 1930s built
on expanding the then predominant form of
therapy, psychoanalytic psychotherapy, to work
with couples. Initially, in this treatment, partners
tended to be seen separately by the same therapist in what was called concurrent therapy, but
eventually this approach segued into the beginnings of conjoint therapies in which both spouses
participated in sessions. Nonetheless, Michaelson (1963) estimated that in the 1940s, only 5%
of couples experienced counseling conjointly; by
the mid-1960s, this number had increased only
to about 15%. Phase 3 was sparked by the impact
of the family therapy revolution in the 1960s and
1970s, in which prominent models of therapy
emerged based in systems theory. Subvariations
of such core family systems therapies as experiential, strategic, psychoanalytic, and behavioral
therapies focused on couples and couple therapy
(Gurman & Kniskern, 1981). These therapies
almost invariably saw partners conjointly. In its
current phase, couple therapy has emerged as a
mature discipline that includes a wide array of
distinct treatments, a well-established underlying
set of theoretical percepts, a stronger evidence
base both in the efficacy of therapies and in its
foundation in the emerging body of relational
science, and an expanded conceptual framework
that includes feminism and multiculturalism,
and thus speaks to a broader diversity of couples.
This era also includes the flourishing of numerous integrative methods and the development of
couple therapy as a format for treating problems
of individual partners.
COUPLE THERAPY WORKS
Previous reviews affirm the effectiveness of
couple therapy in reducing relationship distress
(Bradbury & Bodenmann, 2020; Doss, Roddy,
Wiebe, & Johnson, 2022; Lebow, Chambers,
Christensen, & Johnson, 2012; Roddy, Walsh,
Rothman, Hatch, & Doss, 2020; Shadish &
Baldwin, 2003). The average person receiving
couple therapy is better off at termination than
70–80% of individuals not receiving treatment—
an improvement rate that rivals or exceeds the
most effective psychosocial and pharmacological
interventions for individual mental health disorders. A variety of couple treatments have also
garnered evidence supporting their effectiveness
for specific relationship problems including sexual difficulties, infidelity, and intimate partner
violence.
Separate from reducing either general or specific relationship difficulties, evidence from clinical trials supports the impact of couple therapies for coexisting emotional, behavioral, and
physical health concerns (Fischer, Baucom, &
Cohen, 2016; Goger & Weersing, 2022; Hogue,
Schumm, MacLean, & Bobek, 2022). For example, chapters included in this Handbook describe
evidence supporting couple-based interventions
for depression or anxiety, posttraumatic stress,
and alcohol problems of an adult partner, as well
as couple interventions with parents of youth with
attention-deficit/hyperactivity disorder (ADHD)
or related disruptive behavior disorders. Couplebased interventions for physical health problems
constitute a rapidly expanding application—with
evidence supporting the benefits of couple therapy for a broad spectrum of conditions including cancer, chronic pain, cardiovascular disease,
anorexia nervosa, or type 2 diabetes (Shields,
Finley, Chawla, & Meadors, 2012). Common
components of couple-based interventions for
individual mental and physical health problems
emphasize partner support, improved communication, and increased attention to the disorder’s
adverse impact on the couple relationship. The
extension of couple-based treatments to individual disorders reflects one of the most important
developments of couple therapy in this century.
A VIEW OF COUPLE THERAPY TODAY
Editing this Handbook has been a privilege.
Since the inaugural volume edited by Neil Jacobson and Alan Gurman (Jacobson & Gurman,
1986), it has long been a definitive guide to the
1. Couple Therapy in the 21st Century
couple therapy of the time. Over the past 40
years, authors of chapters in this Handbook have
been a “who’s who” in the field of couple therapy, and the approaches covered have provided
a snapshot into the Zeitgeist of couple therapy at
the time of each edition. In this first chapter, we
look to extrapolate from the various chapters in
this sixth edition to discern broad trends in the
field since the prior edition. Moving beyond the
obvious observation that this Handbook offers
a rich and effective set of approaches, we look
to articulate general trends in the field, as well
as commonalities and continuing major points of
difference and controversy across approaches. As
we have read the various chapters in this edition,
clear trends have emerged. So, in looking at the
approaches in this book, what then can we say of
couple therapy?
Foundation in Relational Science
One aspect of contemporary couple therapy is its
strong foundation in relational science. Bear in
mind that couple therapy began as a method of
practice before there was a field of relational science. Indeed, at the time of its origin, there were
only the most primitive beginnings of social psychology. The infusion of relational science into
practice has been slow and evolving.
The first widely recognized connections to science came in the form of bringing outcome and
efficacy assessments to couple therapies (Gurman & Kniskern, 1981). To no great surprise,
those efforts initially instigated considerable
reactivity from those who practiced therapies less
frequently represented in the research (Gurman
& Kniskern, 1978). Today, the crucial role of evidence in relation to the impact of various couple
therapies is widely acknowledged. Most couple
therapy begins with the clear purpose of reducing relationship distress and promoting couple
wellbeing, measurable outcomes that readily can
be compared to the limited changes in relational
satisfaction typical of those couples in no-treatment control conditions (Baucom, Hahlweg, &
Kuschel, 2003; Roddy et al., 2020).
To some extent, couple therapy has become
more firmly established because both meta-analytic data and systematic reviews of the literature
affirm the considerable broad impact of couple
therapy (Bradbury & Bodenmann, 2020; Doss et
al., 2022; Roddy et al., 2020; Shadish & Baldwin, 2003, 2005) and of several of its specific
approaches (Fischer et al., 2016; Roddy, Nowlan,
Doss, & Christensen, 2016; Wiebe & Johnson,
2016). This research also highlights the impact
5
of couple therapy on individual functioning even
when relational functioning is the primary focus
of the couple therapy. Moreover, unlike spontaneous remission of some disorders in the absence
of treatment, research shows little improvement
in relationship satisfaction among distressed
couples who do not receive therapy. Care delivery systems find links of couple-based treatments
to such clear and measurable outcomes essential.
Even more impactful has been the influence of
basic relational science research on couple therapy. Whereas early couple therapy only drew in
limited ways on the newly emerging field of relational science, most approaches now cite such
basic research as part of the foundation for their
methods, be that research about attachment,
behavior exchanges, emotion, or characteristics
of couples with specific problems or from specific
populations. The linkages between basic research
and practice articulated by John Gottman (see
Gottman & Gottman, Chapter 16) in the late
20th century modeled for others the incorporation of such basic science research into practice.
After the emergence of science-based couple
therapies, those who promoted their ideas about
relationships without providing empirical support, even if remaining fashionable in the popular
media, came to have less credibility or influence
among researchers and clinicians, who increasingly became committed to effective, evidencebased clinical practice. Moreover, with empirical
investigation also came the ability to disconfirm
theories and even identify the potential harmful
effects of certain untested ideas (Lilienfeld, 2007).
Links to Neuroscience
Closely connected to the incorporation of relational science in practice has been the rapid
advance in the integration of relational neuroscience in contemporary approaches. Most models
of couple therapy were well developed before the
technology was available to assess brain function in relational life. However, in the few years
since the publication of the fifth edition of this
Handbook, there has been an explosion in the
information available from neuroscience in relation to couple functioning. Today’s couple therapies have begun to incorporate this emerging and
exciting new knowledge base. Yet, here there is a
caveat. Relational neuroscience is in its infancy.
Studies are complex, with endless possible neurotransmitters and brain structures that may
be simultaneously influencing and influenced
by couple processes. Methodologies range from
those using simple, readily available instruments
6
I. OVERVIEW AND GUIDING PRINCIPLES
such as pulse oximeters (an inexpensive instrument that has utility here) to very expensive functional magnetic resonance imaging (fMRI) scanners. In exploring the literature and evaluating
claims made of findings’ implications for clinical
practice, the reader needs to remain mindful that
a specific finding that supports one approach
might also support another, that research findings require replication, that correlation is not
causation, and that the body of findings is only
just beginning to produce an evidence-based set
of knowledge that is widely accepted.
A Convergence of Methods
Upon examining chapters in Part I of this Handbook describing various models of couple therapy, we discern an emerging and substantial convergence of methods across different approaches.
Couple Therapy Is Both Pluralistic and Integrative
Contemporary couple therapies often cross the
boundaries of schools of therapy and theoretical constructs that typically have been identified in individual therapy and earlier iterations
of couple therapy. Thus, for example, while
psychoanalytic individual therapy almost exclusively focuses on factors such as transference,
the impact of early experience and inner life, the
couple therapy variations of these approaches
have come to include many other elements such
as communication skills building. Similarly, cognitive-behavioral couple approaches today transcend simply focusing on cognitions and behavioral sequences, instead also tapping emotion,
meaning, and early experience. Such integration results from a cross-pollination across the
couple therapies (wise ideas become assimilated
into other models) and the powerful pragmatic
issues that every couple therapist faces regardless
of orientation, such as how to manage spiraling angry interactions, engage the less invested
partner in therapy, promote positive connection,
or deal with comorbid individual emotional or
physical health concerns.
Most approaches build from a biopsychosocial foundation that includes diverse aspects such
as cognition, emotion, the influence of history,
and inner psychological processes. Thus, they
tap into multiple levels of human experience
(Lebow, 2014). For example, Gottman method
therapy addresses the direct behavioral level of
exchanges and a far deeper level of meaning.
Emotionally focused therapy addresses not only
underlying primary and derivative emotions but
also attachment. Enhanced cognitive-behavioral
therapy addresses not only behavioral patterns
but also relational schemas and emotion. Integrative systemic therapy addresses the many levels of
human experience, from behavioral exchange to
inner experience.
Approaches certainly have differences in how
much they emphasize each component, but the
overlap is considerable. Indeed, in editing this
book, we prompted authors to write less about
those aspects of their approaches that were
drawn from other approaches, so that better
conceptual clarity between the essence of schools
of couple therapy might be highlighted. Some
authors explicitly speak of their approaches as
integrative, while others do not; but regardless
of whet
