Observed communication in couples two years after integrative and traditional behavioral couple therapy: outcome and link with five-year follow-up.

One of the central tenants of behaviorally-based couple therapy is that improvements in relationship satisfaction result from improvements in how couples communicate. Consistent with this idea, previous studies have documented decreases in negative behavior (Baucom, 1982; Baucom, Sayers, & Sher, 1990; Halford, Sanders, & Behrens, 1993; Jacobson, 1977) and increases in positive behavior over the course of therapy (e.g., Baucom, 1982; Hahlweg, Revenstorf, & Schindler, 1984; Jacobson, 1977; Sevier, Eldridge, Jones, Doss, & Christensen, 2008). Thus, there is empirical support for the notion that behavioral couple therapies are able to change communication in the manner intended. Unfortunately, no known study of behavioral couple therapy has observed communication after the post-therapy assessment. Available evidence from psychoeducational relationship education is encouraging; it suggests continued declines in observed negatively and stability in observed positivity (e.g., Laurenceau, Stanley, Olmos-Gallo, Baucom, & Markman, 2004). However, given that there is an increase in relationship distress from termination through subsequent follow up in 30% to 60% of couples who undergo couple therapy (Snyder, Castellani, & Whisman, 2006), it is important to establish whether couples evidence similar declines in observed communication after therapy. Although researchers have consistently found that observed communication changes in desired directions over the course of therapy, links between it and relationship outcomes remain largely unclear (Snyder et al., 2006). On the one hand, some studies have found that reductions in negative behavior (e.g., Sayers, Baucom, Sher, Weiss, & Heyman, 1991; Sevier et al., 2008) and increases in positive behavior (e.g., Sevier et al., 2008) are linked with improvements in relationship outcomes, consistent with behavioral theory. On the other hand, a number of studies have failed to find associations between changes in communication and changes in relationship satisfaction (Iverson & Baucom, 1990; Halford, Sanders, & Behrens, 1993), and one study of behavioral couple therapy found that higher observed positivity in both husbands and wives at the end of treatment was associated with greater likelihood of separation 6 months later (Baucom & Mehlman, 1984). Consistent with this finding in couple therapy, one study of PREP found that increases in women’s positive behavior increased the chances that a couple would be distressed 5 years later (Schilling et al., 2003). These findings were replicated in a second sample that participated in a similar prevention program in Germany (Baucom, Hahlweg, Atkins, Engl, & Thurmaier, 2006). While the latter results concerning positive communication in women are surprising and counterintuitive, Schilling et al. (2003) found that links between changes in women’s positive communication and subsequent distress were no longer significant when controlling for wives’ reported mutual avoidance, suggesting that wives who increased their positive behavior over the course of the workshop may have been avoiding discussion of important problems. Critics of this literature have argued that there are potential statistical and methodological issues (e.g., influential cases and very complex and difficult to interpret models) that cannot be ruled out as explanations for such findings (Stanley et al., 2007). However, if Schilling et al.’s (2003) and Baucom et al.’s (2006) interpretations of these results are accurate – that some women may have misinterpreted instruction in the PREP workshop to mean that positive communication is good and negative communication is bad regardless of the context of the behavior – these findings may highlight a problem with purely behavioral approaches to relationship distress, as we discuss in more detail below. Most of the aforementioned intervention research, including PREP, used Traditional Behavioral Couple Therapy (TBCT; Jacobson & Margolin, 1979) or some derivative of it to create change in couples. TBCT increases the frequency of positive behavior (reinforcement) and decreases the frequency of negative behavior (punishment) in order to improve relationship satisfaction. TBCT brings about these changes through direct instruction (e.g., encouragement to engage in positive behavior that has been identified) as well as communication and problem solving training. In the latter, partners are taught appropriate ways to communicate, such as the use of “I” statements, active listening, and problem solving. TBCT therapists use “rule-governed” methods throughout, encouraging couples to deliberately engage in desired behavior by following a set of guidelines for better communication and more constructive behavior. In contrast to the rule-governed change methods used in TBCT, Integrative Behavioral Couple Therapy (IBCT; Jacobson & Christensen, 1998) relies on “contingency-shaped” change in promoting better communication and in fostering emotional acceptance. Instead of teaching couples rules of good communication, IBCT therapists explore partners’ emotional reactions to each other’s messages. IBCT assumes that a focus on these reactions, through the help of a skilled therapist, will shape more sensitive and effective communication between partners. However, these changes in communication may not be as obvious or as dramatic as the changes induced by TBCT, nor are they likely to be as affected by demand characteristics (e.g., if you teach couples specific ways of communicating and then video tape them after this training, they may demonstrate the new ways of talking even if they don’t ordinarily use them). However, an assumption in IBCT is that these, perhaps more subtle, contingency-shaped changes within each partner’s natural communication styles may be more enduring in the couple. Thus, TBCT may induce more dramatic short term changes but IBCT may engender more long-term changes. Interestingly, however, associations between changes in observed behavior and satisfaction are similar during the active phase of treatment in IBCT and TBCT (Sevier et al., 2008).