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From Research to Practice - Page 6

Research has shown that vastly different forms of marital therapy have a positive impact, and each has an overall level of impact similar to the other treatments. As in every form of treatment research, there have been demonstrations of the effectiveness of cognitive-behavioral approaches, but there also have been numerous studies demonstrating the impact of Susan Johnson's Emotionally Focused Couple Therapy. Additionally, two of the best studies in this field have focused on the psychoanalytic-intergenerational treatment called Insight-Oriented Marital Therapy, developed by Douglas Snyder, and a treatment focused on acceptance of one's partner, Andrew Christensen and Neil Jacobson's Integrative Behavioral Couple Therapy.

The cognitive-behavioral therapies accentuate learning and engaging in more skillful marital behaviors, such as communication and problem-solving. Emotionally Focused Couple Therapy centers on building secure attachment between partners through uncovering and nurturing the soft feelings of vulnerability and connection that lie beneath conflict. Insight-Oriented Marital Therapy helps couples understand partners' experiences in their families of origin, and how their family background affects or promotes difficulties in their relationships. This mode of therapy ultimately challenges engrained patterns of interaction. Integrative Behavioral Couple Therapy accentuates developing skills for living with one's partner and accepting the aspects of the other's behavior that can't be changed. Each method shows success in approximately 75 percent of couples. As Alan Gurman of the University of Wisconsin has suggested, it seems clear that there are many routes to the goal of changing the experience of being a couple.

Another finding is that aspects of treatment related to the process of therapy, such as the generation of a positive therapeutic alliance, play a crucial role in the treatment's success. Couples therapy is notoriously difficult. Clients often seek help only after problems have become nearly intolerable. By the time a clinician sees them, one of the partners may have pretty much written off the entire marriage, which undercuts his or her motivation to establish a strong, working relationship with the therapist. Thus, alliances between clients and the therapist are fragile early in treatment.

Studies by Lynne Knobloch-Fedders and William Pinsof of the Family Institute at Northwestern, like other investigations, demonstrate that early alliance predicts treatment outcome. Their findings suggest that therapists must be especially sensitive to what Pinsof calls the split alliance, in which one person feels allied with the therapist and the other doesn't.

In general, research data--even from a small body of studies--make a powerful case for the effectiveness of couples therapy. Yet the same data provide clear indications of its shortcomings.
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