By Elizabeth Mahaney, M.A., LMHC, MFT, NCC, DCC, Ph.D

Abstract

Communication is central to a healthy marriage.  Communication was ranked as the number one problem among couples in therapy (Hecker &Wetchler, 2003). There are several obstacles that can contribute to poor communication between couples. Research findings with regard to communication between couples tends to focus on distressed versus non-distressed couples.  Research findings also stress and focus on the importance of positive communication between couples. The main goal of cognitive behavior therapy is to increase the desired behavior or cognition and decrease the undesirable cognitions and behaviors. There are basically three main phases of goals to help the therapist facilitate communication between couples which include; early-phase, middle-phase, and late-phase. During the early-phase the therapist assesses each partner and gains information about how the couple interacts and communicates. Complimenting and highlighting the couple’s effective communication begins the process of shaping. The therapist could ask the couple to define the problem behavior, as well as determine if there are any unacceptable forms of communication between the partners. Next, during the middle-phase the therapist should focus on decreasing inappropriate communication and increasing suitable communication between the couple. Implementing cognitive behavior psycho-education allows the couple to gain knowledge and information about communication skills and techniques. The late-phase goal of therapy is when the therapist draws attention to the eradication of the conflicting communication styles and patterns and investigates problem-solving competence. Cognitive behavior therapy uses thought patterns to change moods and behaviors. With cognitive-behavior therapy, the therapist should be aware that nonverbal communication is just as important as verbal communication with regards to communication. Self-report scales as well as several different techniques, activities, and homework assignments may be utilized to assess communication problems in a couple’s relationship. Furthermore, in facilitating communication between couples the therapist should demonstrate the importance of using “I” messages. Multicultural issues intermingled with a lack of communication can add a heavy burden on couples. Effective communication is facilitated by a healthy relationship built on mutual respect. Couples from diverse backgrounds are usually faced with greater communication obstacles.

Manual: Facilitating Communication between Couples

With Cognitive Behavior Therapy

Introduction

Communication is central to a healthy marriage.  It is the main source of tranquility, love, and the continuity of a relationship. The absence of communication builds up to conflict, which could possibly end the relationship at hand.  Communication was ranked as the number one problems among couples in therapy (Hecker &Wetchler, 2003).  Communication is something we all know is necessary to keep any relationship strong and loving, and although we are aware of the importance of communication, we still seem to be clueless about what exactly good communication really is. This does not mean you are clueless as a person.  It means that more attention is required on your part, so that you can become more open and invite the many forms of communication that exist.  Hence, you will be able to understand yourself and your partner more adequately.

There is nothing that keeps a relationship healthy better than understanding.  Once you start becoming more familiar with your communicating styles, as well as your partners, you will be able to work better as a team in making the best of your relationship.  Effective communication cannot happen on its own or with the efforts of only one person. Both you and your partner have to be open and willing to work as a team on improving the way you communicate, so that you both can enhance your relationship skills and build a relationship where you both will have an understanding of who you are as individuals and what you both need and want. Just remember to stay real with yourself and avoid painting a foggy and falsified picture- so that you will never be caught off guard with nay-painful surprises or stressful misunderstandings (Ruigrok, 2005).             

Couples are often adept at dealing with people outside the relationship, but few people enter an intimate relationship with the basic understandings or the technical skills that make a relationship blossom.  They frequently lack the know how to make joint decisions, to decipher their partners communication.  Because of the strength of feelings and expectations, the deep dependency, and the crucial, often arbitrary symbolic meanings that they attach to each other’s actions, partners are prone to misinterpret each other’s actions (Hecker & Wetchler, 2003).

Communication problems are one of the most damaging problems that a relationship can face.  Many couples often feel that their partner should know what they are thinking, but do not communicate their thoughts and wants to them.  Open communication sounds good, but in reality it is very difficult. The reason for this is that we do not want to be open, especially in the beginning of a relationship. Consciously or unconsciously, many people think that if we are real, other people are not going to like us.

Presenting Problems in Communication between Couples

There are several obstacles that can contribute to poor communication between couples.  Examples include, but are not limited to:

Contempt: insults or put-downs

One or more partners fails to listen to each other

Criticism: attacking or blaming the other partner

Men and women have different expectations for intimacy independence

Cross-complaining: spouses do not acknowledge each other’s concerns and desires

Fault-finding/Blaming the other partner

Defensiveness: warding off a perceived attack from a partner

Problem escalation: one spouse’s statement of a problem is followed by a negative response from the partner

Lack of clarity when sending/receiving messages while communicating

Debating the truth

Poor logic in a spouse’s statements

Stalemates: each person takes an unyielding position regarding the solution to the problem

Frequent topic shifts

Interruptions

Over-generalized statements: broad conclusions based on limited # of incidents

Dichotomous thinking: all or nothing thinking

Inconsistencies between verbal and nonverbal communication channels

Sidetracking: shifting from one topic to another

Vague statements that do not specify particular behaviors and emotions

Passive aggressiveness to coerce a partner

Selective abstraction: focusing one’s attention on only some aspects of a situation

Personalization: a partner concludes that events are related to them, when this is not the case

Magnification & Minimization: exaggerating or minimizing the significance of an event

Stonewalling/withdrawing

*Source: (Baucom & Epstein, 1990)

Differing communication styles between men and women can also serve as an obstacle to healthy communication.  Examples of male and female communication styles include: (1) men talk to give information or report, while women talk to collect information or gain rapport, (2) men focus on facts, reason, and logic, while women focus on feelings, senses, and meaning, and (3) men thrive on competing and achieving, while women thrive on harmony and relating (Simon & Pederson, 2005).  Cognitive behavior therapy is a theoretical approach that can be utilized to counteract the presenting problems mentioned earlier, as well as teach couples the skills necessary to identify and modify dysfunctional cognitions or behaviors in the future (Baucom & Epstein, 1990). 

Review of Literature

            Research findings with regard to communication between couples tends to focus on distressed versus non-distressed couples.  For example, Baucom and Epstein (1990) note that, “distressed couples exhibit more negative nonverbal communication such as criticism and put-downs, and fewer forms of positive communication, such as acknowledgment, than non-distressed couples” (p. 39).  Research findings also stress and focus on the importance of positive communication between couples.  Epstein and Baucom (2002) point out that, “although the findings are not totally consistent, several studies have demonstrated that happy couples exhibit a higher rate of positive communication than distressed couples when the partners are having a conversation with each other” (p. 29).  These findings are significant because in cognitive-behavioral therapy, the therapist attempts to assess how distressed couples are while they interact with one another, so that the therapist can alter negative behaviors that may be maintaining the poor communication between the couple.  Researchers also study the way that couples send and receive each other’s messages when communicating, which is also referred to as encoding and decoding.  Baucom and Epstein (1990) state that, “research findings regarding the encoding and decoding of marital communication indicate that when attempting to understand a couple’s misunderstandings, it is important to investigate the degree to which it is a problem of unclear expressiveness by one party, or ineffective listening by the other party” (p.34).  Encoding and decoding between couples is important to cognitive-behavioral therapists because they assess the specificity and clarity of these actions while the couple is interacting with one another.  Then the therapist can help the couple alter the manner in which they send and receive each others messages.  As a result, partners will be more understanding of one another.        

Goals and objectives of Cognitive Behavior Therapy

The main goal of cognitive behavior therapy is to increase the desired behavior or cognition and decrease the undesirable cognitions and behaviors. Another goal of cognitive behavioral couples therapy intervention techniques involves the use of cognitive restructuring. Restructuring is a process of evaluating cognitions and determining the accuracy of the cognition and changing those that are inaccurate or unrealistic. Attributions, assumptions, expectations, and standards that are unrealistic are worked on together by the therapist and partners to produce complementary explanations that are more accurate.  Hence, partners can direct more positive feelings towards one another.

There are basically three main phases of goals to help the therapist facilitate communication between couples which include; early-phase, middle-phase, and late-phase.

First, the early-phase goal is for the therapist to establish the therapeutic relationship with the couple by showing respect. The therapist can accomplish this task by modeling appropriate communication skills and positively reinforcing open progressive communication and interaction between the couple both during the session and out of the session. The therapist assesses each partner and gains information about how the couple interacts and communicates. The therapist should also be aware of any unresolved issues that may be contributing to the miscommunication. Complimenting and highlighting the couple’s effective communication begins the process of shaping. Shaping is a technique used by therapists that is based on operant conditioning and implies dividing the behavior into subsections, then rewards and punishments are implemented to produce the desired behavior. The therapist could ask the couple to define the problem behavior, as well as determine if there is any unacceptable communication between the partners.  The therapist may also ask the couple what their views of proficient communication mean to each of them. Homework consisting of charting inappropriate communication could be given to the couple. The use of functional analysis can be used to examine past experiences of communication patterns. Furthermore, a therapeutic contract should be developed during this phase to specify goals and objectives.

Next, during the middle-phase the therapist should focus on decreasing inappropriate communication and increasing suitable communication between the couple. There are several ways that communication can be facilitated during this phase. Implementing cognitive behavior psycho-education allows the couple to gain knowledge and information about communication skills and techniques. Two more major techniques that can be implemented in this phase are problem solving skills and communication enrichment. Challenging irrational beliefs facilitates the exploration of the couple’s inability to communicate. In addition, it is beneficial to investigate pessimistic assumptions and attributions that sustain the lack of communication among partners. It is also imperative that the therapist and couple discuss contracts and charts to observe changes or any need for renegotiation. The couple and the therapist must negotiate how the partners will treat each other and how they will communicate needs, wants, thoughts, and feelings. The therapist should recognize explicit constructive and unconstructive reinforcements for productive communication and let the couple know that it is crucial to maintain consistent reinforcement. The token system may be initiated. The token system is a technique that the therapist and partners develop. An inventory of preferred behaviors is listed with points associated with each item. The partners may earn points or have points deducted depending on the behaviors being displayed. When the points have accrued the couple may trade points for a variety of rewards. Time outs have been a popular disciplinary tool for parents to use with their children but time outs can be a useful instrument to help partners control situations that may escalate into an argument. It is a good idea for the therapist and couple to develop a plan for when the couple feels as though the situation is getting out-of-hand, it may be beneficial to take a time out so ensure that words or behaviors are not inappropriately exchanged.

Finally, the late-phase goal of therapy may be implemented which is when the therapist draws attention to the eradication of the conflicting communication styles and patterns and investigates problem-solving competence. In this phase the therapist and couple discuss any residual issues that may need to be explored and worked out. They also note any changes that have been made in the relationship, as well as changes in communication. Further psycho-education and communication guidance may be employed. It is important for the therapist to check-in with each partner and assess contracts and limitations to their communication. Any miscommunication that still exists should be worked through while maintaining rewarding patterns of communication. A contract may be put into place regarding how long the couple remains in therapy.  This may depend on the couple’s relationship satisfaction, or how well the couple communicates consistently with one another.  For example, the couple will terminate therapy if they appropriately and consistently communicate with one another for thirty consecutive days.  It is beneficial to renegotiate how the partners will treat each other and how they will communicate needs, wants, thoughts, and feelings. References and other support groups should be made available for the couple to explore. The couple and the therapist should make a list of warning signs of falling back into the same patterns of miscommunication and formulate a plan to deal with these issues. In addition, a list of appropriate and reinforcing behaviors and patterns of communication should be created to help the couple sustain improvements in their relationship. 

Theoretical approach and Rationale

The rationale for using cognitive behavior therapy is that when couples experience difficulties in their relationship, especially communication, the problems are likely to include behavioral, cognitive, and affective components.  The assessment of these factors is crucial in preparation for therapeutic interventions with couple’s communication patterns (Baucom & Epstein, 1990).  Hence, cognitive behavior therapy can be utilized if cognitions, behaviors, or emotions are distorted and maintaining a couple’s communication problem.

Cognitive behavior therapy is an approach that originated as a result of the psychodynamic approach (with an added cognitive element). This approach includes behavioral techniques for families, couples, adolescents, children, and sexual dysfunctions. Cognitive behavior therapy uses thought patterns to change moods and behaviors. It is relatively short term. There are several positive aspects of this approach including: being empirically based, goal oriented, practical, active, and collaborative.  Despite these benefits, CBT can not be used for individuals in whom thinking or communicating is severely disturbed. If partners do not complete “homework” and keep accurate records, the therapeutic process can be greatly hindered. In addition, CBT focuses on a client’s present situation and does not attempt to dig up the past which can result in a lack of self compassion.  With cognitive-behavior therapy, the therapist should be aware that nonverbal communication is just as important as verbal communication with regards to communication. 

The key theorists for cognitive behavior therapy include:

Albert Bandura

Aaron Beck

Albert Ellis

Joseph Wolpe

Richard Stuart

B.F. Skinner

Norman Epstein

Neil Jacobson

Gerald Jones

Gerald Patterson

Donald Meichenbaum

Arnold Lazarus

*Source: (Hecker & Wetchler, 2003)

Program Activities and Materials

The program activities and materials are based on Marriage enrichment and relationship enhancement philosophies and concepts.

1.Increasing and Identifying Rewarding Communication:

•One should reward their partner even if he or she is not showing rewarding communication and behavior in return. It may take a little while for one another to teach each other positive communication because the present communication and behavior has been used. It is important to follow the rule of reciprocity; if you communicate, usually, your spouse will reward you by communicating accordingly. Unfortunately, unrewarding actions are also reciprocated.

•It is important to know what each partner likes and dislikes about the other’s communication style and behavior. The partners are not mind readers and need each other to help teach one another and learn what they find rewarding. Many couples spend a lot of time dwelling on the negative and not enough time articulating what is positive and rewarding.

•Each partner should be very specific about the rewarding communication or behavior that they get pleasure from. For example, if a spouse told her partner that she enjoyed how nice he was to her last week, this taught her partner nothing. If a spouse were to say I really enjoyed how you called me Tuesday night to let me know that you would be home a little late, I really appreciate when you are thoughtful, this would give her partner insight and the ability to repeat the rewarding communication and behavior.

Homework assignment:

A.   List seven rewarding ways that your spouse communicated during the past week.

B.    Throughout the up coming week write down seven specific times your partner communicated and behaved in a rewarding manner. Do not show your spouse until the next therapy session.

C.    List seven specific rewarding things, which do not take up too much time, that you would like your spouse to do during the next week.

1.Taking Responsibility and Rewarding Communication-

·      Both partners in a relationship must take responsibility for change to occur. A general rule is actions that are rewarded will increase and actions that are punished will decrease.

·      Both partners must teach each other specific actions that they like and follow these rules;

A.   Articulate the specific action that pleased you,

B.    Genuinely reward your spouse immediately,

C.    Stay in the here and now.

Activity:

Ask yourself if you have ever heard or said any of these statements;

·      “You never talk about anything with me anymore” (thinking in a way that it is all or nothing).

·      “You told me how you felt today but you usually never tell me about anything” (using the zap method of treatment).

·      “Why can’t you be more open, caring, emotional” (using why as an accusation)?

·      Do you tend to withdraw, mope, or sulk?

Now think about how you would respond to these statements and what the outcome would be.

·      The all or nothing statement will promote feelings that your spouse can do nothing to make a difference so there is no need to try resulting in withdrawal or defensive interactions and behavior.

·      The zap method ends with punishment or accusation regarding the past so the spouse will more than likely remember the negative accusation and not the reward.

·      The “why” statement is the most common statements made by couples in distress and usually the outcome is an argument and then withdrawal. How is your spouse supposed to respond to this question? Withdrawal may decrease the chances of an argument but will annoy the other partner and furthermore, withdrawal does not teach each other what you do enjoy.

1.Build on the Positive-

·      The more the specific behavior is rewarded the better the chance of the behavior to increase. It is up to each partner to let the other know what he or she likes. The purpose of teaching each other what is enjoyable is to improve the relationship and facilitate better communication skills between each other.

Homework:

·      List seven specific times and examples of when you reward your spouse during the upcoming week.

4. Thoughts that are Automatic-

Automatic thoughts are ideas or notions that may or may not be accurate and are usually associated with negative viewpoints. It is beneficial to be aware and challenge automatic thoughts. The following is a list with examples of some automatic thoughts that are common among distraught couples.

ü     Labeling- giving your spouse a name such as “aggressive” and believing that he or she will always be that way and is not capable of changing.

ü     Shoulds- an irrational way of thinking about your relationship and standards that ought to be upheld. For example, “I should not have to ask my spouse to tell me what is on his or her mind”, “I should never be bored or discontented in my relationship”, “why should I have to change”?, “change should just happen and occur quickly”, If my spouse can not get the hint of what I want, than why should I stay in this marriage”?

ü     Fortune-telling- predicting that your spouse will never change which results in telling yourself that you will never be happy.

ü     Perfectionism- comparing your relationship to an impracticable idealistic view of how a relationship should be. For example, “it is not like we just met, we have been together for a while so he should know exactly what I want”.

ü     Mind-reading- perceiving that your spouse is insinuating something with out sufficient evidence. For example, a spouse may think that her husband does not care about her because he did not open the door for her.

ü     Discounting the positive- when a spouse ignores the rewarding behavior or styles of communication by believing that the actions are insignificant because that is what a husband or wife should do. Another illustration of discounting the positive when one believes that his or her success is trivial.

ü     Catastrophic thinking- believing that the argument or issue that occurred means that your marriage is awful and doomed.

ü     Emotional reasoning- you feel a certain way and relate the way you feel with how your marriage is going. For example, “I feel depressed which means that my marriage must be failing”.

ü     Negative filter- when a partner only focuses on the negative and does not see the positive aspects of the relationship.

ü     Externalizing- believing that you have no control over what happens.

ü     Over-generalizing- taking a broad view of the situation and using statements such as “if I fail at me marriage, I will fail at everything”.

Homework:

Write a list each day of the automatic thoughts or comments and notice any patterns.

5. Ground Rules Regarding Having Differences of opinions and Arguing-   

·      Use “time out” if you and you spouse are prone to explosive actions and comments. (It is important to allow for your partner to ask for a time out and receive it without the other partner following Him or her in to the other room).

·      The issue should be solved by both of you and each person should be invited to discuss their opinion and offer ideas to the solution. Possible solutions should be prioritized from most acceptable to not suitable.

·      It is imperative that both partners compromise and come to a mutual agreement. Keep in mind that modifications may be needed if the first arrangement is not sufficient.

·      Stay on the present issue and do not bring up differences from the past or material that is irrelevant.

·      Accept responsibility for the role each person plays in the dilemma.

·      Remember not to label, use the why accusation (why do you always…?), withdrawal, mope, use sarcasm, use a loud tone of voice, or use threats or ultimatums.

·      Consider that rewarding each other for cooperating and compromising may increase more positive correspondence in the future.

6. Empathetically Listening to Your Partner-

Rephrasing is a good way for couples to show that they are truly listening to one another. When having a discussion briefly state the point of the conversation using only about three statements and then ask your partner to rephrase your statements. After your partner rephrases specify what was correct and clear up any misunderstandings. If there were any misunderstandings, explain your point once more and ask your partner to rephrase again. Next, ask for any disagreeing view points. If there are disagreements subsequently rephrase the differential statements. The rephrasing technique can be used to be certain that each partner is being heard clearly and may help decrease the severity of the altercation.

A number of other different techniques and activities may be employed in cognitive-behavioral therapy to help patients uncover and examine their thoughts, as well as change their behaviors.  They Include:

•Cognitive rehearsal- The patient imagines a difficult situation and the therapist guides him through the step-by-step process of facing and successfully dealing with it.  The patient then works on practicing, or rehearsing, these steps mentally.  Ideally, when situation arises in real life, the patient will draw on the rehearsed behavior to address it.

•Journal- Patients are asked to keep a detailed diary recounting their thoughts, feelings and actions when specific situations arise.  The journal helps to make the patient aware of his or her maladaptive thoughts and to show their consequences on behavior.  In late stages of therapy, it may serve to demonstrate and reinforce positive behaviors.

•Modeling- The therapist and patient engage in role-playing exercises in which the therapist acts out appropriate behaviors or responses to situations.

•Conditioning- The therapist uses reinforcement to encourage a particular behavior.  For example, a child with ADHD gets a gold star every time he stays focused on tasks and accomplishes certain daily chores.  The gold star reinforces and increases the desired behavior by identifying it with something positive.  Reinforcement can also be used to extinguish unwanted behaviors by imposing negative consequences.

•Systematic Desensitization- Patients imagine a situation they fear, while the therapist employs techniques to help the patient relax, helping the person cope with their fear reaction and eventually eliminate the anxiety altogether.  The imagery of the anxiety producing situations gets progressively more intense until, eventually, the therapist and patient approach the anxiety causing situation in real life.  Exposure may be increases to the point of “flooding”, providing maximum exposure to the real situation.  By repeatedly pairing a desired response (relaxation) with a fear producing situation, the patient gradually becomes desensitized to the old response of fear and learns to react with feelings of relaxation.

•Validity testing- Patients are asked to test the validity of the automatic thoughts and schemas they encounter.  The therapist may ask the patient to defend or produce evidence that schema is true.  If the patient is unable to meet the challenge, the faulty nature of the schema is exposed. 

•Self-report scales- May be utilized to assess communication problems in the couple’s relationship.  Some examples include: the Marital Communication Inventory, the Primary Communication Inventory, the self-report form of the Verbal Problems Checklist, and the Problem-Solving Communication and Affective Communication scales from the Marital Satisfaction Inventory (Baucom & Epstein, 1990).  These inventories are effective tools for gathering information about the couple’s patterns of communication, and they help with determining what areas the couple needs to work on during the treatment process.

•“I” Messages- In facilitating communication between couples the therapist should demonstrate the importance of using “I” messages. “I” type messages place focus on the speaker’s feelings with regard to their partner’s behavior. By using “I” statements the listeners can gain a better understanding of the effects their actions have on their partner.  The therapist should understand what type of communicator each client is. Expressive communicators tend to share emotions and feelings. These individuals usually need responsive feedback. Problem-solving communicators may seldom talk about their feelings. These types of communicators may place facts in place of their feelings when giving a statement (Baucom & Epstein, 1990).

Diversity Issues

Diversity issues can sometimes create severe conflict within a relationship.  Couples who are combated with diversity and communication issues are dealt a dueling dilemma when trying to coexist in harmony.  Gender differences are the first issue couples must deal with. Men and women can be on opposite ends of the communication spectrum. Communication between members of the opposite sex can be difficult when neither party understands the issues being brought forth by each other. When gender roles (with regard to responsibility) are strongly defined within a relationship, a couple’s communication may suffer. When gender issues are combated with communication issues, the role of the therapist becomes more difficult. The therapist must be sensitive to both sides and respect the argument given by both parties involved.

            Multicultural issues intermingled with a lack of communication can add a heavy burden on couples. Effective communication is facilitated by a healthy relationship built on mutual respect. It is imperative that couples understand each others culture, beliefs, and values. Multicultural frameworks are important in therapy. With the U.S. being a collection of diverse individuals, effective couples therapy is of grave importance (Hecker & Wetchler, 42). Couples from diverse backgrounds are usually faced with greater communication obstacles. Learning and understanding the cultural norms of a partner is important. Not being culturally aware can cause a breakdown in communication. Some groups, such as Native Americans feel that problems should be dealt with on a personal level. If in a relationship with an individual of strong Western ideology, communication can become compromised. Hanna & Brown (1995) present questions for assessing racial and cultural factors in therapy:

§       How does your racial/cultural/religious heritage make your family different from other families you know?

§       Compared to other families in your cultural group, how is your family different?

§       What are the values your family identifies as being important parts of your heritage?

§       At this particular time in you family’s development, are there issues related to your cultural heritage that are being questioned by anyone?

§       What might an outsider not understand about your racial/cultural/religious background? (Hecker & Wetchler, 429)

Not only could the answers to these questions aid in facilitating communication between a diverse couple but it could also aid the therapist in gaining an understanding of that culture. Exploration into the importance of culture can assist in understanding and overcoming communication obstacles (Hecker & Wetchler).

Program Evaluation

l     Assess diagnostic workup of patients at the start of therapy placing emphasis on problems, needs, and issues brought to the table.

l      Review treatment plans including the goals and the couples needs for therapy.  Assess their level of communication, anxiety and stress from the start of therapy.

l     After reviewing information and history from the beginning of therapy, therapists can evaluate the progress made by clients by means of discussing with clients the progress they have made, observation of new and beneficial communication skills, charting/journaling, evaluation of goals met and satisfaction of relationship between the couple.

l     Assess if the desired behavior or cognition has been increased and the undesirable cognitions and behaviors have been decreased or eliminated.

l     Measure whether restructuring has taken place-determining the accuracy of a cognition and changing those that are inaccurate or unrealistic

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