Marriage and Divorce
Richard Niolon, Ph.D. 02/05

History of Marital Therapy

Gurman, A. S. & Fraenkel, P. (2002). The history of couple therapy: A millennial review. Family Process, 41, 199-260.

G&F point out that couples therapy (formerly marital therapy) has been largely neglected, even though family therapists do 1.5-2 times as much couple work as multigenerational family work. They also note this is not such a bad ratio, as 40% of people coming to therapy attribute their problems to relationship issues. G&F define Four Phases in the History Couples Therapy:

Phase I
1930 to 1963
Atheoretical

1929 to 1932 - Three marital clinics opened; they were service and education oriented, and saw mostly individuals
The closest thing to theory was what was borrowed from psychoanalytic - interlocking neurosis
1931 the first marital therapy paper was published
Theory was marginalized due to a lack of brilliant theorists, and a lack of distinction from individual analysis

Phase II
1931 to 1966
Psychoanalytic Experimentation

Therapists are seen as telling truth from distortion, rather than creating a truth
Mostly individual sessions, but some conjoint; still treated like seeing two individual clients in the same room though
Some started to downplay the role of the therapist
Family was outshining couples work, and the couple techniques weren't innovative or particularly effective

Phase III
1963 to 1985
Family Therapy Incorporates

Family therapy overpowers couples, even though a number of big name people really mostly saw couples
- Jackson
  Coined concepts like quid pro quo, homeostasis, and double bind for conjoint therapy
- Satir
  Coined naming roles members played, fostered self-esteem and actualization, and saw the therapist as a nurturing teacher
- Bowen
  Multigenerational theory approach, with differentiation, triangulation, and projection processes, with the therapist as an anxiety-lowering coach - societal projection process was the forerunner of our modern awareness of cultural differences Copied from the web.
- Haley
  Power and control (or love and connection) were key. Avoided insight, emotional catharsis, conscious power plays. Saw system as more, and more important, than the sum of the parts

Phase IV
1986 to now
Refining and Integrating

1986 was the publication of G&K book
New Theories were tried and refined, like Behavioral Marital Therapy, Emotionally Focused Marital Therapy, and Insight-Oriented Marital Therapy. All four have received good empirical support. Couples therapy was used to treat depression, anxiety, and alcoholism.
Efforts were focused on preventing couples problems with programs like PREP
Feminism, Multiculturalism, and Post-Modernism impacted the field
Eclectic integration, brief therapy, and sex therapy ideas were incorporated as well into our work Copied from the web.

Four Shifts in the Field

the individual exists again
mental disorders are considered
the most helpful theories grew from individual theory
it is a vibrant and active field

Research Stages
G&F also denote three research stages for the field:

Stage I - 1930-1974 - the Search for Data - there's not much there
Stage II - 1975-1992 - Exuberance - All over Gurman's conclusions that couples therapy works!
Stage III - 1993 to now - Cautious Optimism - It works, and all of it works about the same. It gets good effect sizes, with 60%-75% of couples getting better, esp. when they are young, flexible, in low distress, and emotionally attached. While relapse might be high, it's 1) as good as indiv thx at managing disorders, 2) cost effective, 3) facing unfair criticisms and dealing with couples in crises with long term problems and short-term motivation