Journal of Marital and Family Therapy doi: 10.1111/jmft.12019 April 2014, Vol. 40, No. 2, 178–192

THE ALLIANCE IN RELATIONSHIP EDUCATION PROGRAMS Kelley Quirk and Jesse Owen University of Louisville, College of Human Development and Education

Leslie J. Inch, Tiffany France, and Carrie Bergen SGA Youth and Family Services

Couple relationship education (CRE) programs are associated with positive romantic relationship outcomes; however, the mechanisms by which these gains occur are less understood. The current study (122 couples) utilized actor–partner modeling to examine the association between the therapeutic alliance and dedication and negative and positive communication for racial/ethnic minority couples. Additionally, we examined whether gender and delivery format moderated these relationships. Results demonstrated that both men’s and women’s alliance scores were significantly related to their own outcomes. Higher ratings of alliance were related to partner outcomes for men only. The association between partners’ alliance and dedication outcomes was stronger within the group format as compared to the couple format. Implications for leaders of CRE programs are offered. Couple relationship education (CRE) programs are an effective way to enhance relationship communication and prevent relational distress for married and unmarried couples (Carroll & Doherty, 2003; Hawkins, Blanchard, Baldwin, & Fawcett, 2008; Stanley, Amato, Johnson, & Markman, 2006). Of the various CRE programs, the Prevention and Relationship Education Program (PREP; Markman, Stanley, & Blumberg, 2010) is a commonly utilized program that teaches couples positive communication techniques, conflict management skills, clarifies expectations between partners, and seeks to enhance dedication. The efficacy of PREP has been supported in numerous studies (e.g., Halford, Sanders, & Behrens, 2001; Markman, Renick, Floyd, Stanley, & Clements, 1993; Stanley et al., 2001), with recent research supporting the effectiveness of PREP with racial/ethnic minority (REM) and lower socioeconomic status couples (Beach et al., 2012; Owen, Chapman et al., 2012; Owen, Quirk et al., 2012; Stanley, Allen, Markman, Rhoades, & Prentice, 2010). Notwithstanding the support for CRE programs, less is known about specific process factors associated with positive effects. There are likely several mechanisms of change in CRE programs, such as teaching specific communication and problem-solving skills, bolstering positive connections, and fostering couple coping (e.g., Halford, Markman, Kline, & Stanley, 2003; Hawkins, Stanley, Blanchard, & Albright, 2012). To facilitate couples use of the techniques, leaders need to cultivate a collaborative environment to engage couples in the curriculum. Specifically, CRE leaders aim to foster agreement with participants on their goals in the program and the approaches used to reach those goals, couched within a strong relational bond between leaders and individuals. These factors are commonly referred to as the working alliance (Bordin, 1979) and have been shown to be associated with positive outcomes for individuals, couples, and families within the therapy literature (e.g., Anker, Owen, Duncan, & Sparks, 2010; Friedlander, Escudero, Heatherington, & Diamond, 2011; Horvath, Del Re, Fl€ uckiger, & Symonds, 2011; Johnson & Talitman, 1997; Pinsof, Zinbarg, & Knobloch-Fedders, 2008). It is commonly assumed that the alliance predicts therapy outcomes in a casual manner; however, the directionality of alliance–outcome relationship is more difficult to Kelley Quirk, MA, Jesse Owen, PhD, College of Human Development and Education, University of Louisville; Leslie J. Inch, PhD, SGA, Tiffany France BA, SGA, Youth and Family Services. Carrie Bergen MSW, LCSW, SGA Youth and Family Services. Address correspondence to Kelley Quirk, Counseling Psychology, University of Louisville, College of Human Development and Education, Louisivlle, Kentucky 40203; E-mail: [email protected]

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determine (Baldwin, Wampold, & Imel, 2007). For instance, the association between the alliance and outcome may reflect co-occurring processes, wherein initial positive gains may result in better alliances, which could later impact greater outcomes. Notwithstanding these debates regarding the directionality of the alliance–outcome association, the alliance is commonly thought to be a necessary and important ingredient for individual and couple therapy. However, it is less clear whether the alliance is an important facet in CRE programs (Wadsworth & Markman, 2012). Forming and maintaining an alliance with couples can prove difficult and complex as partners may not have the same the initial goals for couple therapy and the level of distress in the relationship can affect the degree to which therapists can reach agreement on the goals for therapy and the ways to reach those goals (Knobloch-Fedders, Pinsof, Mann, & Barton, 2004; Owen, Duncan, Anker, & Sparks, 2012; Pinsof & Catherall, 1986). In CRE programs, leaders typically build relational bonds with couples through informal conversations before and after sessions, getting to know each couple and their story, while also using occasional personal disclosures. In this way, leaders are able to assess needs and struggles for each couple and can be responsive, adjusting the approach toward goals within the curricula (Stiles, 1994, 2009). For instance, if couples have trouble utilizing certain techniques, leaders can assist them in modifying approaches to make them fit unique couple dynamics or personality styles. In this way, strong alliances between leaders and couples may decrease dropout rates (Taft, Murphy, Elliott, & Morrel, 2001) and may increase engagement in the process through leader support and modeling of skills such as active listening and empathy. Currently, the role of the alliance between leaders and couples has been underexplored in CRE programs, especially with regard to REM clients. In fact, only two known studies have examined the alliance in CRE programs, both with primarily Caucasian middle-class samples. Bourgeois, Sabourin, and Wright (1990) found that, after accounting for pre-intervention distress, individual ratings of alliance accounted for 5% and 8% of outcome for women and men, respectively, in a CRE program. Similarly, Owen, Rhodes, Stanley, and Markman (2011) found that CRE couples who reported strong alliances with leaders had better outcomes, such as positive changes in communication quality and relationship satisfaction. However, it is unclear whether these findings would extend to a REM sample. Accordingly, we examined whether the alliance was associated with relationship outcomes for REM couples who participated in a CRE program (i.e., PREP). Further, we examined two moderating effects for the association between partners’ alliance–outcome relationship: gender and delivery format. Longstanding dynamics of oppression, discrimination, and unequal access to resources have engendered and maintained distrust and apprehension toward mental health services for many individuals within REM groups (Reis & Brown, 1999; U.S. Department of Health & Human Services, 2001). Indeed, ever-increasing cultural diversity of the United States has motivated clinicians to develop culturally adapted treatments (Benish, Quintana, & Wampold, 2012; Castro & Alarcon, 2002). At the root of these treatments is the desire for mental health professionals to be oriented toward socio-political and cultural dynamics that can affect individuals and couples. Studies have found that REM clients who feel their therapy is consistent with their cultural beliefs, and values are less likely to drop out of treatment and have better treatment outcomes (Benish et al., 2012; Campbell & Alexander, 2002; Flaskerud & Nyamathi, 2000; Griner & Smith, 2006; Sue, 2003). In addition, REM individuals may experience CRE programs and alliance in different ways as compared to dominant group members, especially given the history of greater apprehension of forming a trusting relationship with a mental health provider (Gelso & Mohr, 2001; Taft et al., 2001). As such, the current study seeks to better understand the role of the alliance with REM individuals within CRE programs. Gender may also play an important role in the generation and maintenance of the alliance within CRE programs. The ways in which men and women experience the alliance is not universal, and it is important to account for and examine these differences. As such, the use of actor–partner modeling may aid in the understanding of differential processes. Alliances in CRE programs are complex, as the way in which each partner experiences the alliance can influence their own relationship outcomes (this is referred to as an actor effect) as well as their partner’s outcomes (this is referred to a partner effect; Kenny, Kashy, & Cook, 2006). For instance, when one partner feels aligned to the leaders and becomes more engaged in the program, he or she may be more likely to April 2014

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acquire and use relationship skills (e.g., through doing homework assignments or participating in group discussions), and this process may increase his or her own perceived relationship quality (actor effect) and his or her partner’s perceived relationship quality (partner effect). Within couple interventions, empirical results have been mixed regarding the role of gender and partner effects as they relate to the therapeutic alliance and outcome. For example, in a CRE study, Owen et al. (2011) found a significant actor effect; that is, men’s and women’s own alliance with CRE leaders was associated with reported relationship adjustment and relationship confidence. Moreover, these authors found a significant partner effect; men’s and women’s positive communication quality was associated with their partner’s alliance with the CRE leaders. Further, the authors found no significant gender differences for the association between alliance and outcome. However, some studies have found men’s alliance scores to be significantly associated with relationship outcome—yet women’s alliance scores were not (Brown & O’Leary, 2000; Symonds & Horvath, 2004); while other studies have found women’s ratings of alliance were significantly related to outcome—yet men’s alliance were not (Knobloch-Fedders, Pinsof, & Mann, 2007; Pinsof et al., 2008). To date, most studies address the interdependence of partners by separating genders and then examining alliance and outcome individually, with some exceptions, (e.g., Anker et al., 2010; Knerr et al., 2009). However, examination of men’s and women’s alliance separately obscures the influence that partners have on one another as they engage in the CRE program, failing to account for the interdependence of partner alliance ratings on outcome. Additional research is needed to further our understanding of how individuals’ ratings of alliance can influence their own and their partner’s outcomes. Differing CRE formats may also have an effect on alliance formation and couple outcomes. Commonly, CRE programs are delivered in a group format consisting of many couples engaging in the process together, or in a couple format wherein one couple is paired with a leader(s). Few studies have examined differences in outcome as they relate to delivery format. A recent study (Owen, Chapman et al., 2012; Owen, Quirk et al., 2012) found that couples who engaged in PREP via group format reported greater outcomes on three of the seven outcome variables (negative communication, dedication, and relationship confidence) as compared to those participating in the couple format. Both formats seem to exhibit benefits and drawbacks such as individualized leader attention within the couple format and added social connections and support in the group format. However, the alliance can be more challenging in a group format as compared to the couple format. Within group settings, building an alliance with multiple couples simultaneously can be difficult and requires more than building a general positive atmosphere of belongingness consistent with group cohesion (Dion, 2000). Instead, leaders build an alliance with each couple by connecting with their unique dynamics and goals and subsequently tailoring approaches responsive to each couples’ needs. This commonly happens via break-out sessions wherein couples work on skills learned, applying them to their own relationship issues, while leaders facilitate and assist. Individualized attention occurs in smaller doses in the group format, as compared to the couple format that allows for much more time and attention to be paid to the couple. Thus, we considered whether the format of the CRE program would influence the association between alliance and relationship outcomes.

HYPOTHESES For the current study, we predicted that higher ratings of alliance for men and women would be positively related to higher ratings of their own reported positive communication (hypothesis 1a-men & hypothesis 1b-women) and dedication (hypothesis 1c-men & hypothesis 1d-women), and lower ratings of their own negative communication (hypothesis 1e-men & hypothesis 1fwomen). We refer to this set of hypotheses as actor effects—that is, participants’ own ratings of the alliance would be associated with their own relationship outcomes. In addition, we hypothesized partner effects for the relationship outcomes. Specifically, we predicted that higher ratings of alliance for men and women would be positively related to higher ratings partner ratings of positive communication (hypothesis 2a-men & hypothesis 2b-women) and dedication (hypothesis 2c-men & hypothesis 2d-women), and lower partner ratings negative communication (hypothesis 2e-men & hypothesis 2f-women). The next set of hypotheses reflects potential moderators of the actor–partner associations between alliance and outcome. Specifically, we predicted that the association between actor and 180

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partner alliance and relationship outcomes would be differentially associated based on gender. Given mixed findings in the literature regarding gender and alliance, we did not make a formal prediction about whether men or women would have a greater association between alliance and relationship outcomes. However, we tested whether gender moderated the association between actor and partner effects for positive communication (hypothesis 3a- actor & 3b-partner), dedication (hypothesis 3c-actor & 3d-partner), and negative communication (hypothesis 3e-actor & 3f-partner). Finally, we hypothesized that the associations between actor and partner alliances and relationship outcomes would be stronger in couple format (vs. group format) for increased levels of dedication (hypothesis 4a-actor & 4b-partner) and positive communication (hypothesis 4c-actor & 4d-partner), as well as decreases in negative communication (hypothesis 4e-actor & hypothesis 4f-partner).

METHODS Participants A total of 244 individuals (122 couples) participated in this study; of which, 87.7% of participants identified as African American, 10.3% identified as Latino/a, and 0.8% identified as Caucasian. The average length of relationship was 5.02 years (SD = 4.85), 83.6% of the sample was unmarried (N = 204 individuals, 102 couples) and 40 were married (N = 20 couples), and the couples had on average 1.83 (SD = 1.35) children. Couples received 16 hr of PREP, in a group format (N = 124 individuals; multiple couples with coleaders) or in a couple format (N = 120 individuals; one couple plus one leader). Due to the naturalistic treatment setting, assignment to the specific format was not randomized. Instead, leaders sought to extend access to the program to widest range of community members, and thus, couples self-selected into each format based on their individual needs or restrictions (e.g., lack of transportation). The couples were recruited from eight Chicago neighborhood communities that are typically lower income (e.g., 45–71% of individuals were considered low income or less than $38,622 household income), and the median income in these neighborhoods was very low (range = $4,096–$12,480; Metro Chicago Information Center, 2010. Information retrieved from http://mcic3.mcfol.org/). We did not directly assess the economic status of couples. Couples were purposefully recruited, with a specific focus on couples who were currently pregnant or recently had a child (within 3 months postbirth). However, there was no preference given to the marital status of the couples. The retention rate (pre to post) was 100%, which is somewhat unusual. In previous recruitment periods, the retention rate was approximately 90%, which is consistent with other national figures on therapy drop outs (see Swift et al., 2012). However, during this recruitment period, retention of couples was greater. Although it is unknown what made this particular recruitment time different from the past, we believe that several reasons account for a high level of retention. Leaders or organizers provide numerous supports for couples to attend the sessions and the staff contact couples between sessions to encourage them to attend and provide check-ins. For instance, the PREP leaders worked in the communities where the participants were recruited, childcare was provided, phone calls from leaders to couples to remind them about their upcoming session, which included check-ins to about how they are doing. The program was also delivered in a flexible format, with make-up sessions available for participants. Although we recognize that these steps are not typical of mental health treatment, they do occur (e.g., receiving a phone call from an administrative staff prior to a psychiatric visit). Procedures Prevention and Relationship Education Program leaders recruited couples from a neighborhood in the Chicago area and reached out to participants through community meetings, social services agencies, distributing brochures, and talking to members of the community. Couples who were expecting a child or recently had a child (3 months or younger) were actively recruited, as new parenthood is a typical time for increased distress in relationships (Belsky & Rovine, 1990; Cox, Paley, Burchinal, & Payne, 1999). In addition, unmarried couples who are becoming new parents are at even greater risk for decreased relationship satisfaction (Carlson, 2007). As such, participants were recruited to maximally reach couples at greater risk for relationship distress or April 2014

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dissolution. The local area was comprised of a significant proportion of individuals at or below the poverty line. Lower-SES individuals are more likely to be unmarried as compared to those of higher SES status (Howe, Levy, & Caplan, 2004; Karney and Bradbury, 1995; Johnson, 2012) and unmarried new parent couples are at greater risk for relationship distress. To reduce barriers for attendance childcare, food, and transportation reimbursement were offered. In addition, couples who completed the 16-hr PREP program received a certificate of completion and a $25 gift card for participant support costs. Pre-assessment measures were collected prior to the first meeting, and the postassessment measures were collected at the conclusion of the last meeting. This assessment process mirrors what has been carried out in psychotherapy research for decades. Couples completed the measures in separate rooms to ensure that their answers were not influenced by one another and to maintain confidentiality. CRE Intervention Prevention and Relationship Education Program leaders were paraprofessionals who received the standard 3-day training from the PREP institute. Within this training, there was no specific training on building alliances. Leaders utilized the PREP manual and supporting materials (e.g., handouts, role-play demonstrations) to structure the workshops; however, given the naturalistic nature of the study there were no measures of fidelity. Leaders worked within the communities served, and they closely matched participants’ racial/ethnic background (three African American male leaders, two African American female leaders, one Latina female leader, and one Caucasian female leader). As the PREP leaders all worked in the target communities (e.g., schools, medical clinics, churches, and social service organizations), they were familiar with the typical barriers that many participants faced such as unemployment, poor school systems, and violent communities. Leaders utilized this knowledge and experience to tailor the PREP curriculum to make the workshop most applicable to the situations couples may have been facing. The CRE program used for the current student was the aforementioned PREP program, and was delivered over the course of 16 hr through couple sessions or group-based relationship education workshops. Both formats addressed the core principles in the PREP curriculum, such as increasing effective problem-solving strategies and bolstering protective factors (e.g., enhancing dedication, promoting forgiveness). Group-based sessions typically utilized a male–female cofacilitating team in the workshops, had three to eight couples in each group, and were offered at various convenient locations throughout the community. The couple format was offered at the home of the couple or at a common meeting place (e.g., the community agency) with one PREP leader and one couple. For both formats, sessions lasted between 1 and 2 hr each depending on availability and typically occurred weekly until the couple had successfully graduated from the program. The complete PREP program was conducted over the course of 2–3 months (approximately eight sessions). Measures Demographics. To assess the characteristics of the sample, several open-ended questions were asked including gender, age, ethnicity, number of children, and length of relationship. Dedication. Couples’ perceptions of their interpersonal dedication to their partner were one of three primary outcome measures. The dedication subscale has four items—adapted from the Commitment Inventory (Stanley & Markman, 1992)—that assess the degree to which couples feel an interpersonal commitment to the future of the relationship, couple identity, and primacy of the relationship. An example item is: “My relationship with my partner is more important to me than almost anything else in my life.” The items were rated on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree), with higher scores indicating more dedication. The validity of the dedication subscale has been shown in several studies (Einhorn et al., 2008; Owen, Chapman et al., 2012; Owen, Quirk et al., 2012; Owen et al., 2011). In the current study, Cronbach alphas were .86 (men-pre) and .83 (men-post), and .86 (women-pre) and .84 (women-post). Positive and negative communication quality. The Communication Skills Test (Saiz & Jenkins, 1996) was originally a 32-item measure developed to assess positive and negative communication quality. We utilized five items to assess positive communication quality and six items to assess neg182

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ative communication quality. One example item for positive communication quality is: “When our talks begin to get out of hand, we agree to stop them and talk later.” Items were rated on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree), with higher scores indicating more positive and negative communication, respectively. The 5-item version of the positive relationship quality scale was utilized in Einhorn et al. (2008). Moreover, the reliability and validity of the CST has been supported in prior studies (Owen, Rhoades, & Stanley, in press; Stanley et al., 2001, 2005). In the current study, the Cronbach’s alphas for positive communication were .92 (men-pre) and .81 (men-post), .92 (women-pre) and .76 (women-post). Chronbach’s alphas for the negative communication subscale were .83 (men-pre) and .87 (men-post), and .84 (women-pre) and .86 (women-post). Working Alliance Inventory—Short Form (WAI–SF, Tracey & Kokotovic, 1989). We utilized six items (of the original 12 items) from the WAI–SF, which is a measure of working alliance that assesses goals and tasks for therapy, as well as the relational bond between the participants and leaders (Note two items from the goals, tasks, and bond factors were selected for this study). Items are rated on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree), with higher scores indicating a better working alliance. The WAI–SF is a commonly used measure of working alliance, and the reliability and validity have been established in numerous studies that compared the WAI–SF with other working alliance scales and therapy outcome measures (see Horvath et al., 2011 for a review). For the current study, we utilized the adapted version of the WAI for the CRE context (Owen et al., 2011). Example items include: “[Leader] did not understand what I wanted to accomplish in premarital training (reverse-coded)” and “I felt that [Leader] appreciated me.” The WAI-SF was administered at the end of the CRE program. Cronbach’s alphas were .87 for women and .85 for men. Relationship satisfaction. Participants were asked: “All things considered, how happy are you with your present relationship.” with scores ranging from 1 (very unhappy), 4 (happy), to 7 (perfectly happy). This item was completed at pre-intervention to assess the level of relationship distress before the intervention.

RESULTS Preliminary Analyses The preliminary analyses aimed to identify potential differences in alliance ratings based on gender, format, or pre-intervention relationship functioning. First, we examined whether men and women differed in their ratings of alliance, and there were no significant differences between men and women on their alliance ratings (p > .05). Second, we tested differences in alliance ratings based on CRE formats (group vs. couple format), and the results demonstrated no significant differences (p > .05). Third, we examined the association between men’s and women’s prescores of positive and negative communication as well as prededication scores and alliance scores. In doing so, we will be able to examine the potential that pre-intervention distress might affect alliance ratings. The results demonstrated no significant associations between prerelationship functioning and alliance ratings for men and women (ps > .05). Fourth, and more descriptively, couples’ relationship satisfaction ratings at pre-intervention suggested a moderately distressed sample (M = 3.91, SD = 1.77). Finally, we examined the amount of change in the dependent variables from pre to post by gender. Results showed large-sized effects (ps < .01) with Cohen’s d absolute values ranging from 1.38 to 2.61 (Table 1). Cohen’s d effect sizes are interpreted by the following ranges: 0.20 = small-sized effect, 0.50 = medium-sized effect, 0.80 = large-sized effect. Primary Analyses Due to our hypotheses about the effects of actor and partner alliances on relationship outcome variables, we utilized the actor–partner interdependence model (APIM; Kashy & Kenny, 2000). Using this model within hierarchical linear modeling Version 6 (HLM 6: Raudenbush, Bryk, Cheong, & Congdon, 2005), we were able to analyze interdependent data that is inherent in assessing couples’ scores. Actor effects refer to the association between a participant’s score on a predictor variable (e.g., alliance) with their own outcome (e.g., dedication, communication quality). Partner effects refer to the association between a participant’s score on a predictor variable (e.g., April 2014

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Table 1 Means and Standard Deviations for Women and Men on Alliance and Relationship Variables Women

Alliance Dedication Positive communication Negative communication

Men

Pre

Post

d

Pre

Post

— 4.27 (1.56) 3.27 (1.39) 4.78 (1.32)

6.66 (0.45) 6.39 (0.65) 5.98 (0.96) 2.63 (1.59)

— 1.36 1.95 1.63

— 4.21 (1.53) 3.24 (1.45) 4.73 (1.35)

6.64 (0.43) — 6.42 (0.63) 1.44 6.24 (0.73) 2.06 2.69 (1.66) 1.51

d

Notes. Cohen’s ds were calculated by subtracting postscores from prescores and then dividing the product by the prestandard deviation. Cohen’s d values can be interpreted as 0.20 = a small effect, 0.50 a medium effect, and 0.80 a large effect.

alliance) and their partner’s score on an outcome variable such as dedication or communication quality (Kashy & Kenny, 2000). As such, there are two actor effects (i.e., women’s alliance on their own outcome and men’s alliance on their own outcome) and two partner effects (i.e., women’s alliance on their partner’s outcome and men’s alliance on their partner’s outcome). To illustrate, the association between participants’ alliance and on their own dedication score (for both men and women) are represented by the actor-alliance effect (i.e., the paths for men and women are constrained to be equal). To adequately test whether the associations between alliance and outcomes vary by gender, it is necessary to include an interaction effect (i.e., alliance X gender; allowing the paths for men and women to be free to vary). This process is analogous to main effects and interaction effects in traditional statistical processes (e.g., regression, ANOVA). For instance, the main effect for alliance reflects the association between both men’s and women’s alliance score and relationship outcomes (e.g., dedication and communication quality) after controlling for the variance in the other variables as well as the interdependencies between couples’ ratings. The interaction effect between actor alliance and gender will test whether the associations between alliance and relationship outcomes are similar for men and women. We created three APIMs with postscores of dedication, positive communication, and negative communication as the outcome variables, respectively. The predictor variables were gender, alliance scores, the interaction between gender and alliance scores, and we controlled for participants’ prefunctioning for the outcome variables, number of children, length of relationship, CRE format, and marital status (see Table 2). The analyses were conducted utilizing Hierarchical Linear Modeling Version 6 (Raudenbush et al., 2005).1 The results for the actor effects demonstrated men’s and women’s alliance scores were significantly associated with their own negative communication, positive communication, and dedication (supporting hypothesis 1a–1f). That is, men’s and women’s own alliance scores were associated with their perceptions of negative communication (men’s d = 0.77; women’s d = 0.80; ps < .05), their perceptions of positive communication (men’s d = 0.23; women’s d = 0.24; ps < .05), and increase their perceptions of dedication in the relationship (men’s d = 0.28; women’s d = 0.26; ps < .05). All of the actor effects reported here were consistent for men and women (e.g., no significant interaction effects for Gender X Actor Alliance). That is, the results demonstrated that gender did not moderate the associations between men’s and women’s alliance ratings and their own communication quality and dedication (not supporting hypotheses 3a, 3c, or 3e). The results for the partner effects demonstrated that participants’ partner alliances were associated with lower negative communication for both men and women (men’s d = 0.92 and women’s d = 0.95; ps < .05). There were two significant interaction effects, gender X alliance on positive communication and dedication (supporting hypothesis 3b and 3d, but not supporting hypotheses 3f). As seen in Figure 1, as men reported higher alliance with their CRE leader women reported 184

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Table 2 Alliance and Relationship Outcomes: Summary of Main Fixed Effects Model 1: Neg Comm Coefficient (SE) Intercept Actor alliance Partner alliance Gender Actor alliance X Gend. Partner alliance X Gend. Control variables Actor-Pre Rel. Partner-Pre Rel. Group vs. couple Length of Rel Marital status Number of children

Model 2: Positive Comm Coefficient (SE)

Model 3: Dedication Coefficient (SE)

1.79 (.38)*** 1.06 (.22)*** 1.26 (.20)*** 0.02 (.09) 0.24 (.47)

6.67 (.15)*** 0.34 (.10)** 0.25 (.14) 0.27 (.10)** 0.68 (.23)

6.79 (.16)*** 0.41 (.09)*** 0.25 (.09)** 0.02 (.05) 0.26 (.25)

0.00 (.44)

0.59 (.26)*

0.48 (.24)*

0.22 (.10)* 0.26 (.09)** 0.61 (.33) 0.01 (.03) 0.62 (.42) 0.13 (.09)

.01 (.067) .22 (.07)** 0.12 (.21) 0.01 (.01) 0.80 (.21)*** 0.24 (.04)

0.05 (.04) 0.10 (.05)* 0.04 (.12) 0.00 (.01) 0.44 (.21)* 0.09 (.03)**

Notes. Neg Comm = Negative Communication, Pos Comm = Positive Communication, Pre Rel. = Relationship functioning (i.e., negative communication, positive communication, or dedication) scores at Pre, Gend. = Gender, Gender was coded 0 = women, 1 = men. Coefficients are unstandardized effects. *p < .05, **p < .01, ***p < .001.

higher positive communication (d = 0.17) and dedication (d = 0.16) scores at post, after controlling for the variance in the other variables. Lastly, we tested whether the association between alliance ratings and relationship outcomes would be moderated by CRE format.2 The results demonstrated that format moderated the association between men’s and women’s alliance and their own dedication scores (b = 0.43, SE = .17, p < .05, men’s d = 0.28; women’s d = 0.28) and their partner’s dedication scores (b = 0.37, SE = .17, p < .05, men’s d = 0.25; women’s d = 0.25). These results support hypotheses 4a and 4b. That is, the association between actor and partner alliance with dedication ratings was greater for those in the group format as compared to the couple format. Figure 2 illustrates the interaction effect for the actor alliance as the partner effect had a similar pattern. There were no significant moderation effects for positive or negative communication by group format for actor or partner (ps > .05; thus, not supporting hypotheses 4c–4f).

DISCUSSION Although CRE programs are well established in their effectiveness with relationship improvement, the ways in which they affect change are less understood, especially for lower-income REM couples. We examined a common therapeutic change mechanism in the psychotherapy literature— the alliance. In doing so, we found that higher quality alliances were related to more positive communication and greater levels of dedication as well as fewer negative communication behaviors. These findings are consistent with previous results regarding the alliance and outcomes in the individual, couple, and family psychotherapy literature (Friedlander et al., 2011; Horvath et al., 2011) as well as the two studies within the CRE literature (Bourgeois et al., 1990; Owen et al., 2011). Consequently, the alliance may be considered a common mechanism of change for couple interventions. April 2014

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6.61

Women Men

Post Dedication

6.48

6.35

6.22

6.10 -0.65

-0.40

-0.15

0.10

0.35

Partner Alliance

Post Positive Communication

6.42

Women Men

6.26

6.10

5.94

5.78 -0.65

-0.40

-0.15

0.10

0.35

Partner Alliance

Figure 1. Partner alliance by Gender on Post dedication and Positive Communication. Yet, the association between alliance and outcome can become convoluted when considering the possibility that positive outcomes may account for higher ratings of alliance, or that the two may co-occur within successful therapy or interventions. Although this is possible, the alliance has been shown to predict therapy outcomes over and above early change in couple and individual therapy, suggesting that the alliance may uniquely contribute to outcome (Anker et al., 2010; Barber, 2009). Thus, it seems that the quality of the alliance between CRE leaders and partners may be instrumental to changes in couples’ relationship functioning outcomes. For CRE programs and, this study in particular, with foci on serving REM lower-income individuals, the alliance may be linked to outcomes even more strongly when the leaders were community members who made explicit attempts to culturally adapt the intervention material (e.g., tailoring lessons to the common experiences of lower-SES REM couples) as well as address the barriers for engagement in the program (e.g., providing childcare). Interestingly, the association between participants’ ratings of the alliance and negative communication was large-sized effect, whereas the association between ratings of alliance and positive communication and dedication was small-sized effect. Why there are differences in the association between alliance and the type of outcome is not quite clear. It could be that the alliance is a better barometer for participants’ willingness to engage in techniques to attenuate their negative communication processes, such as utilizing the speaker–listener technique—a structured communication 186

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6.60

Couple Format Group Format

Post Dedication

6.46

6.32

6.19

6.05 -0.65

-0.40

-0.15

0.10

0.35

Actor Alliance

Figure 2. Alliance and Post Dedication by CRE Format. skills intervention aimed at reducing negative communication behaviors that is common to CRE programs, especially PREP (Markman et al., 2010). This technique is not a natural communication process (Gottman, Coan, Carrere, & Swanson, 1998); thus, it may require more “buy-in” from couples to effectively engage in the process. Yet, more research is needed to understand how the alliance interacts with techniques to promote better outcomes. Systemically, participants’ engagement in treatment processes can influence their partner. In particular, men’s alliance with CRE leaders had a positive association with their partner’s ratings of dedication and positive communication. However, women’s alliance scores were not significantly related to men’s relationship functioning. Gender differences may be even more pronounced for REM individuals. Commonly, men and women are socialized to conform to culture-specific gender norms. For example, African American men often face the conflict of healthy expressions of anger and frustration being misinterpreted or viewed through stereotypical frameworks as “overly aggressive.” This conflict can become important within romantic relationships where effective expression of emotions is paramount. In addition, African American women are often raised with an emphasis on strength, independence, and autonomy (Boyd-Franklin, 2003), which may complicate healthy dependency within romantic relationships. In a similar way, Cohen, Schulz, Weiss, and Waldinger (2012) found women’s perception that their partner was making an effort to be empathic was more impactful on relationship functioning as compared to men. In this way, it could be that men’s engagement in CRE programs counters traditional gender norms of how they engage in relationships, such as being emotional restricted, avoidance of problems, or distaste for seeking help (see Mahalik et al., 2003), which may promote women’s confidence and trust in the relationship. The degree to which this also counters or contributes to stereotypes within lower-SES REM couples and families is yet to be determined; however, it is important to recognize that the positive effects of men’s engagement on women’s outcome may not be the same as women’s engagement on men’s outcomes. Additionally, these findings are consistent with previous studies that have identified men’s ratings of alliance as being notably impactful for positive couple outcomes (e.g., Brown & O’Leary, 2000; Glebova, Foster, Cunningham, Brennan, & Whitmore, 2012; Symonds & Horvath, 2004). Collectively, while engendering strong alliances with both partners is important for promoting change in CRE programs, when men are engaged and collaborative, their partner may see this as a sign of relationship investment. Couple Relationship Education programs have been adapted to various delivery formats (e.g., group format, couple format, online), and all of these formats have empirical support (e.g., Braithwaite & Fincham, 2011; Hawkins et al., 2008; Owen, Chapman et al., 2012; Owen, Quirk et al., 2012). The role of the alliance may be an important mechanism of change in different ways within individual or group CRE formats. Although we expected that alliance would be more influential in the couple format, we found the alliance in the group format was associated with higher participant and partner scores of dedication (but not communication quality), while this effect was April 2014

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not as evident for those who participated in the couple format. It seems that the alliance within the group format may exert a stronger influence in facilitating couples’ dedication through increased social support and interaction. In the same way, Owen, Chapman et al., (2012) and Owen, Quirk et al., (2012) found that as couples developed a strong couple identity with other couples, they expressed a stronger commitment to their partner. This study also examined the experiences of REM individuals within a CRE program, and these findings may suggest that there is a unique interaction between cultural values of community support and engagement and relationship outcomes in these types of groups. Consistently, group cohesion is commonly described as a positive collective atmosphere, consisting of feelings of belongingness and commitment that helps consolidate and strengthen work carried out in the group (Dion, 2000). This collectivist nature may engender social support for couples to work toward positive goals and to strengthen their couple identity. These group dynamics may be especially important for strengthening couples’ dedication as compared to other relationship variables. The current findings should be considered within the methodological limitations. First, we only conducted assessments pre- and postintervention; thus, the degree to which our findings extend to longer-term effects is unknown. Second, our findings are correlational’ thus, we cannot know for certain the directionality of our effects. In addition, our findings are based on self-report measures, which make it more difficult to identify true changes in outcome variables or alliance scores, or the temporal order of these associations. Although ratings of couple-level alliance with CRE leaders may be informative, we believe the self-leader alliance is an important element of CRE programs. Future studies should add observational methods to strengthen the conclusion that changes in communication scores are reflective of actual changes in couple communication. Typical to CRE designs, alliance is assessed at the end of the program (Owen et al., 2011), and it is thus difficult to determine whether higher alliance scores are a product of positive outcomes or vice versa. We also only assessed self-leader alliance, not examining the couple-level ratings of the alliance. Future studies should assess the alliance periodically throughout the CRE program to disentangle this complication and utilize a couple-level measure of alliance. In addition, the current study only assessed relationship satisfaction at pre-intervention, and it is unknown how or if this component changed throughout the intervention. Still, couple dedication was assessed at pre and post, and this variable has been closely associated as a corollary of satisfaction within romantic relationship studies (r = .66; e.g., Owen et al., in press). Lastly, we utilized a sample of couples who all engaged in the PREP program, so we do not know whether the alliance would be associated with the outcomes examined in the same way, with other programs. Characteristics of the sample (participants and leaders) call into question the degree of generalizability of the results. Due to the largely heterogeneous racial/ethnic makeup of couples and leaders (i.e., 98% REM individuals) and unique socioeconomic and familial features of the sample (i.e., largely low income, unmarried, new parent couples), generalizations to the broader population may be problematic. Whether this is true or not, we believe the results of the current study raise important points for REM couples within CRE programs. Specifically, the retention rate of 100% of couples across the duration of the program begs the question; how? We feel that the approaches taken to maintain participation in the program are important steps that not only improve retainment, but also build and maintain the therapeutic alliance with REM clients. Implications Ultimately, our findings suggest that CRE programs may be best implemented when the leaders engender strong alliance with participants. Given the manualized structure of CRE programs, there may be more focus on predetermined goals and standardized tasks for CRE program. Leaders must be attuned to ways they can tailor the CRE uniform approaches to the individualized needs of each couple and the couples’ preferred avenues to reach their goals. This may be accomplished through adjusting CRE techniques (e.g., the speaker–listener) to fit with specific personalities, learning styles, and couple dynamics. Leaders can also tailor approaches by addressing culture-specific dynamics such as systemic constraints and experiences of stereotype pressures. For example, African American couples’ who report instances of oppression and racism also express worse communication quality and increased relational aggression (e.g., Kelly & Floyd, 2006). Ideally, a balance must be reached in

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adhering to the structure of the of CRE program, while being mindful of the spirit and aims of the programs and unique needs of REM couples (Owen, Antle, & Barbee, under review). The ways in which men and women experience the alliance within CRE programs seem to differ and have corresponding important implications for couple outcomes. Our finding that men’s alliance was related to self and partner outcome, while women’s alliance was not related to partner outcome, it is an important distinction that CRE leaders would be wise to consider. Commonly, women initiate therapy or CRE programs and, as such, may already be engaged with the aims of the interventions and the leaders to a larger degree than men. Careful monitoring of men’s alliance and engagement may give leaders a better sense of where the couple is at and how on track they are to reaching their relationship goals. Cultivating and tracking men’s alliance may assist leaders in knowing when to stay the course, and when to adapt CRE approaches to better suit the individual couple dynamics and preferences. Finally, CRE leaders and couples appeared to form similarly strong alliances in the group and couple format. Moreover, the alliance in both formats was associated with couples’ relationship functioning, suggesting that the alliance may have trans-format effects as a mechanism for change in CRE programs. As compared to couple format, the alliance in the group format was more strongly associated with dedication. Potentially, couples’ engagement in interventions within a supportive cohesive group environment might strengthen their dedication. This effect can be bolstered through CRE leaders’ attention to this process, by linking couples, promoting group discussion and sharing, thereby facilitating bonding and support between couples. This may be an especially salient point within REM groups where community support is prized and linking with other similar couples is highly valued. In summary, we have provided further evidence that the alliance is a potentially viable mechanism of change within CRE interventions, with racial/ethnic minorities. We hope that more attention will be given in research, practice, and training for the role of the alliance in CRE programs and how the alliance interacts with other mechanisms of change.

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NOTES 1

The effect sizes for the APIMs were calculated by taking their unstandardized coefficient divided by the standard deviation for the measure. 2 For these analyses, we constrained men’s and women’s alliance scores to be consistent.

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