Psychological Reports, 1992, 70, 787-790. O Psychological Reports 1992
WHEN IS COUPLES THERAPY NECESSARY AND SUFFICIENT? ' ARNOLD A. LAZARUS
Graduate School of Applied and Professional Psychology Rzrtgers-The State University of New Jersey Summary.-Couples therapy is not a unified form of treatment but draws on a heterogeneous range of influencing processes. When distressed couples are relatively stable and interested in effecting a harmonious modus vivendi, didactic training will usually achieve salubrious outcomes. When individual agendas, hidden or otherwise, undermine the relationship, individual therapy is often essential before the couple can benefit from conjoint therapy. Those who insist on working only within dyadic, triadic, or family contexts may fail to achieve desirable goals.
During 1990 and 1991 I treated 33 couples who asked for my professional services. In another 16 cases, I was approached by individuals, but soon ended up seeing the person who had consulted me together with his or her partner. In surveying these 49 couples, the diverse range of methods, strategies, and modalities employed under the rubric of "couples therapy" leads me to ask if there is indeed such an entity. In the present sample (n = 49), 16 couples achieved their goals after a mean of seven sessions of "didactic instruction." Their presenting problems seemed serious in some instances (e.g., they displayed behaviors that were hypercritical, passive-aggressive, hypersensitive, hostile, volatile, compulsive, perfectionistic, or detached; and several expressed ideals and expectations that were decidedly unrealistic). Yet these 32 people rapidly learned to abandon coercive tactics, to forgo impossible romantic ideals, to appreciate the value of reciprocity, to put common sense do's and don'ts into effect, and to replace negative impasses with constructive compromises and negotiations. Here "couples therapy" consisted mainly of a few "training sessions" involving good listening skills, positive communication styles, quid pro quo interactions, and the use of positive reinforcement, as well as "bibliotherapy" [they perused Fay's (1990) PQR: Prescription for a Quality Rekztionship and my own book Marital Myths (Lazarus, 1985)l. Among the aforementioned couples the mean pretreatment score on the Marital Satisfaction Questionnaire (Lazarus, 1985) was 74, suggesting "satisfactory" feelings, which rose to 81 points at the end of therapy (representing "good" feelings and interactions). Although statistically insignificant, this result is clinically suggestive. These 16 couples came into treatment displaying (a) genuine love and caring, (b) a basic level of emotional/psychological stability, and (c) no evidence of gross incompatibility. When conditions (a) and 'Address correspondence to Arnold A. Lazarus, Ph.D., Rutgers University, GSAPP, Busch Campus, P O Box 819, Piscataway, NJ 08855-0819.
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(c) do not apply, divorce counseling is a logical alternative. If (a) and (c) apply but (b) does not (i.e., one or both are psychologically disturbed), in most cases therapy needs to be directed at the individuals and their disorders. In these instances, the purpose of so-called "couples therapy" is mainly to circumvent the reinforcement of maladaptive behaviors. Contrary to systems theorists who insist on working only within dyadic, triadic, or family contexts, it is my experience that unless individual needs are specifically addressed, progress is unlikely to ensue and therefore individual therapy often needs to be the major vehlcle of change. Hayakawa (1964) emphasized that from a semantic perspective, "when the use of language results, as it so often does, in the creation or aggravation of disagveements and conflicts, there is something linguistically wrong with the speaker, the listener, or both" (p. 18). In other words, when a discussion does not resolve differences but leads to increasing disagreement, there are significant problems with the language habits (i.e., thinking processes) of one or more of the persons involved. When this is the case, discussions (i.e., therapies) are apt to follow a rather torturous pathway, unlike the relatively smooth sequence discussed above. Among the other 33 couples, one or both partners suffered from undue anxiety, extreme insecurity, abject misery, and other significant problems. Here, didactic rehearsals and specific readings had no impact, and it was necessary to address hidden agendas, accumulated resentments, distorted perceptions, pernicious demands, and, at times, clear-cut psychopathology that seemed to occasion the dyadic distress. Very often, working with them as a couple proved counterproductive, except when they were seen together for the explicit purpose of learning to cope with and not reinforce unfortunate behaviors and proclivities. (Very frequently, when being seen together, their terrors and hates would escalate and obscure the important issues, but with individual work, treatment would remain focused.) There were 12 cases with whom "couples therapy" was attempted initially (i.e., the couple was seen together with a view towards resolving their individual and mutual problems) but, in each instance, it soon seemed clear that therapeutic headway could best be made by seeing them individually. In another four cases, it soon became evident that the respective partners had entered "couples therapy" with a predetermined intention of obtaining a divorce. I n two of the cases, "couples therapy" soon turned into "divorce mediation," and a reasonably amicable uncoupling process ensued. The third couple elected to consult lawyers immediately. In the fourth case, the wife grew vituperative towards her husband and me and accused us of colluding in a male conspiracy. A combative dvorce is still in progress. What problems seemed to account for the extreme distress of some of the other couples?
COUPLES THERAPY: NECESSARY, SUFFICIENT?
789
One case concerned a woman's morbid fear of pregnancy and childbirth despite her expressed desire to have children. At the same time, her husband was expressing an inordinate desire to start a family. Fewer than a dozen systematic desensitization sessions with the wife extinguished her phobia. She became pregnant and gave birth to their first child. As soon as conception had been confirmed, the marital problems dissipated. Could this be called "couples therapy?" (I had wanted to address the husband's untoward demands, but he was unwilling to see me.) Another case rested on the fact that the wife was agoraphobic and made incessant demands on her husband. Here, individual treatment of the wife eliminated her phobic reactions and, contrary to some systems theorists, led to a profound and positive change in this couple. Treatment in this case called for a robust combination of cognitive and behavioral interventions. I n a third case, the major problem seemed to be the husband's depression. H e was referred to a psychiatrist for medication and also underwent a course of "cognitive therapy" with the writer. The wife was treated individually for problems with her siblings. Thereafter, they were seen together for three didactic training sessions. There were four cases in which evidence of paranoia, a schizotypal personality disorder, and borderline features were present. Here again, it soon proved futile to undertake either training or therapy with the couples, but instead, intensive individual therapeutic attention is still underway. So-called "couples therapy" has become an extremely popular therapeutic modality, and many books, entire journals, and numerous articles are devoted to the subject. I t is this writer's contention that this trend has created false foci that bypass the real issues that need to be addressed if many people who are psychologically distressed are to receive significant help. I have seen therapists who continue to treat couples who, from my perspective, are bound to remain deaf to their endeavors unless and until individual impediments can be overcome. Those couples therapists who refuse to see individuals will inevitably overlook significant dimensions that may require intensive therapeutic attention. Prof. W. Dryden drew my attention to Ellis (1962) who stated that "in most instances disturbed marriages (or premarital relationships) are a product of dsturbed spouses; and that if people were truly to be helped to live happily with each other they would first have to be shown how they could live peacefully with themselves" (p. 2). Ellis also observed that: "If neurotics have basically irrational assumptions or value systems, and if these assumptions lead them to interact self-defeatingly with their mates, then the marriage counselor's function is to tackle not the problem of marriage, nor of the neurotic interaction that exists between the marital partners, but of the irrational ideas or beliefs that cause this neurosis li deux" (p. 2 10).
790
A. A. LAZARUS
I think that therapists should treat people-not couples, not families, not groups-and in so doing, assess whether each person is likely to respond best to individual attention, to being seen with one or more significant others, or any combination thereof (Lazarus, 1989). REFERENCES
ELLIS, A. (1962)
Reason and emotion in psychotherapy. New York: Lyle Stuart. FAY,A. (1990) PQR: prescription for a quality relationship. New York: Simon & Schuster (Fire-
side). HAYAKAWA, S. I. (1964) Longuage in thought and action. New York; Harcourt, Brace & World. LAZARUS, A. A. (1985) Marihl myths. San Luis Obispo, CA: Impact. LAZARUS, A. A. (1989) The practice of mtrltimodal therapy. Baltimore, M D : Johns Hopkins Univer. Press. Accepted March 19, 1992.
WHEN IS COUPLES THERAPY NECESSARY AND SUFFICIENT? ' ARNOLD A. LAZARUS
Graduate School of Applied and Professional Psychology Rzrtgers-The State University of New Jersey Summary.-Couples therapy is not a unified form of treatment but draws on a heterogeneous range of influencing processes. When distressed couples are relatively stable and interested in effecting a harmonious modus vivendi, didactic training will usually achieve salubrious outcomes. When individual agendas, hidden or otherwise, undermine the relationship, individual therapy is often essential before the couple can benefit from conjoint therapy. Those who insist on working only within dyadic, triadic, or family contexts may fail to achieve desirable goals.
During 1990 and 1991 I treated 33 couples who asked for my professional services. In another 16 cases, I was approached by individuals, but soon ended up seeing the person who had consulted me together with his or her partner. In surveying these 49 couples, the diverse range of methods, strategies, and modalities employed under the rubric of "couples therapy" leads me to ask if there is indeed such an entity. In the present sample (n = 49), 16 couples achieved their goals after a mean of seven sessions of "didactic instruction." Their presenting problems seemed serious in some instances (e.g., they displayed behaviors that were hypercritical, passive-aggressive, hypersensitive, hostile, volatile, compulsive, perfectionistic, or detached; and several expressed ideals and expectations that were decidedly unrealistic). Yet these 32 people rapidly learned to abandon coercive tactics, to forgo impossible romantic ideals, to appreciate the value of reciprocity, to put common sense do's and don'ts into effect, and to replace negative impasses with constructive compromises and negotiations. Here "couples therapy" consisted mainly of a few "training sessions" involving good listening skills, positive communication styles, quid pro quo interactions, and the use of positive reinforcement, as well as "bibliotherapy" [they perused Fay's (1990) PQR: Prescription for a Quality Rekztionship and my own book Marital Myths (Lazarus, 1985)l. Among the aforementioned couples the mean pretreatment score on the Marital Satisfaction Questionnaire (Lazarus, 1985) was 74, suggesting "satisfactory" feelings, which rose to 81 points at the end of therapy (representing "good" feelings and interactions). Although statistically insignificant, this result is clinically suggestive. These 16 couples came into treatment displaying (a) genuine love and caring, (b) a basic level of emotional/psychological stability, and (c) no evidence of gross incompatibility. When conditions (a) and 'Address correspondence to Arnold A. Lazarus, Ph.D., Rutgers University, GSAPP, Busch Campus, P O Box 819, Piscataway, NJ 08855-0819.
788
A. A. LAZARUS
(c) do not apply, divorce counseling is a logical alternative. If (a) and (c) apply but (b) does not (i.e., one or both are psychologically disturbed), in most cases therapy needs to be directed at the individuals and their disorders. In these instances, the purpose of so-called "couples therapy" is mainly to circumvent the reinforcement of maladaptive behaviors. Contrary to systems theorists who insist on working only within dyadic, triadic, or family contexts, it is my experience that unless individual needs are specifically addressed, progress is unlikely to ensue and therefore individual therapy often needs to be the major vehlcle of change. Hayakawa (1964) emphasized that from a semantic perspective, "when the use of language results, as it so often does, in the creation or aggravation of disagveements and conflicts, there is something linguistically wrong with the speaker, the listener, or both" (p. 18). In other words, when a discussion does not resolve differences but leads to increasing disagreement, there are significant problems with the language habits (i.e., thinking processes) of one or more of the persons involved. When this is the case, discussions (i.e., therapies) are apt to follow a rather torturous pathway, unlike the relatively smooth sequence discussed above. Among the other 33 couples, one or both partners suffered from undue anxiety, extreme insecurity, abject misery, and other significant problems. Here, didactic rehearsals and specific readings had no impact, and it was necessary to address hidden agendas, accumulated resentments, distorted perceptions, pernicious demands, and, at times, clear-cut psychopathology that seemed to occasion the dyadic distress. Very often, working with them as a couple proved counterproductive, except when they were seen together for the explicit purpose of learning to cope with and not reinforce unfortunate behaviors and proclivities. (Very frequently, when being seen together, their terrors and hates would escalate and obscure the important issues, but with individual work, treatment would remain focused.) There were 12 cases with whom "couples therapy" was attempted initially (i.e., the couple was seen together with a view towards resolving their individual and mutual problems) but, in each instance, it soon seemed clear that therapeutic headway could best be made by seeing them individually. In another four cases, it soon became evident that the respective partners had entered "couples therapy" with a predetermined intention of obtaining a divorce. I n two of the cases, "couples therapy" soon turned into "divorce mediation," and a reasonably amicable uncoupling process ensued. The third couple elected to consult lawyers immediately. In the fourth case, the wife grew vituperative towards her husband and me and accused us of colluding in a male conspiracy. A combative dvorce is still in progress. What problems seemed to account for the extreme distress of some of the other couples?
COUPLES THERAPY: NECESSARY, SUFFICIENT?
789
One case concerned a woman's morbid fear of pregnancy and childbirth despite her expressed desire to have children. At the same time, her husband was expressing an inordinate desire to start a family. Fewer than a dozen systematic desensitization sessions with the wife extinguished her phobia. She became pregnant and gave birth to their first child. As soon as conception had been confirmed, the marital problems dissipated. Could this be called "couples therapy?" (I had wanted to address the husband's untoward demands, but he was unwilling to see me.) Another case rested on the fact that the wife was agoraphobic and made incessant demands on her husband. Here, individual treatment of the wife eliminated her phobic reactions and, contrary to some systems theorists, led to a profound and positive change in this couple. Treatment in this case called for a robust combination of cognitive and behavioral interventions. I n a third case, the major problem seemed to be the husband's depression. H e was referred to a psychiatrist for medication and also underwent a course of "cognitive therapy" with the writer. The wife was treated individually for problems with her siblings. Thereafter, they were seen together for three didactic training sessions. There were four cases in which evidence of paranoia, a schizotypal personality disorder, and borderline features were present. Here again, it soon proved futile to undertake either training or therapy with the couples, but instead, intensive individual therapeutic attention is still underway. So-called "couples therapy" has become an extremely popular therapeutic modality, and many books, entire journals, and numerous articles are devoted to the subject. I t is this writer's contention that this trend has created false foci that bypass the real issues that need to be addressed if many people who are psychologically distressed are to receive significant help. I have seen therapists who continue to treat couples who, from my perspective, are bound to remain deaf to their endeavors unless and until individual impediments can be overcome. Those couples therapists who refuse to see individuals will inevitably overlook significant dimensions that may require intensive therapeutic attention. Prof. W. Dryden drew my attention to Ellis (1962) who stated that "in most instances disturbed marriages (or premarital relationships) are a product of dsturbed spouses; and that if people were truly to be helped to live happily with each other they would first have to be shown how they could live peacefully with themselves" (p. 2). Ellis also observed that: "If neurotics have basically irrational assumptions or value systems, and if these assumptions lead them to interact self-defeatingly with their mates, then the marriage counselor's function is to tackle not the problem of marriage, nor of the neurotic interaction that exists between the marital partners, but of the irrational ideas or beliefs that cause this neurosis li deux" (p. 2 10).
790
A. A. LAZARUS
I think that therapists should treat people-not couples, not families, not groups-and in so doing, assess whether each person is likely to respond best to individual attention, to being seen with one or more significant others, or any combination thereof (Lazarus, 1989). REFERENCES
ELLIS, A. (1962)
Reason and emotion in psychotherapy. New York: Lyle Stuart. FAY,A. (1990) PQR: prescription for a quality relationship. New York: Simon & Schuster (Fire-
side). HAYAKAWA, S. I. (1964) Longuage in thought and action. New York; Harcourt, Brace & World. LAZARUS, A. A. (1985) Marihl myths. San Luis Obispo, CA: Impact. LAZARUS, A. A. (1989) The practice of mtrltimodal therapy. Baltimore, M D : Johns Hopkins Univer. Press. Accepted March 19, 1992.
