Marital & Family Therapies Dr. Anisha Shah Department of Clinical Psychology NIMHANS

Marital/couple therapy research “possibly efficacious” Agoraphobia/panic disorder: couple communication training Depression: behavioral marital therapy Marital Discord: behavioral marital therapy, Cognitive behavior therapy, cognitive therapy, emotion focused couple therapy, insight- oriented marital therapy Sexual dysfunction: reduce sexual anxiety and improve communication

Family therapy research Obsessive-compulsive disorders: family assisted ERP & relaxation Bipolar disorder: family therapy Anorexia: behavioral family systems therapy, family therapy Schizophrenia: behavioral family therapy, family systems therapy, supportive long-term family therapy

…with children & adolescents ADHD: behavioral parent training Anxiety disorders: CBT & family anxiety management training Conduct disorders: functional family therapy, multisystemic therapy, parent-child interaction therapy, parent-training based on living with children, videotape modeling parent training

…. Disruptive disorders: structural family therapies Psychophysiological disorders: family therapy

Guidelines for conducting couple & family therapy Develop systemic perspective Consider context Various viewpoints of members Circular causality maintains problems Respect family diversity Ethical considerations Assessment and intervention from first contact clarify participants Engagement and alliance building Influence of FOO on present family

Guidelines… Brief format Improve relationships Promote solutions, coping, family health Negotiate goals Move family from habitual patterns Use individual, biological, couple, family and macrosystemic interventions Empathy, communication, reinforcements, structure

Guidelines… Promote individuals to take responsibility of own behaviour Conjoint sessions for couples Address criticisms, contempt, defensiveness, stonewalling Psychoeducational approaches for severe mental illness Create stabilizing rituals Safety when violence and abuse Maintenance of change & termination

Theoretical models marital/couple therapy Behavioral Jacobson, Margolin, Stuart, Weiss, Hops, Patterson Cognitive Baucom, Epstein, Waring Sex therapy LoPiccolo, Friedman Emotion-focused Greenberg, Johnson, Prevention/enrichment /enhancement Markman, Floyd, Stanley, Lewis MT & Ind psychopathology Beach, Oleary, Jacobson

In therapy: focus on communication, problem solving, analysis of sequences, contingencies, reciprocities Alter consequences, allow spouses to choose freely in order to prevent resistance, modify antecedents Practice, feedback, modeling, instructions, + and – communication styles, feelings, define problems without blaming, active listening

Cognitive interventions: beliefs & expectations Relabel negative attributions Modify unrealistic expectations Create positive expectancies Diminish negative emotions Avoid extreme statements/interpretations Maximize +ve/realsitic expectations Predict expected relapses Cheerleading and TA, enthusiasm, humor Learn to prevent future problems with collaboration and mutual responsibility

Suggested reading Chambless, D.L. & Oliendick, T.H. (2001) Empirically supported psychological interventions; Controversies and evidence, Annual Review of Psychology, 52, 685-716 Snyder, D.K., Castellani, A. M. & Whisman, M. A. (2006) Current status and future directions in couple therapy, Annual Review of Psychology, 57, 317-344