Marriage Education for Clinicians

Introduction

Marriage education, with a history in the faith-based community, has traditionally focused on clergy helping premarital couples prepare for marriage. It was rare for clinically-trained professionals to participate in marriage education workshops. Clinicians tend to focus solely on psychopathology, and those clinicians with interest in relationships more typically conduct marital therapy for couples in distress rather than marriage education for healthy couples. As a result, nonprofessionals have come to dominate the marriage education field, and workshops run the risk of becoming little more than pep rallies in support of marriage. This is unfortunate because clinicians’ understanding of change processes has much to offer the field of marriage education.

Since marriage education services target healthy couples, there is the opportunity to impact a much larger segment of society, including many people who would otherwise not receive psychological services. To be specific, during the last few years, relationship education programs have received hundred of millions of dollars in federal funding. Roughly 300 community-based organizations around the nation have served hundreds of thousands of couples (Myrick, Ooms, & Patterson, 2009; Hawkins & Fellows, 2011).¹ Few psychology-related program receive anywhere near that kind of new funding or have that level of widespread impact (TAGGS, 2011). It makes sense for clinicians to claim this field as our own.

The premise of marriage education is that relationship skills can be taught and learned, just as math skills can be taught and learned. Whether taught in structured workshops for groups of couples, described in self-help books, or developed in media campaigns, marriage education is intended to be a prevention program, with the potential of benefitting everyone who takes it. People come to relationships with varying degrees of relationship skillfulness, and some of us may require significant remediation, but all of us can benefit from practicing these skills. We view marriage education as a wellness program, and frequently use the analogy that marriage education is a way to enhance and maintain relationship health just as one visits the gym to enhance and maintain physical health. We encourage couples to invest as much time and effort into their relationships as they would with their physical conditions. Learning relationship skills not only requires the acquisition of new knowledge about how relationships function, but it also requires repeated, sustained practice over months to reinforce this learning in an ongoing way. The aim of marriage education has been defined as the prevention of marital distress and discord before problems become entrenched (Halford, Markman, & Stanley, 2008).

As a wellness program, marriage education may be differentiated from marital therapy (Markman, Stanley, Jenkins, Petrella, & Wadsworth, 2006), just as weight or aerobic training may be distinguished from physical therapy. Everyone benefits from getting into good physical shape, but the workout regimen is different if one requires physical therapy to rehabilitate from an injury. Similarly, when a marriage is in significant crisis, marital therapy is indicated, either in lieu of marriage education or in addition to it. In this regard, marriage education helps couples capitalize on positive feelings and good will when their relationships are strong. Marriage education focuses on general relationship skill-building rather than resolution of specific conflict issues. In contrast, marital therapy typically targets couples in distress, addressing specific conflicts with the aim of repairing the relationship. While this distinction may become blurry around the edges, we have found it to be useful in practice.

History of Marriage Education

Marriage education has its roots in three separate traditions: the Catholic Church doctrine of Pre-Cana, psychologists with interest in couples functioning, and public policy experts who focused on reducing poverty. While these three worlds share little overlap, they came together when the federal government funded the Healthy Marriage Initiative in 2006 (see www.acf.hhs.gov/healthymarriage for an overview of the Healthy Marriage Initiative).

Marriage preparation programs date back to the 1930s, becoming more widely available in the 1960s, predominantly through the Catholic Church (Sayers, Kohn, & Heavey, 1998; Ooms, 2005). By 1980, Pre-Cana, premarital counseling programs led by priests, were declared mandatory in most U.S. dioceses for Catholic couples planning to wed. The Church also organized Marriage Encounter weekend retreats led by married lay couples. As a result, nearly all Catholic couples marrying in the last three decades have had marriage education. According to a recent large, random household survey, 44% of couples married since 1990 have attended some form of premarital education (Stanley, Amato, Johnson, & Markman, 2006), and an overwhelming majority (93%) of these couples received marriage preparation services in a religious setting.

In conjunction with rising divorce rates in the 1970s and early 80s, psychologists began conducting observational and longitudinal research on marital communication patterns. Since then, much has been learned about predictors of marital outcomes (for reviews see Bradbury, Fincham, & Beach, 2000; Gottman, 1994; Gottman, Coan, Carrere, & Swanson, 1998;Karney & Bradbury, 1995; Halford, 2011). The way in which spouses interact with one another, especially in the context of conflict, has received considerable attention in the literature. Negative affect (e.g., contempt) as well as negative communication styles (e.g., criticism, defensiveness, interrupting) are predictive of relationship dissatisfaction, as are patterns of negative reciprocity and demand-withdrawal interactions. Conversely, positive emotional expressions (e.g., humor, affection) and positive communication (e.g., respectful listening, clarifying questions) predict relationship satisfaction. Not surprisingly, the main finding is that couple interaction is the most powerful predictor of marital outcomes.

Various approaches to couple therapy target these interaction patterns and other characteristics that differentiate distressed couples from nondistressed couples, several of these approaches have earned empirical support in selected settings (Baucom et al., 1998; Christensen et al., 2010; Wood, Crane, Schaalje, & Law, 2005). This might be all well and good, but unfortunately, the majority of couples never seek couples treatment (Doss, Rhoades, Stanley, & Markman, 2009), and for those who do, dropout rates are typically quite high and customer satisfaction is correspondingly low (Halford, 2011). The lack of motivation to seek or stay in marital therapy may be a function of the fact that couples who seek treatment do so after enduring many years of distress (an average of 6 years) prior to entering treatment (Doss et al., 2009), at which point it is often “too little too late.” Thus, psychologists interested in couples functioning began to develop approaches focused on stabilizing relationships before couples became distressed, thereby preventing divorce.

There are more than 100 marriage education curricula currently available (Dion, 2005), though most have not been evaluated for effectiveness (Cowan, Cowan, & Knox, 2010). While curricula vary to some extent with regard to content, intended population, teaching modalities, and method of service delivery, most curricula address communication, conflict management, and problem-solving skills. Other topics, such as friendship and intimacy, commitment, stress and emotion management, expectations and beliefs, are often incorporated as well.

Two of the earliest marriage education curricula were Couple Communication ([CC] Miller, Nunnally, & Wackman, 1979) and Relationship Enhancement ([RE] Guerney, 1977), both of which targeted communication and conflict-resolution skills and demonstrated positive impacts on communication and relationship satisfaction (Accordino & Guerney, 2003; Butler & Wampler, 1999). The widely disseminated Prevention and Relationship Enhancement Program ([PREP] Markman, Floyd, Stanley, & Storaasli, 1988) originated as a program for premarital couples and expanded traditional psycho-education on communication and conflict management skills to include content on the exploration of expectations and the importance of commitment, friendship, and intimacy in marriage. Several randomized controlled studies have shown PREP, and programs derived from it, to have positive effects on communication and conflict-resolution skills and relationship satisfaction (e.g., Laurenceau, Stanley, Olmos-Gallo, Baucom, & Markman, 2004;Markman, Renick, Floyd, Stanley, & Clements, 1993;Halford, Sanders, & Behrens, 2001; Halford, Wilson, Watson, Verner, Larson, Busby, & Holman, 2010). Another longstanding curriculum developed by a marriage and family therapist is the Practical Application of Intimate Relationship Skills program ([PAIRS] DeMaria, Hannah, & Gordon, 2003), which targets communication, conflict resolution, and emotional understanding. Quasi-experimental pre–post research designs have demonstrated positive impacts on relationship satisfaction and conflict (e.g., Durana, 1994), and a federally funded demonstration project is underway (see http://www.pairs.com), however no randomized trials have been published to date (Cowan et al., 2010). Other curricula, such as Becoming a Family (Cowan & Cowan, 2000), Bringing Baby Home (Shapiro & Gottman, 2005), and Couple CARE for Parents (Halford, Petch, & Creedy, 2010) target couples entering the transition to parenthood by adding content on parenting and co-parenting. These programs have demonstrated positive impacts on marital quality, parent–child relationship quality, and other child outcomes.

More recently, several of these evidenced-based curricula have been adapted for low-income populations and are undergoing evaluation in a large demonstration projects. Notable curricula include John and Julie Gottman’s Loving Couples Loving Children ([LCLC Inc.], 2008); Within Our Reach ([WOR]; Stanley & Markman, 2008) adapted from PREP; an adaptation of PAIRS (Gordon, DeMaria, Haggerty, & Hayes, 2007); and Love’s Cradle (Guerney & Ortwein; see www.skillswork.org) adapted from Relationship Enhancement. These newer generation curricula adopt an experiential approach, relying more on discussion, role playing, and skills practice rather than solely lectures, readings, and written exercises.

In general, marriage education approaches have demonstrated effectiveness among middle-to-upper class couples (Knox & Fein, 2008; Jakubowski, Milne, Brunner, & Miller, 2004;Hawkins & Ooms, 2010). A series of meta-analyses suggest that preventive psycho-educationally oriented programs produce moderate positive effects on both relationship satisfaction and communication (Carroll & Doherty, 2003; Hawkins, Blanchard, Baldwin, & Fawcett, 2008;Blanchard, Hawkins, Baldwin, & Fawcett, 2009; Fawcett, Hawkins, Blanchard, & Carroll, 2010). However, many of the studies included were small, were comprised primarily of White, middle-class, nondistressed couples, and investigated a limited range of outcomes. Therefore, little is known regarding the long-term impact of marriage education on marital quality, communication, or other important outcomes (e.g., marital stability, relationship aggression, child well-being), and we are only beginning to learn how marriage education may benefit lower income couples where the problems may be different, the stresses more intense, and where there exists a great deal of cynicism about relationships (see Hawkins & Fackrell, 2010; Hawkins & Ooms, 2010). Interestingly, we do know that low income couples who are at the highest risk for relationship distress and dissolution are highly interested in relationship education (Ooms & Wilson, 2004).

While psychologists had long demonstrated that healthy relationships confer many benefits to adults and children (Karasu, 2007; Karasu & Karasu, 2005; Wilcox, Waite, & Roberts, 2007), relationships’ impact on society have just begun to be articulated. Over the past two decades, public policymakers have come to appreciate the importance of marriage on a wide variety of economic and intergenerational outcomes for children. Stable marriage is associated with increased happiness, improved health and longevity, reduced stress, and improved behavioral outcomes for children (happiness, academic accomplishments, fewer behavioral problems), but most especially, with greater income and wealth (Markman, Halford, & Lindahl, 2000; Wilcox, Waite, & Roberts, 2007; Fincham & Beach, 2010; Zagorsky, 2005). By the same token, policy researchers have reported that “fragile relationships” (Fein, 2004) and family instability are associated with increased economic difficulties, and have numerous negative impacts on children (Amato, 2005; Knox, Cowan, Cowan, & Bildner, 2011).

In the 1990’s, the public policy findings on healthy relationships justified political efforts to strengthen marriage (e.g., the development of state-funded healthy marriage initiatives and marriage coalitions; see National Healthy Marriage Resource Center, 2009), and led to an important shift in economic policy for low-income families. In 2002, the Administration for Children and Families (ACF), Department of Health and Human Services (HHS), began to fund marriage and relationship education demonstration programs under the Healthy Marriage Initiative. This was followed by Temporary Assistance for Needy Families (TANF) welfare reform reauthorization in 2006, which resulted in $150 million a year for five years to fund healthy marriage and responsible fatherhood programs (see www.acf.hhs.gov/healthymarriage for an overview of the Healthy Marriage Initiative). Because this funding came through the federal welfare system, many clinically focused programs did not pursue it. The majority (60%) of grantees receiving this funding were community-based organizations (NHMRC, 2010) as well as faith based organizations (16%). Notably, approximately one third of grantees reported minimal or no prior experience with the provision of marriage education services.

Federal funding for healthy marriage programs stirred considerable controversy. Part of the resistance to marriage education was the criticism that such programs would be coercive, forcing people to remain in relationships which might be unhealthy or even dangerous. Furthermore, many critics felt that marriage is a private matter, not to be promoted by the government. They were uncomfortable with religious proselytizing and moralizing about the sanctity of marriage. To address this skepticism at the time when the funding was announced, Wade Horn, Assistant Secretary for Children and Families of the Department of Health and Human Services, explained, “The goal of the healthy marriage initiative is to boost the number of good marriages, not just the number of marriages” (Chamberlin, 2005).

As one of the few academic institutions to receive healthy marriage funding, we developed a Supporting Healthy Marriage program in the Department of Psychiatry and Behavioral Sciences at Montefiore Medical Center, and were selected as a site for the large-scale random-assignment Supporting Healthy Marriage (SHM; Knox & Fein, 2008) demonstration project, led by MDRC,² a highly respected think tank, which is examining the impacts of marriage education for low-income married couples with children (for an overview see www.supportinghealthymarriage.org). An early implementation report has been released (Gaubert, Knox, Alderson, Dalton, Fletcher, McCormick, 2010) and evaluation data will be reported over the next few years.³ Here, we offer our unique perspective on the field of marriage education based on almost five years’ experience seeing over 1,200 couples.

Our SHM Program

Our program is housed within a major academic medical center in the Bronx, NY, and we were able to recruit the majority of the married couples for our Supporting Healthy Marriage program from outpatient Pediatrics and Obstetrical clinics at our facility, as well as from various local community organizations that serve families.

The Bronx, with an estimated population of more than 1.3 million people, is one of the poorest urban counties in the nation, and the demographics show below average labor force participation, educational attainment, and income, and high unemployment rates. Congressional District 16 (covering much of the South Bronx), has the highest poverty rate (38%) in the nation, the highest child poverty rate (49%), and the lowest median household income in the country (Annie E. Casey Foundation, 2009). According to recent district figures, only 27% of children live in a married-couple family; 63% of children reside with a single mother, which is the highest rate of all New York City boroughs (Annie E. Casey Foundation, 2009). These figures indicate that the Bronx provides a rigorous testing ground for demonstrating the effectiveness of marriage education for fragile families under significant stress and they underscore the need for marriage education services in this community.

To be eligible for the program, couples had to be couples married, at least 18 years of age, and have a least one child under age 18 living in the home. Funding also dictated that couples must have reportable household income of below 200% of poverty level. Most couples served by our SHM program were Hispanic (53%) or African-American (42%). The majority of couples (48%) fell between 31 and 45 years of age; ages ranged from 18-72. The average duration of marriage was 7 years.

The program included Marriage Education Workshops, Extended Activities (after the core workshops ended), and Family Support Services. Couples attended at least 24 hours of a core series of group-based marriage education workshops led by clinically trained male/female facilitator pairs, delivered in weekly 2-hour modules in the evening over a 3-month period. Workshops consisted of approximately 10 to 15 couples who stayed together as a cohort in order to promote bonding and support. These workshops were fun, engendered lively discussion, and were delivered in a multimedia format. We selected the Loving Couples, Loving Children ([LCLC Inc.], 2008) curriculum, developed by John and Julie Gottman, and we adapted many of the basic concepts to our own taste and style to meet the needs of our population. This curriculum was clinically sophisticated and included a 15-minute “talk show” type video of high production value showing three to four couples discussing the module topic; it was facilitated by a clinician moderator. The content was crafted to suit the needs of low-income couples with varying educational backgrounds, was interactive, and utilized several different teaching modalities. The “talk show” was followed by a 30-minute facilitated group discussion after which facilitators briefly presented research-based information and basic concepts related to healthy marriage. Modules always concluded with a skills-building exercise with monitoring and coaching by marriage educators as needed, and a wrap-up to reiterate key concepts and address questions. Couples received workbooks which they took home to practice skills they had learned.

Attendance at these workshops was excellent (in part because they were preceded by a free 30-minute dinner), with 83% of enrolled couples attending their first workshop and 75% of them completing the core marriage education series. After the core workshops were completed, couples were invited to attend Extended Activities for the following 9 months. These activities included booster marriage education workshops on special topics to reinforce the core skills as well as social events and guest speakers. More than 750 people attended these extended activities. Family Support Services consisted of case management for all couples to promote program engagement and link couples to supportive services (e.g., employment services, mental health referrals, child care assistance).

Our primary goals were to help couples understand how to form and maintain better relationships, to become better parents for their children, and to have healthy long-lasting marriages. We provided services with the understanding and appreciation that couples want to trust each other and build positive relationships and connections with each other and their children. Program services were delivered from a strength-based perspective that assumed that parents are competent and came to the program with knowledge and experience to build on as well as the capacity to develop new skills and ways of thinking about their relationships. That said, we viewed relationships as inherently conflictual, and our main focus was to help couples develop the skills necessary to negotiate these conflicts.

Role of the Workshop Leaders

Most marriage education programs utilize nonprofessionals to serve as workshop leaders based on the rationale that the leaders are required to strictly adhere to formal, structured curricula (see Markman et al., 2006). These programs emphasize the preferred personality traits of the leaders, highlighting extroversion and enthusiasm, and some compare marriage education to marketing or public relations (see Robredo, 2007). But since the role of the workshop leaders is so critical to the success of any marriage education program (see Owens, Rhoades, Stanley, & Markman, 2011), we advocate the use of clinically trained professionals (i.e., licensed psychologists or social workers) rather than lay people. Not only are clinically trained staff able to troubleshoot and identify couples in need of referrals for more intensive psychological services (i.e. diagnosing significant psychopathology or substance use, evaluating mental status changes and risk of domestic violence), they are also qualified to deviate from or elaborate on workshop content based on issues that emerge during the workshops. Highly trained professionals are better able to competently assess and manage the inevitable distress and intense affect that often emerge within the context of couples interactions (see also Cowan, Cowan, Pruett, Pruett, & Wong, 2009). Clinicians are also more keenly attuned to participants’ use of metaphor and language, and will use culturally appropriate and relevant examples that resonate with group members. These metaphors and illustrations will, of course, vary from cohort to cohort, and only someone well-trained will have the comfort and flexibility to apply the basic concepts in new ways.

One of the primary responsibilities of workshop leaders is to develop a climate of trust, respect, and community. Couples, especially the husbands, often enter the program with distrust, skepticism, or ambivalence about participating in marriage education. It is crucial to establish a safe environment for self-disclosure and learning. Rapport building and motivational enhancement are continual focuses of the leaders. Facilitators try to demonstrate care and respect for participants to gain trust, promote a strong working alliance with participants, and instill hope. This is accomplished by adopting and accepting and nonjudgmental stance, conveying the belief that all couples have knowledge to contribute and can learn from one another, and reinforcing spontaneous participation and self-disclosures with empathy, validation, and support. Facilitators also work to build group cohesion and community. During the initial workshop, strategies for building cohesion include introductions/icebreakers and the collective creation of group norms for participation. While the various couples in a workshop may be quite heterogeneous with respect to age, ethnicity, relationship stage and functioning, the facilitators are charged with making connections between participants’ experiences and tying the group together. Humor is an important contributor to fostering a sense of community and putting people at ease. We utilize fun icebreakers and typically introduce workshop modules with a joke or cartoon about relationships; it is important to be able to laugh at ourselves. Serving a meal before every workshop also affords the opportunity for couples to socialize and build relationships.

Although we use a flexible marriage education curriculum, the key elements of each workshop are the group discussions. It is the leaders’ main responsibility to facilitate meaningful group discussions. We have found that trained clinicians are best able to elicit participation from everyone, and attend to the group dynamics, regardless of the specific content under discussion. In guiding the discussion, workshop leaders model important communication skills, such as turn-taking, respecting differing points of view, listening, paraphrasing, and empathic validation. It should be noted that the goal of group discussions is not to provide couples with explicit advice or solutions to specific problems. Rather, discussions serve as a means to help participants identify and voice their own thoughts, feelings, and goals related to their specific issues, to highlight commonalities or differences in experiences across couples or subsets within the group (e.g., men vs. women), and to provide encouragement and motivation to learn some new tools to help couples better understand and manage these issues as a team. In our experience, the group processes that emerge during these discussions provide an important therapeutic opportunity for self-reflection, growth, acceptance, and change. Facilitators encounter countless challenges in leading workshops and they must handle these challenges confidently and effectively with skill and finesse. Group discussions and couples’ exercises may evoke strong affect and conflict, either within couples or among participants, which must be processed and contained. Participants may show discomfort with or resistance to learning new skills or openly express hostility, cynicism, or hopelessness about the potential for change, all of which must be recognized and addressed. Difficult or disruptive participants (e.g. discussion monopolizers, those with character pathology) must be managed, and individuals who are “low participators” must be drawn out and encouraged to share.

Finally, workshop leaders also provide skills coaching and practical feedback to individual couples during exercises. This requires facilitators to adopt an active role in correcting or shaping participants’ use of skills and reinforcing positive behaviors while resisting the pull to step in and assume the role of problem solver or provide direct advice. These interactions help build rapport, trust, and hope, and also offer additional opportunities to model skills, normalize the experience of marital conflict, and encourage couples to try something different and practice often. We strive for each couple to have a success experience during each of these exercises even if they struggle with them; if nothing else, we hope to help couples learn how an interaction went wrong and what they might do differently in the future. In our opinion, trained clinicians are best qualified to walk this fine line.

Workshop Content

John Gottman’s (1994, 1999) longitudinal marital research provides the basis for not only the LCLC curriculum, but also informed many of the other curricula in existence (e.g., PREP). Gottman’s research consistently shows that happily married couples behave like good friends and handle their conflicts in positive ways (LCLC Inc., 2008). Based on these two core findings, Gottman developed a theoretical framework known as the Sound Relationship House (Gottman, 1999). The foundation of the house is the building of marital friendship, the main floor of the home is the managing of conflict and the upper tier of the house includes the creation of couples’ sense of shared meaning. Gottman asserts that happy couples feel emotionally close to one another and have relationships based on respect, affection, and empathy (LCLC Inc., 2008). From observing thousands of couple interactions, Gottman has noted that happy couples make many more positive comments than negative comments to one another, even during times of conflict (a ratio of 20:1 during normal, everyday interactions and 5:1 during conflict).

Gottman noted that happy couples don’t get gridlocked by their perpetual problems, but instead “fight fair” by talking to one another, listening respectfully, and working toward reaching a compromise (LCLC Inc., 2008). Consequently, the way a couple deals with inevitable conflict is the core “floor” of the sound relationship house. Gottman identified four harmful ways of managing conflict, which he initially called the “four horsemen of the apocalypse” and later termed the “four train wrecks,” that are predictive of marital break-up: criticism, defensiveness, contempt, and stonewalling. Further, Gottman noted there are four tell-tale signs that a relationship is headed for trouble: things become more negative than positive, couples frequently engage in the four train wrecks, both partners become overwhelmed during conflict, and repair attempts fail. On the other hand, Gottman has identified four positive characteristics which lead to more healthy exchanges: starting conversations gently, turning toward one another for emotional support, successful recovery from conflict, and accepting influence from each other. Together, these concepts make up the foundation of the LCLC curriculum.

In our program, we emphasize the importance of managing conflict with workshops on identifying train wrecks, taking a break (to prevent conflict escalation), gentle start-up, speaker-listener skills, compromise, recovery conversations, and perpetual problems. Thus, 60% of our workshop time is spent from the outset on acknowledging the inevitability of conflict and developing strategies for managing it. Couples are surprised by this since many of them come into the workshops with the belief and expectation that healthy relationships do not have conflict. We clarify that it is not the absence of conflict that characterizes the healthiest relationships, but how that conflict is addressed. Group discussion offers the opportunity for facilitators to consistently normalize relationship conflict and reiterate the point that conflict can be productive, rather than destructive, if it is managed with skill, can, in fact, bring couples closer, and enhance trust when it is managed effectively. Over the course of the weekly workshops, couples become quite skilled at identifying the “train wrecks” (especially when other people exhibited them). The taking-a-break workshop focuses on how to protect the relationship when tempers flare, and gentle start-up workshop focuses on couples learning how to raise complaints without criticism. Despite initial skepticism that saying things gently would be awkward and inevitably lead to manipulation (e.g., “If I say it nicely, he will walk all over me.”), over time couples are able to incorporate the message that it isn’t only what you say, but how you say it that matters.

Developing speaker-listener skills represents the core of our marriage education approach. This entails paraphrasing what the spouse says without rebuttal or argument. Most couples believe that communication depends on the clear articulation of what one thinks or feels, but we show how being a good listener is a much more difficult task than being a good speaker. Couples like speaker-listener exercises because it gives one person the floor without interruption and takes the pressure off the listener to have to argue or debate. However, listening is not an easy skill to learn, and initially couples struggle to repeat even the most benign statements. It is hard for them to let go of their own agendas or stifle the urge to offer advice or solutions. In the first portion of one exercise we ask couples to share a fantasy vacation idea with one another so that they can experience an early success with speaker-listener skills, but even this task proves difficult for many couples. For example, during one group, a wife turned to her husband and shared that she hoped they can take a vacation to Paris. After being asked to simply repeat what his wife had said, her husband commented, “You know I hate to fly!” Despite initial failures with reflective listening, with much diligent practice, couples do learn to better hear and eventually understand their spouse’s point of view.

The speaker-listener workshop leads directly into the working toward compromise workshop in which conflict resolution is viewed as negotiation rather than winning or losing. We make the distinction between compromise and sacrifice or submission. Compromise is a win-win proposition, and is predicated on the notion that we must accept people as they are. We introduce the idea that one cannot force change on one’s spouse (such attempts often produce the opposite of the desired effect). This theme is revisited again and again across workshops. The penultimate workshop on conflict focuses on recovery conversations since making peace after an argument is critical for reestablishing trust and learning from past communication mistakes. After learning how to recover from fights, we present a module on the perpetual nature of problems and reinforce again the idea that couples will always have conflict. Further, this module asks couples to begin to consider the underlying meaning and roots of their perpetual conflicts so that they can better understand each other’s perspective. Once couples are able to step outside their own deeply held beliefs, they can begin to better tolerate and become curious about their partners’ views. This workshop leads nicely into a workshop on “emotional wounds” in which couples try to develop a road map of their individual emotional vulnerabilities. As couples become aware of each other’ sensitivities, they are better able to tread lightly. The next workshop addresses how people should handle strong emotions, both in themselves and in others. We help couples learn to label emotions, teach self-soothing techniques (including a standard relaxation exercise) as well as offer advice on how to handle emotions in children (lessons that apply equally to adults). The next workshop is on sex and intimacy where we stress the significance of creating and maintaining closeness, including the importance of expressing appreciation and maintaining a respectful friendship. We believe that once conflict is contained and emotions well-controlled, there is an opportunity for promoting emotional closeness, and emphasize the value of sexual intimacy. The last official workshop is on commitment and honoring dreams in which we emphasize how commitment creates an atmosphere of trust and safety. By this time, ten or more weeks into the program, couples have invested an enormous amount of time and effort, indicative of their commitment to improving their relationships. This is followed by a graduation ceremony the next week where couples are “tested” on their relationship knowledge, reminisce about what happened over the preceding weeks, and receive graduation certificates.

Clinical Process

Couples with low income in our SHM program often arrive disillusioned about relationships and are struggling with a constellation of stressors including health problems, financial and employment problems, blended family concerns, and sometimes, legal issues. Many feel hopeless about their unstable marriages and do not have adequate skills for managing the inevitable ups and downs of close relationships. They may be genuinely at a loss as to how to keep their families together and likely have had few successful models in their communities. Many of our couples were raised in single-parent households where witnessing well-managed marital conflict was rare. Consequently, many of our couples lack basic skills for building and maintaining strong relationships, feel significant self-doubt, and lack the necessary confidence to try to do things differently. Many couples come in playing the blame game, pointing fingers at one another, escalating quickly and staying angry for days about who received a text from whom or who forgot to pick up the milk. Minor transgressions feel like deal breakers to many couples, and repeated harmful conflict contributes to a pattern of chronic marital instability. As a result, couples in our program tend to fight about absolutely anything, and many present with the hidden agenda of demonstrating their spouse’s deficiencies, while minimizing their own contributions to relationship turmoil.

Many couples come to SHM with distrust in one another and the relationship, holding secrets from one another, and often publicly criticizing one another in the group. They are simultaneously protecting themselves and attacking their spouse. Closeness, intimacy, and friendship are the foundation of a healthy, satisfying marriage, but it feels hard to stay or become close when couples feel so fragile, raw, and over-exposed. Often couples are easily embarrassed, hurt, and can be edgy or prickly, like a porcupine. We acknowledge to our couples that getting and staying close is a difficult thing to do, but that working towards it offers many rewards. As couples begin to feel more connected during the course of the groups, they begin to feel hopeful about the future.

We express to couples that in relationships characterized by distrust, it is only natural to want to turn away from our partners in order to protect ourselves. Informed by Sue Johnson’s Emotionally-Focused Couples Therapy approach (Johnson, 2004; Johnson, 2008), we see couples’ conflict as stemming from distressing emotional disconnection and conceptualize spouses’ attacks on one another as wishes for connection motivated by the desire to calm attachment fears. At the same time, we teach couples that this kind of self-protection in actuality deprives them of the emotional closeness they deeply desire. We focus on teaching couples the importance of becoming open to taking relationship risks. And concretely, we teach couples that in order to take risks each individual must play a role in making things safer. We encourage couples to keep their word, behave respectfully toward one another, and not “play dirty” so that the environment becomes increasingly safe for emotional disclosure. Many spouses want their partners’ to change before they make concessions of their own. However, we emphasize that this “tit-for-tat” mentality and score keeping only perpetuate the adversarial nature of the relationship. Instead, we encourage spouses to work together as a team and we reiterate to couples that continuing to work against one another will deprive them of emotional connection. Although couples attending our program often begin by feeling they have lost this sense of emotional connection forever, many of them emerge feeling re-connected and able to take at least some risks trusting one another again.

How do couples begin to feel safer and more able to trust? Initially we focus on the importance of safety, trust, and connectedness to all healthy relationships. We distinguish between personal safety (domestic violence and intimidation are wholly unacceptable), emotional safety (words do hurt and cause damage to relationships), and commitment safety (Can I count on you, and if so, for how long?) (see Stanley, Markman, & Whitton, 2002). Safety allows couples to trust, and is a precondition for opening up, feeling emotionally vulnerable, even dependent. We teach couples that dependency is not a bad thing; in human relationships, mutual dependency is a healthy aspiration. We are dependent from early infancy, and it is a fundamental aspect of human nature, not something we should run away from. Being dependent does not mean that we are not also self-sufficient or unable to take care of others; it merely means that we trust others enough to allow them to take care of us. Psychological theories which suggest that we should all take care of ourselves and emphasize independence only tell part of the story: the single greatest problem in romantic and marital relationships today is not that people are too dependent on one another; it is that people are afraid to trust and are afraid to become dependent on their spouse. We teach couples that when you take the leap to trust someone, it starts a virtuous cycle of good will because “believing is seeing.”

During group process discussions, couples learn that other couples have similar struggles, and they begin to feel revitalized to stay together. Learning that they are “not alone” is one of the benefits most frequently cited by couples attending our program. When couples are able to hear one another’s stories of unmet relationship expectations (e.g., he was late again!), they learn that they are not alone with their disappointment and that, even in healthy, happy relationships, there is conflict and frustration. For many couples, this is a revelation. Normalizing conflict and disappointment enables them to make more room for a broader perspective about relationships. Chiefly, they become aware that all couples struggle with managing conflict and getting their needs and desires attended to; this new perspective replaces their old belief that frequent fighting and unmet expectations are evidence of damaged or flawed relationships that cannot be salvaged.

Once bonded with other couples over similar struggles, couples begin to feel increasingly hopeful and can engage in relationship skill development with one another. Skills acquisition for conflict resolution is integral to all of our SHM groups. When couples use these skills to speak and listen well to one another, they build relationship safety. Further, by practicing skills in a group setting they learn that it is okay to try things differently and trust others (in the group and with one another). Further, when couples experience success using their new communication skills, they soften, feel more connected, and are able to make attempts to address conflict in more adaptive ways (e.g., making requests to share household tasks rather than making demands about how the house must be kept).

Couples frequently report to workshop leaders that they use the communication and problem solving skills learned at SHM with their spouses. Many couples also share that they use these listening skills with difficult supervisors at work, or are able to access and implement the skills when their child has had a difficult day. We see couples learn how to better communicate and find evidence that these skills generalize across contexts, contributing to reductions in relationship distress in ways couples could not have anticipated. Couples leave marriage education better prepared not only to manage marital conflict, but conflict of all kinds.

By attending our groups together, couples begin to redevelop the sense of emotional safety they had previously lost. We believe that simply attending and engaging in the marriage education program is itself beneficial. Few of these couples were able to spend that much time together under typical circumstances. As others have observed (Hawkins, Stanley, Blanchard, & Albright, in press), merely attending a marriage education activity demonstrates commitment to the relationship.

Couples clearly benefit from attending marriage education workshops. Husbands and wives may benefit because attending and engaging in workshop content shows their spouse they are invested in the relationship, that they can be relied upon, that they can be trusted with difficult emotions, and that they are safe enough to stay close and maintain commitment to the marriage. We include a vignette describing one of our couples to illustrate how the SHM program impacts couples. Although this is only one case example, they are typical of many of the couples we have seen over the past five years.

Susan and Thomas

Susan and Thomas, an African American couple in their late 40s, were invited to attend a program open house at the insistence of another couple who had completed the program a few years prior when they had been on the brink of divorce. During the open house event, Susan openly expressed doubt regarding the possibility for change in their 20-year marriage, whereas Thomas appeared guarded and withdrawn. Shortly thereafter, they attended an intake appointment where they complained of feeling “disconnected” during the past several years, to the point that they had considered separation a few years ago. They explained that Thomas worked two jobs to help put their three teenage children through college, leaving little time for them to spend together as a couple. Both spouses agreed that conflicts typically revolved around time spent together, intimacy or affection, and trust, with Susan wanting more closeness and intimacy and Thomas wanting some separateness and autonomy. They also described differences in their styles of communicating and managing conflict. Susan described herself as more “emotionally expressive,” and demanding or critical at times, while Thomas stated he relied more on “logic and reason” and was more apt to withdraw during periods of conflict. This pattern was certainly evident during their intake interview. In a misguided bid for connection, Susan openly expressed growing resentment toward her husband for choosing to spend rare moments of free time engaged in solitary hobbies and blamed him for creating “the ocean between us.” Rather than acknowledging or validating Susan’s feelings of loneliness, this prompted Thomas to defend his position and rationally explain how time alone helped him manage chronic stress, Furthermore, the interaction between Susan and Thomas was unbalanced, with Susan talking a great deal and Thomas disclosing far less during the interview. The more Susan expressed her anger, rather than her underlying hurt, disappointment, and fear, the more Thomas withdrew and remained silent, reinforcing Susan’s feelings of rejection and isolation. The couple agreed that improved communication and the rebuilding of trust and connection were their primary goals for the program.

Initially, Susan and Thomas benefited from the opportunity to spend dedicated time together every week. For Susan especially, the commitment to attend weekly workshops together in part satisfied her request for “more quality time together,” and helped her feel cared for and valued. During the first workshop, Staying Close, Susan spoke at length about the current lack of closeness in their relationship in the group discussion period; however, the “love map” exercise infused some positivity back into the relationship by encouraging them to reminisce about their past and demonstrate how well they knew each other. Both partners’ affect was markedly more positive at the conclusion of the first workshop, as compared to previous contacts with them, and it appeared that they very much enjoyed the opportunity to reconnect.

During the workshop covering the “four train wrecks,” each partner was able to identify the train wrecks they commit most often (for Susan, criticism/contempt, for Thomas defensiveness/stonewalling). This workshop also allowed them to develop a “take-a-break plan” for deescalating conflict as an alternative to stonewalling. This helped the couple to conceptualize Thomas’ tendency to withdraw during conflict as a means of protecting the relationship rather than avoiding or dismissing Susan’s concerns. In the following weeks, the couple practiced using “gentle start ups” to raise complaints without criticism (something Susan certainly benefited from) and they practiced speaker-listener skills. While both partners admitted to struggling with speaker–listener skills at first, as all couples do, the structured nature of the exercise allowed them to achieve a more balanced discussion so that both partners could share and feel heard. This also occurred within the context of group discussions across the workshop series. Susan was always very eager to share in the group, and the marriage educators had to simultaneously keep her from dominating group discussions, validate her experiences, and provide space and encouragement for Thomas to self-disclose as well (no easy task for even a seasoned clinician!). The couple experienced some difficulty during the compromise workshop, as many couples do, but in utilizing speaker-listener skills they were able to negotiate a “win-win” compromise around spending time together. In this compromise, Thomas agreed to go cycling every other weekend, rather than every weekend, for the following month so that he could free up more of his time to spend with Susan. In return, Susan agreed that she would allow Thomas to go on these stress-reducing outings without criticizing him when leaving or returning for neglecting to spend time with her. The following week they struggled to do an “instant replay” of a recent argument without re-engaging in the argument during the recovery conversations exercise; this presented the opportunity to practice their take a break plan to de-escalate harmful conflict. During the workshop covering intimacy, the couple who identified sex as one of several marital strengths at intake, enjoyed discussing new ways to increase sensuality and affection in their marriage.

The couple stated that the most meaningful workshops for them were healing emotional wounds, emotion coaching, and perpetual problems. Through group and couple discussions during these workshops, both partners shared how their family and cultural upbringings contributed to the expectations and sensitivities they each brought to the marriage, particularly Susan’s father’s absence and her need for closeness, and the impact of family and cultural norms around emotional expression and independence on Thomas, who was raised in the Caribbean. For Susan especially, drawing the connection between her childhood experiences with her father and ongoing conflict with her husband around closeness and intimacy felt like an “epiphany.” Both partners also identified with another couple in the group describing similar, and even more polarizing, conflicts around closeness versus distance. Hearing another woman express a point of view similar to Susan’s aided Thomas in better understanding his wife’s perspective and needs, as the message could be more easily received without any perceived judgment or criticism from a more neutral third party. Similarly, another younger husband in the group immigrated to the United States from the same island as Thomas, and they bonded over similarities in their upbringings and values. For Susan, hearing this young man’s stories helped her depersonalize her husband’s more limited emotional expression to some extent. Practicing foundational communication skills first allowed this couple and others in their cohort to feel more connected to one another and created a safe atmosphere for self-disclosure. As a result, discussion around these more sensitive, emotionally-laden topics could take place in the latter end of the core workshop series.

At graduation, both Susan and Thomas reported feeling stronger and more connected in their marriage, and they expressed a renewed sense of optimism for the future, balanced with some anxiety about being able to maintain gains without the weekly workshops. Susan stated, “I came here to fix him, but I actually learned a lot about myself.” Thomas expressed gratitude for now having “tools in the toolbox.”

One month after their graduation, the couple accepted our invitation to speak at an open house to share their experiences with new couples considering participation in the program. They reflected on their initial reluctance and cynicism they experienced only a few months prior, anticipating that new couples in the room were likely experiencing similar feelings. They shared how much they learned about themselves, reflecting on the importance of working on oneself rather than pushing your spouse to change, and stated that they now felt closer as a couple and spent more time together. They highlighted how much they valued hearing the experiences of other couples and knowing that they were not alone in their struggles. Lastly, the couple expressed gratitude for the opportunity to encourage other couples to attend the program that benefited them so much.

Conclusion

This vignette provides an example of the kind of impact brief marriage education groups can have on couples’ relationships, and it underscores the importance of clinically sophisticated case conceptualizations to the provision of these services. Clinicians direct group discussion in ways that enable couples to share their most intimate difficulties, and they offer one-on-one skills coaching to facilitate improvements in couples’ ability to successfully negotiate conflict. Couples feel heard by the clinicians leading their groups, and clinicians’ understanding of relationship complexities help couples believe in the possibility of positive change. Furthermore, clinicians understand that it is not the content of the marital conflict that matters, but rather the process in which the couple engages to address and manage it. In our experience, less clinically savvy facilitators are not as readily able to make this distinction, and as a result marriage groups may become men against women (or vice versa) gripe sessions about common marital problems or forums for offering unsolicited advice or solutions. Seasoned clinicians know when to push further and when to step back to provide perspective; this balance contributes to couples’ continued investment in attending and participating in group discussions. Couples who initially arrive reluctant to disclose personal matters to a group of strangers often remark that they were surprised by how “deep” the workshops became and by the bonds they developed with other couples over a short period of time. Indeed, our clinical staff was also surprised by how rewarding it has been to work with so many couples simultaneously rather than just a few couples very intensively. Over the course of the workshops, couples are moved to tears of joy at their successes and to tears of sadness at program graduation. These graduations closely resemble successful psychotherapeutic termination sessions, illustrating the meaningful impact marriage education, like psychotherapy, can make in the lives of those who engage in it.

Talented clinicians certainly have something special to offer marriage education, and marriage education also has much to offer clinicians and their clients. We encourage clinicians who work not only with couples, but also with individual adults or adolescents, to consider integrating marriage or relationship education into clinical practice. Many patients present to therapy with relationship issues, either primarily or in conjunction with emotional, behavioral, or health problems, and clinicians who are well versed in how to teach relationship skills and principles, either formally or informally, will also have “more tools in the toolbox” at their disposal. Furthermore, referral to marriage or relationship education workshops can augment one’s work in individual or couple therapy, as patients will return to therapy with a different perspective on their relationships. With the influx of federal funding for marriage education, there are now more service providers than ever before, and we encourage clinicians to become aware of resources in their communities; websites, such as http://www.twoofus.org and http://www.smartmarriages.com, offer convenient search functions by state and many states now have healthy marriage initiative websites as well. Finally, we encourage our fellow clinicians to enter the field of marriage and relationship education. As clinicians, we have found it professionally and personally fulfilling to know that we are reaching couples who might not feel comfortable seeking clinical services or who might have significant barriers to accessing them, and perhaps we serve as the first step toward securing the services they need. As marriage educators we have directly impacted the lives of not only thousands of couples, far more than we could ever serve in couples therapy, but also indirectly impacted their children, families, and communities, as the couples we have served share new skills and information with those around them and reap their benefits.