Marital Therapy May Not Help/Snoring - 4/05
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Tue Apr 19 11:08:58 EDT 2005
- MARRIED WITH PROBLEMS? THERAPY MAY NOT HELP
- SNORING CAN BE THE CAUSE OF DIVORCE
- MARRIED WITH PROBLEMS? THERAPY MAY NOT HELP
By SUSAN GILBERT
The New York Times Science Section
April 19, 2005
> But some experts who were trained as couples therapists have now become so
> disillusioned that they question the value of couples therapy in any form.
> They say that couples are better off taking marriage education courses -
> practical workshops that teach couples how to get along and that do not ask
> them to bare their souls or air their problems to a third party.
> Two large nationwide marriage education programs, Practical Application of
> Intimate Relationship Skills and the Prevention and Relationship Enhancement
> Program, offer such workshops. . . .
> . . . But even when a therapist loses hope in a couple's future, the couple
> may not give up. Many couples, determined to avoid becoming yet another
> divorce statistic, keep searching for new therapists or programs to help them
> stay together.
> After two rounds of couples therapy and one separation, Jim, of Boonton, and
> his wife, Valerie, decided to try Retrouvaille, a program of intensive weekend
> workshops and follow-up seminars affiliated with the Roman Catholic Church and
> geared to couples who are on the verge of divorce or separation.
> "There are talks on various subjects, like disillusionment, forgiveness and
> the sacrament of marriage, and then you write about them," Jim said. "The big
> focus is on feelings. You end up feeling what your partner feels."
> Another advantage for Jim is that Retrouvaille did not have the stigma of
> "Regular people get up and tell their stories about infidelity, overspending
> and other problems," he said. "There's comfort in numbers. It takes away some
> of the embarrassment and shame."
> Six years after their Retrouvaille weekend, Jim and Valerie now lead
> Retrouvaille sessions, symbols of hope to couples on the edge. But they still
> struggle with their own marriage.
Each year, hundreds of thousands of couples go into counseling in an effort
to save their troubled relationships.
But does marital therapy work? Not nearly as well as it should, researchers
say. Two years after ending counseling, studies find, 25 percent of couples
are worse off than they were when they started, and after four years, up to
38 percent are divorced.
Many of the counseling strategies used today, like teaching people to listen
and communicate better and to behave in more positive ways, can help couples
for up to a year, say social scientists who have analyzed the effectiveness
of different treatments. But they are insufficient to get couples through
the squalls of conflict that inevitably recur in the long term.
At the same time, experts say, many therapists lack the skills to work with
couples who are in serious trouble.
Unable to help angry couples get to the root of their conflict and forge a
resolution, these therapists do one of two things: they either let the
partners take turns talking week after week, with no end to the therapy in
sight, or they give up on the couple and, in effect, steer them to divorce.
"Couples therapy can do more harm than good when the therapist doesn't know
how to help a couple," said Dr. Susan M. Johnson, professor of psychology at
the University of Ottawa and director of the Ottawa Couple and Family
One couple, in Boonton, N.J., saw two marriage counselors over 13 years.
"One therapist hurt our marriage and actually a caused our separation," said
the husband, Jim, who did not want his last name used out of concerns for
"She told my wife, 'You don't have to put up with that,' " referring to his
battle with alcoholism, he said.
To be sure, many couples credit counseling with strengthening their
marriages. And therapists say that they could save more marriages if couples
started therapy before their relationships were in critical condition.
"Couples wait an average of six years of being unhappy with their
relationship before getting help," said Dr. John Gottman, emeritus professor
of psychology at the University of Washington and executive director of the
Relationship Research Institute in Seattle. "We help the very distressed
couples less than the moderately distressed couples."
In the last few years, efforts to find ways to save more marriages and other
long-term relationships have increased.
With an experimental approach called integrative behavioral couples therapy,
for example, 67 percent of couples significantly improved their
relationships for two years, according to a study reported in November to
the Association for the Advancement of Behavior Therapy.
Instead of teaching couples how to avoid or solve arguments, as traditional
counseling techniques do, the integrative therapy aims to make arguments
less hurtful by helping partners accept their differences. It is based on a
recent finding that it is not whether a couple fights but how they fight
that can destroy a relationship.
Especially encouraging, all of the couples in the study were at high risk of
divorce. "Many had been couples therapy failures," said Dr. Andrew
Christensen, a professor of clinical psychology at the University of
California, Los Angeles and the lead author of the study.
But some experts who were trained as couples therapists have now become so
disillusioned that they question the value of couples therapy in any form.
They say that couples are better off taking marriage education courses -
practical workshops that teach couples how to get along and that do not ask
them to bare their souls or air their problems to a third party.
Two large nationwide marriage education programs, Practical Application of
Intimate Relationship Skills and the Prevention and Relationship Enhancement
Program, offer such workshops.
"When I was a practicing therapist, I was like a judge listening to each
partner tell why the other was ruining the marriage," said Diane Sollee, a
former couples therapist who founded Smartmarriages, a clearinghouse of
marriage education programs. "There was a lot of crying. Marriage education
classes are more empowering."
Developed several decades ago mainly to prevent marital problems in
newlyweds or engaged couples, marriage education programs are now attracting
couples who have not been helped by couples therapy but who want to try one
last thing before deciding to divorce.
How effective these programs are is unclear.
Some studies indicate that couples who take marriage education classes have
a lower divorce rate than couples who do not take the classes.
But Dr. Gottman, who uses marriage education workshops and couples therapy,
has found that workshops alone are insufficient for 20 percent to 30 percent
of couples in his research. These couples have problems - like a history of
infidelity or depression - that can be addressed only in therapy, he said.
Couples therapy, also called marriage counseling and marriage therapy,
refers to a number of psychotherapy techniques that aim to help couples
understand and overcome conflicts in their relationship.
It is conducted by psychologists, psychiatrists and social workers, as well
as by marriage and family therapists.
Three types of couples therapy have been found to improve people's
satisfaction with their marriage for at least a year after the treatment
The oldest approach, developed more than 20 years ago but still widely used,
is behavioral marital therapy, in which partners learn to be nicer to each
other, communicate better and improve their conflict-resolution skills.
Another, called insight-oriented marital therapy, combines behavioral
therapy with techniques for understanding the power struggles, defense
mechanisms and other negative behaviors that cause strife in a relationship.
With each method, about half of couples improve initially, but many of them
relapse after a year.
A relatively new approach that studies have found highly effective is called
emotionally focused therapy, with 70 to 73 percent of couples reaching
recovery - the point where their satisfaction with their relationship is
within normal limits - for up to two years, the length of the studies.
Dr. Johnson, who helped develop emotionally focused therapy in the 1990's,
said that it enabled couples to identify and break free of the destructive
emotional cycles that they fell into.
"A classic one is that one person criticizes, the other withdraws," she
said. "The more I push, the more you withdraw. We talk about how both
partners are victims of these cycles."
As the partners reveal their feelings during these cycles, they build trust
and strengthen their connection to each other, she said.
Surprisingly, Dr. Johnson said, until emotionally focused therapy came
along, therapists were so intent on getting couples to make contracts to
change their behavior that they did not delve into the emotional
underpinnings of a relationship.
"It was like leaving chicken out of chicken soup," she said.
Dr. Johnson's latest research, completed in January, included 24 of the most
at-risk couples, people who were unable to reconcile because their trust in
each other had been shattered by extramarital affairs and other serious
injuries to their relationship.
"These injuries are like a torpedo," she said. "They take a marriage down."
The study found that after 8 to 12 sessions, a majority of the couples had
healed their injuries and rebuilt their trust.
Most important, these gains lasted for three years. "It's very satisfying to
know that we can make a difference with these couples and that it sticks,"
Dr. Johnson said.
Alice, a library program coordinator in Honesdale, Pa., credits her couples
therapy, which focused on emotional issues, with getting her and her husband
to reunite after a yearlong separation.
"The marriage counselor brought us back together," she said.
Alice, who did not want her last name used out of privacy concerns, said an
important catalyst for their reunion was the therapist's asking each to
think about the ways that the other person wanted to feel appreciated and
loved. Gradually, she said, she has come to see that her husband's needs
were different from her own.
"Going back to this exercise is one thing that has gotten us through hard
times," she said.
Researchers have begun to identify which qualities in a couple make for a
lasting relationship. The findings challenge some common assumptions - that
couples who fight a lot are beyond help, for example.
Over more than two decades of videotaping and analyzing the behavior of
happy and unhappy couples, Dr. Gottman has found that all couples fight and
that most fights are never resolved. What is different between happy and
unhappy couples is the way they fight.
The happy couples punctuate their arguments with positive interactions, he
said, like interjecting humor or smiling in fond recognition of a partner's
foibles. The unhappy couples have corrosive arguments, characterized by
criticism, defensiveness and other negative words and gestures.
Of course, even the happiest of couples can get nasty sometimes. But Dr.
Gottman has found that as long as the ratio of positive to negative
interactions remains at least five to one, the relationship is sturdy. When
the ratio dips below that, he says, he can predict with 94 percent accuracy
that a couple will divorce.
Dr. Gottman says that couples therapists can use this information to help
keep couples together. "You can't just teach a couple to avoid conflict," he
said. "You have to build friendship and intimacy into the relationship. If
you don't, the relationship gets crusty and mean."
But not all marriages are salvageable, therapists say. "Some people are
fundamentally mismatched, and they can't benefit from therapy," Dr. Gottman
Others - beyond the scope of couples therapy or marriage education programs
- are people with personality disorders and relationships marred by violence
"We have nothing to offer them," he said.
Couples therapy is designed to be relatively short term: 26 weeks or less.
"The vast majority of my patients do better after 5 to 10 sessions and are
satisfied. The cycle of blaming is interrupted," said Dr. John W. Jacobs, a
psychiatrist in New York and author of the 2004 book "All You Need Is Love
and Other Lies About Marriage."
But even when a therapist loses hope in a couple's future, the couple may
not give up. Many couples, determined to avoid becoming yet another divorce
statistic, keep searching for new therapists or programs to help them stay
After two rounds of couples therapy and one separation, Jim, of Boonton, and
his wife, Valerie, decided to try Retrouvaille, a program of intensive
weekend workshops and follow-up seminars affiliated with the Roman Catholic
Church and geared to couples who are on the verge of divorce or separation.
"There are talks on various subjects, like disillusionment, forgiveness and
the sacrament of marriage, and then you write about them," Jim said. "The
big focus is on feelings. You end up feeling what your partner feels."
Another advantage for Jim is that Retrouvaille did not have the stigma of
"Regular people get up and tell their stories about infidelity, overspending
and other problems," he said. "There's comfort in numbers. It takes away
some of the embarrassment and shame."
Six years after their Retrouvaille weekend, Jim and Valerie now lead
Retrouvaille sessions, symbols of hope to couples on the edge. But they
still struggle with their own marriage.
"We both realize that our marriage is something that needs to be worked on,"
Jim said. "But we're committed to staying together."
- SNORING CAN BE THE CAUSE OF DIVORCE
People who snore have sexual intercourse less often than others, says a
survey published today.
More than a quarter "hardly ever" have sex and 60 per cent are regularly
told to sleep in the spare room, says the report at the start of National
Stop Snoring Week.
The British Snoring & Sleep Apnoea Association study confirms many
widely-held assumptions and says the problem causes rows and can lead to
More than half of the couples questioned admitted that they had sexual
intercourse less than once a month and said they would do so more often if
the snoring stopped.
Marianne Davey, the co-founder of the association, said: "We have looked at
the clinical side of snoring like causes and the treatments but there is
very little written about the psycho-sexual effects of snoring."
Snoring can occur as a result of sleep apnoea, when the muscles of the
throat go floppy at night causing the airways to narrow and become blocked,
reports the Telegraph.
The couple are not alone - there are around 15 million snorers in the UK,
although the majority are men. Today is the start of National Stop Snoring
Week, which aims to draw attention to their plight.
A survey by the British Snoring and Sleep Apnoea Association today says 69
per cent of snorers in Scotland sleep in another room to their partners -
and 97 per cent say their relationship would be better if they stopped
Robert Royston, a clinical scientist at the Royal National Throat Nose & Ear
Hospital in London, says: "Snoring is often dismissed as a joke but it can
lead to the breakdown of relationships because partners cannot endure the
disturbed or sleepless nights caused by it."
Marianne Davey, co-founder of the British Snoring and Sleep Apnoea
Association, adds: "Snoring is defined as a coarse sound made by vibrations
of the soft palate and other tissue in the mouth, nose and throat - caused
by partial blockage of the upper airway. It is important to find out what
causes your snoring so you can choose the appropriate treatment."
Causes can include obesity, excessive drinking or allergies - but in seven
years Zoe has yet to find the source of her problem, tells the Scotsman.
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