الفهرس 
Overview of Marital TherapyOnly 14 pages are availabe for public view
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Abstract
Couple therapy, traditionally referred to as ”marital therapy” (or, before that, as ”marriage counseling”, refers to a varied set of interventions, techniques, methods, strategies, and perspectives intended to help intimate relationship partners reduce important (and usually recurrent) aspects of relationship distress and enhance relationship satisfaction. Usually, but not always, provided to partners in conjoint meeting.
Marital therapy is important for many reasons such as: the alarmingly high rates of divorce and the increase of incidents of delinquency among juveniles. Also, significant cultural changes in last half-century have had an enormous impact on marriage, and expectations and experiences of those who marry. More liberal attitudes about sexual expression and the growth of economic and political power of women have all increased the expectations and requirements of marriage to go well beyond maintaining economic viability and ensuring procreation. And the transformations of marital expectations have led the ”shift from death to divorce” as the primary terminator of marriage whether through actual divorce or chronic conflict and distress, the breakdown of marital relationships exacts enormous costs and are associated with wide variety of problems in both adults and children.
The history of marital therapy indicates that, marriage counseling movement occurred largely outside the mental health field. It was initiated by clergy, lawyers, physicians, social workers and educators. Marriage counseling, in these early days of the movement, was a part-time endeavor. It wasn’t until the early 1930s that the first marriage counseling centers were established with professionals devoting full time attention to providing marriage counseling. Throughout the 1960s and 1970s, the marriage counselors, or couples therapists, were basically absorbed within the field of family therapy. By the mid-1980s, couple therapy began to re-emerge with an identity rather different from that of family therapy.
There are different types of marital therapy as: Individual Therapy, Individual Couples Therapy, Conjoint Therapy, Four-Way Session, Group Psychotherapy and Combined Therapy.
There are different classifications of the schools of couples therapy such as: traditional behavioral couple therapy, cognitive behavioral couple therapy, and emotion focused couple therapy. In addition, strategic couple therapy, insight-oriented couple therapy, and integrative couple therapy. All have some evidence of efficacy in management of marital discord. But it is difficult for therapists to become proficient in many therapy models. There is a risk of becoming superficial, facile, and inconsistent. Therapeutic tools from different schools may be useful, but a skilled couples therapists is likely to use one or two conceptual frameworks to guide his or her treatment. Clinicians have to decide for themselves which approach fits best with their worldview, personality style, and therapeutic capabilities and it is useful to have some conceptual understanding of these schools.
These empirically supported couple therapies help many distressed couples and another show a reliable increase in relationship satisfaction but still report some relationship distress after couple therapy. But also leave a substantial minority of couples who show no benefit, or actually get worse across the course of couple therapy.
CBMT is a relatively new development in couple therapy, emerging in early 1980s, although its precursors all have longer histories. CBMT clinical assessment and intervention strategies have adopted major components of both BCT and CT. The theoretical and empirical foundations of CBMT lead to its rapid growth and successful applications in practice.
Behavior, cognition, and emotions play roles in determining couples’ levels of marital satisfaction or distress, and consequently they play roles in the treatment of marital problems. Social learning and social exchange models of close relationships provide important concepts for understanding how the behaviors of two spouses are intertwined. Research results have demonstrated that processes such as negative reciprocity and conflict escalation differentiate distressed from non-distressed couples. These finding can serve as guidelines for the clinical assessment and treatment of dysfunctional marriages.
Clinical and research finding regarding distorted and inappropriate perceptions, attributions, expectancies, assumptions, and standards demonstrate how people commonly make particular types of errors in processing the information available to them, and these do not constitute pathological processes, but most often represent poor use of human information-processing capacities. The cognitive assessment and intervention procedures are intended to identify and alter clients’ information-processing errors and limitations that seem to be due to at least in part to underdevelopment and underutilization of cognitive skills.
Affect is a factor of considerable importance in a cognitive-behavioral approach to marital problems. One can’t alter spouses’ cognitions or behaviors without having some impact on the emotional quality of the relationship. Therapists need to assess aspects of affect in a couple and apply interventions carefully designed to have a positive impact on the interplay of affect, cognition, and behavior in the relationship.
The one aspect about the cognitive behavioral approach that differs radically from many of the other current modalities for couples’ therapy involves the specific use of assessment tools, in the form of questionnaires and inventories. There is a basic premise that assessment is necessary in order to plan appropriate interventions, and that assessment is an ongoing process during the course of treatment.
The instruments are typically used after the initial conjoint interview which consists mostly of history taking and time for the therapist to develop an initial impression of how the partners interact with each other. During the initial conjoint interview the therapist gains an understanding of how each of spouses view their problem in the relationship differently and the specific attributions that they make with regard to their conflict. Then the therapist presents a formulation of the couple’s strengths and weaknesses, problems, the proposed treatment plan, and any concerns about the couple’s ability to work on their relationship in the therapy
In fact, the presence of differences between the spouses is a normal finding, but the problem is how to deal with these differences. So cognitive-behavioral interventions for couples were designed to enhance partners’ skills for evaluating and modifying their own problematic cognitions by: teaching couples the cognitive models, identifying automatic thoughts, introducing the concepts of cognitive distortions, strategies for challenging dysfunctional cognitions and introducing the concepts of distorted and inappropriate perceptions, attributions, expectancies, assumptions, and standards. Also, behavioral interventions include: behavioral change agreements, skills for communicating and solving problems constructively.
Our approach to alter emotions is based on cognitive and behavioral interventions. A wide range of treatment strategies is available, and the particular intervention chosen depends on the specific goals that the therapist has in mind. Such as, (1) Labeling and understanding emotions, (2) emotional expressiveness training and (3) Dealing with dysfunctional emotions (as anger, depression, jealousy and anxiety).
In CBMT, the therapist should deal with the couples’ sexual relation because sexuality is not a lifestyle issue; it is a quality of life issue. The psychiatrist’s goal is to maintain, restore, or improve a patient’s quality of life, and sexual function should be a routine part of that clinical service mandate. Specific details of a couple’s sexual encounters, including thoughts, behaviors, and feeling, help to clarify areas of distraction, inhibition, or impairment, as well as areas for potential growth or recovery.
There is some evidence to support the efficacy of cognitive behavioral treatment of some sexual dysfunctions as hypoactive sexual desire disorder, erectile dysfunction, premature ejaculation, dyspareunia, vaginismus and Paraphilias. A mainstay of this approach is a focus on modifying dysfunctional attitudes and thoughts about sexual behavior. Another technique involves identifying distractions during sexual stimulation and then removing these distractions and the combination of cognitive behavioral pain management and sex therapy. While thought substitution, redirection, and distractions are taught as ways to replace maladaptive thoughts and redirect thinking toward more healthy topics for Paraphilias.
CBMT is a well structured process with specific details in its outlines such as: indications, contraindications, assessment, goal setting, development of overall treatment plan, number of sessions, structure of each session, use of homework assignment, sequencing intervention strategies, role of the therapist, out-of-sessions contacts with members of the couples, contact with only one spouse, CBMT applicability and role of prevention, new means of delivering care, sources of difficulty in the therapeutic change, therapeutic alliance in special situations, termination, preventing relapse, poor outcome and success of therapy.
All reviews of studies outcome reach the same conclusion: CBMT is an efficacious intervention for distressed couples. But brief CBMT improvements are not maintained for many couples over a number of years, although some couples maintain and even improve upon their gains. And these studies outcome are consistent with the outcome in our country.
So, despite the need to be cautious about treatment gain using any approach, it is important to note that over (at least) the past 15 years, cognitive behavioral marital therapy has consistently been found to be as or more effective than any other type of marital therapy.
At last, CBMT does not ensure the maintenance of any marriage or relationship. In these cases, couples may continue to meet with therapists to work through the difficulties of separating and obtaining a divorce, a process that has been called divorce therapy.