HopeFocused Marital Therapy and Enrichment Everett L' Worthington, Jr' Virginia Commonwealth Univers

1
Hope-Focused Marital Therapy and
EnrichmentEverett L. Worthington, Jr.Virginia
Commonwealth University

• A workshop presented at Regent University on
  September 15, 2006, for training in Hope-focused
  Marital Therapy in preparation for (a) clinical
  trial and (b) standardized training. As a minor
  part of the workshop, I present a study. I
  acknowledge the following colleagues Jack W.
  Berry, David E. Canter, Connie Sharp, Mark
  Yarhouse (Regent University), Michael Scherer,
  Andrea J. Miller, and Joshua N. Hook (VCU). The
  study was supported by grant 239 from the John
  Templeton Foundation and a grant to the General
  Clinical Research Center at VCU 5M01
  RR000065-410535. And further by the John Fetzer
  Institute (2254.01 and 2266).

2
Workshop Goals

• Explore marriage research in most recent 7 years
• Review Hope-focused marriage counseling
• Look at two components HOPE FREE
• (HOPE is communication-based)
• (FREE is forgiveness-based)
• Compare these in a study of newly married couples
• Appendix General discussion of promoting
  forgiveness in couple therapy and in
  psychoeducational formats

3
Hope-focused Marital Therapy Communication and
Forgiveness
4
(No Transcript)
5
My approach to Marital Therapy

• Worthington, E. L., Jr. (1989). Marriage
  counseling A Christian approach to counseling
  couples. Downers Grove, IL InterVarsity Press.
• Worthington, E. L., Jr. (1999). Hope-focused
  marriage counseling. Downers Grove, IL
  InterVarsity Press.
• Worthington, E. L., Jr. (2005). Hope-focused
  marriage counseling, rev. ed. Downers Grove, IL
  InterVarsity Press.

6
A lot happened in research between 1998 and 2005

• Update on Literature on Marriage, 1998-2004
• 1. Marriage is usually beneficial (Linda Waite
  Maggie Gallagher).
• 2. Most bad marriages recover (Gallagher et al.
  , 2002).
• 3. Marriage, not just living monogamously, is
  good for people.
• 4. Seeing marriage as a covenant, not a
  contract, is good for making marriages last
  longer.

7
continued

• 5. The 5-to1 Gottman ratio aint as simple as it
  looks.
• 6. Couples positive and negative acts each seem
  to increase or decrease independently of each
  other. (They are related but not completely tied
  together.)
• 7. How people get to the 5-to-1 ratio is as
  important as the ratio.
• 8. Negative reciprocity is very important. (When
  negatives follow negatives, that is a bad sign
  for the marriage. It usually indicates that
  negative arousal is just below the surface.)
• 9. Positive reciprocity, unlike early theory, is
  important only in inoculating against problems.

8
continued

• 10. Being a bulldog about problems will often
  bite you in the end. (When people cant let go of
  an issue, it keeps both partners aroused.)
• 11. It really matters if you cool off after an
  argument. (Not letting the sun go down on your
  anger isnt just a proverb.)
• Kiecolt-Glaser et al. (2001)
• 10-yr study not just hot reactors ruminators we
  see also that bulldogs create people who stay
  upset
• 12. Whining accusations keep people mired in
  negative feelings.

9
continued

• 13. When conflict dramatically worsens, it
  indicates high negative arousal. (Most couples
  are pretty constant on the amount of conflict
  over the years.)
• 14. Negative thoughts and emotions are
  intertwined.
• 15. Stress increases negative emotionsits not
  all family systems.

10
continued

• 16. Personal issues are more important than we
  used to think they were.
• a. Marital goals. change emergent goals, react
  to get ever, protect self happy couples dont do
  what comes naturally for as long
• b. Agreeableness is good for marriage
  neuroticism (emotional reactivity) is not.
• c. Willingness to sacrifice (instead of battle
  for ones own way) is good
• d. Implicit theories (soul matework for
  stability)
• e. Covenant or contract
• f. Forgivingness (willingness to repair damaged
  emotional bonds across relationships)

11
A lot has happened between 1998-2005
Implications of the Review of the Literature

• Its not so much skills, communication, conflict
  resolution per se.
• Its ability to control and limit the negative
  emotional climate (and restore the positive
  emotional climate).
• Valuing, safety, security
• Hope
• Cutting short negative reciprocity
• Letting go of negative moods not ruminating
  healing ruptures in negative bonds by forgiving

12
continued

• Advances in Couple Therapy
• 1. CBT, IBT, EFT, Insight-oriented couple
  therapy These all emphasize the emotional bond
  rather than skills.
• 2. Many continue to be popular without research
  base Solution-focused Therapy, some family
  systems adaptations to couples.
• 3. Note the modifications have been away from
  skills, and toward managing negative emotional
  climate

13
Questions and Answers
14
Hope-focused Marriage Enrichment has been
designated as 1 of 4 ESTs (Empirically Supported
Treatments) for marriage enrichment

• Jakubowski, S. F., Milne, E. P., Brunner, H.,
  Miller, R. B. (2004). A review of empirically
  supported marital enrichment programs. Family
  Relations, 53, 528-536.
• It lists Hope-focused enrichment as one of four
  ESTs in marital enrichment PREP, Relationship
  Enhancement, Couple Communication Program, and
  Strategic Hope-focused Enrichment.

15
Hope-focused Marital Therapy

• Much use by practitioners (informal reports of
  effectiveness)
• Awaiting a clinical trial to provide evidence of
  efficacy

16
Hope-focused Marriage Enrichment

• Journal of Counseling Psychology, Worthington et
  al. (1997) showed that 5 hours of intervention
  produced effect sizes greater than 1 for some DVs
• What causes the power of the intervention?

17
Previous Component Research on Hope-focused
Marital Enrichment

• Hammond Worthington (1985), American Journal of
  Family Therapy, found leaders strongly guide
  couples attention to issues in groups
• Worthington, Buston, Hammonds (1989), Journal
  for Counseling and Development, found support of
  group members gt 3 hours of information about
  communication, conflict resolution, and
  information in psychoeducational groups
• Worthington et al. (1995), Journal of Counseling
  Psychology, found that assessment and feedback to
  individual couples account for about ¼ of the ES
  in marital enrichment

18
Summaries of Hope-Focused Marriage Therapy

• Hope-focused Marriage Counseling, rev ed. (2005,
  IVP) (includes research update since 1998)
• Worthington, E.L., Jr., Lerner, A., Sharp, C.
  (2005). Repairing the emotional bond versus
  skills training for marital intervention. Journal
  of Psychology and Christianity,24, 259-262.
• Worthington, E.L., Jr. (2003). Hope-focused
  marriage. Recommendations for researchers and
  church workers. Journal of Psychology and
  Theology, 31, 231-239.
• Worthington, E.L., Jr. (2002). Aconselhando
  Relacionamentos Relationship counseling.
  Aconselhamento O Jornal do Aconselhamento Crisao
  Evangelico no Brasil Brazilian Journal of
  Counseling, 1, 39-48. original article,
  translated into Portugese by Robson Gomes
• Worthington, E.L., Jr., Ripley, J.S. (2002).
  Christian marriage and marital counseling
  Promoting hope in lifelong commitments. In T.
  Clinton G. Ohlschlager (Eds.), Competent
  Christian counseling Practicing and pursuing
  compassionate soul care, Vol. 1 (pp. 455-474).
  Denver Waterbook Press.
• Worthington (1999). Hope-focused Marriage
  Counseling (IVP)
• Worthington, E. L., Jr. (1994). Marriage
  counseling A Christian approach. Journal of
  Psychology and Christianity, 13, 166-173.
• Worthington, E. L., Jr. (1991). Marriage
  counseling with Christian couples. In G. R.
  Collins (Ed.), Case studies in Christian
  counseling (pp. 72-97). Dallas Word.
• Worthington, E. L., Jr. (1990). Marriage
  counseling A Christian approach to counseling
  couples. Counseling and Values, 35, 3-15.

19
Hope-Focused Marital Therapy and Enrichment
Description of the intervention and techniques
for promoting change

• Hope Willpower Waypower Waitpower

20
Hope-Focused Marital Enrichment

• Strategy Promoting Love, Work, Faith

21
Hope-Focused Marital Enrichment

• Areas
• Central Vision, Core Values, Confession
  Forgiveness, Communication, Conflict Resolution,
  Cognition, Closeness, Commitment

22
Hope-Focused Marital Enrichment

• Interventions

23
Hope-Focused Marital Enrichment

• Preliminary assessment
• Report
• Worthington et al. (1995), Journal of Counseling
  Psychology, found that assessment and feedback to
  individual couples account for about ¼ of the ES
  in marital enrichment probably this is the most
  powerful single technique you could use in
  marital therapy.

24
Assessment Battery

• Marital Inventories
• Dyadic Adjustment Scale
• Commitment Inventory
• Intimacy thermometers
• Discussion of an issue they disagree about
  (communication, problem solving, conflict styles)
• Forgiveness
• Decisional Forgiveness Scale and Emotional
  Forgiveness Scale and single items
• Transgression-related Interpersonal Motivations
  Inventory (TRIM)
• Religion
• Religious Commitment Inventory-10

25
Questions and Answers
26
Hope-Focused Marital Therapy

• Communication
• STEPS (Situation, Thoughts, Emotions, Plans,
  Statement of Value) or more recently the
  Communication TANGO
• Listening
• Requests (Making, Refusing)

27
Communication/Conflict Resolution (Theoretical
Enrichment)

• What is good communication?
• Semantics of communication
• Syntax of communication
• Pragmatics of communication

Invest in good communication.
28
Exercise

• STEPS (Situation, Thoughts, Emotions, Plans,
  Statement of Value)
• Communication TANGO
• See Sherod Miller, who has a whole program that
  teaches this systematically, and has lots of
  empirical support.

29
Communication TANGO

• TTell what happened, directly and briefly
• AAffected me It affected me. (feelings)
• NNurture A nurturing, valuing statement
• GGet it? Reflect what you heard to make sure
  you understood
• OObserve how this conversation is
• affecting you both right now.

30
Hope-Focused Marital Therapy

• Conflict Resolution
• LListen and repeat
• OObserve your effects
• VValue your partner
• EEvaluate both partners interests

31
Hope-Focused Marital Therapy

• Closeness CLEAVE
• CChange actions to positive
• LLoving romance
• EEmploy a calendar
• AAdjust intimacy elsewhere
• VValue Your Partner
• EEnjoy yourselves sexually

32
Hope-Focused Marital Enrichment

• Closeness
• Use of Space

33
Closeness (Theoretical Enrichment)

• Attachment the formative experiences with an
  important caregiver or mentor that contribute to
  the formation of working internal models
• Working model of God
• Working model of self
• Working model of other

34
Closeness (Theoretical Enrichment)

• Robert Wuthnow (dwelling and seeking) David
  Schnarch (crucibles) LeRon Shults Steven J.
  Sandage (spiritual transformation)
• Dwell ? Intensification, Purgation (by
  habituation or boredom, external insult, internal
  crisis) ? Seeking or Questing (questions, crisis,
  anxiety, heat, explosive power, centrifugal
  forces, dark nights) ? disintegration or
  Transformation, cooling ? Dwelling

35
Hope-Focused Marital Enrichment

• Commitment
• Joshua Memorial
• Final Assessment
• Report

36
Commitment (Theoretical Enrichment)

• Contract or Covenant?
• For life or serial monogamy?

37
Questions and Answers
38
FREE Forgiveness and Reconciliation through
Experiencing Empathy

• REACH
• Bridge to Reconciliation

39
2003 Christian book
40
New (2006) secular book
41
Forgiveness (Theoretical Enrichment)

• Forgiveness and reconciliation are primarily
  about repairing the damage to the emotional bond
  caused by a history of transgressions at the
  hands of each other.
• Trauma damage that threatens physical existence
  leading to helplessness.
• When an attachment figure is not helpful (or is
  perceived as malevolent) during a time when a
  person is needy, an injury to the attachment
  system occurs.
• Marital problems, conflicts, and transgressions
  can traumatize, and if God isnt there or the
  partner isnt there, attachment bonds are
  strained or ruptured.

42
Forgiveness is one powerful way of healing the
wounds and scars of the trauma of experiencing
the partner (and God) as not there during need.
43
Injustice Gap

• Size of injustice gap is proportional to
  difficulty forgiving. Thus,
• Reduce injustice
• Apologize
• Offer Restitution

44
Decisional Forgiveness

• Make a decision
• It is beneficial to forgive physical, mental,
  relational, or spiritual health.
• Decisional forgiveness On the basis of Scripture
  or sacred writings or appeal to virtue, do you
  want to forgive?
• Can you give decisional forgiveness now?

45
Emotional Forgiveness

• Replacement of negative unforgiving emotions with
  positive other-oriented emotions, such as
  empathy, sympathy, compassion, and love. This is
  facilitated by other non-self-focused emotions,
  like hope, humility, and gratitude for having
  been forgiven.

46
Exercise

• Pair up
• Take turns explaining to each other why a person
  might forgive and yet still get angry about the
  incident later (after forgiveness has occurred).
• Share creative ways of explaining this with the
  big group.

47
Questions and Answers
48
Five Steps to REACH Emotional Forgiveness
49
FREE

• REACH
• R Recall the hurt
• Technique not victimization, not blame instead
  objective

50
FREE

• REACH
• E Empathize with the one who hurt you
• Techniques
• Letter from others point of view
• Talk about others experiences
• Empty chair
• Symbolizing the experience Yellow and dark heart
• Multiple repetitions with sympathy, compassion,
  altruistic (agape) love, romantic love

51
FREE

• REACH
• A Altruistic gift of forgiveness

52
FREE

• REACH
• C Commit to forgive
• Techniques certificate, letter, washing the
  hands of the transgression

53
FREE

• REACH
• H Hold onto forgiveness during doubts
• Technique hurt does not equal unforgiveness,
  white bears

54
Exercise

• Pair up
• Explain to each other the five steps

55
Questions and Answers
56
FREE

• Bridge to Reconciliation
• Plank 1 DecisionDecide whether, when, and how
  to reconcile

57
FREE

• Bridge to Reconciliation
• Plank 2 DiscussionSoft talk about forgiveness
  (Talking about Transgressions)
• Reproaches
• Accounts
• Denials
• Justifications
• Excuses
• Confessions

58
FREE

• Bridge to Reconciliation
• Confessions (CONFESS)
• C Confess without excuse
• O Offer apology (convey sincere regret and
  contrition)
• N Note his or her pain (empathically show that
  you understand the pain or anger you caused)
• F Forever Value (say that you value the person)
• E Equalize (Offer to make some restitution Is
  there anything I can do to make it up to you?)
• S Swear never again (Express intent not to harm
  similarly again)
• S Seek forgiveness
• (Give reasons to promote empathy)

59
Exercise

• Pair up
• Practice a good confession

60
FREE

• Bridge to Reconciliation
• Dealing with the confession
• Accept (grant forgiveness)
• Reject (withhold forgiveness)
• More time needed (not yet ready to grant
  forgiveness)
• What if one feels the reproach is inaccurate (you
  want to deny) or your behavior was justified?
• Ask, Can you explain what made you think this?
  Explanation
• I see why you think the way you do. Im really
  sorry that this occurred. I feel badly that Ive
  hurt your feelings. I did not mean for that to
  happen.
• I wonder if I might explain the way I was
  looking at the incident? Explanation

61
FREE

• Bridge to Reconciliation
• REACH Forgiveness
• Plank 3 DetoxifyReverse the Negative Cascade
• Criticism ? Defensiveness ? Contempt ?
  Stonewalling

62
FREE

• Bridge to Reconciliation
• Plank 3 (cont.) Deal with failures in
  trustworthiness
• Attitude of gratitude
• Attitude of latitude

63
FREE

• Bridge to Reconciliation
• Plank 4 DevotionPromote Love
• Techniques Love Bank (Harley), Increase the
  Gottman ratio (Gottman), Love languages (Chapman)

64
Questions and Answers
65
Study

• Does This Method Work?

66
Hope-focused Marital Enrichment Component
Analysis in the Current Study

• Hope-focused HOPE FREE
• HOPEHandling Our Problems Effectively
  (communication and conflict resolution
  components)
• FREEForgiveness and Reconciliation through
  Experiencing Empathy

67
Method
68
Design of StudyEarly Married Couples

• O HOPE O O
• O FREE O O
• O O O

69
Participants

• 156 Couples in their first 5 months of marriage
• 52 per group, matched by timing of the three
  testing times (Note analyses showed no
  differences initially on any variables in the
  study)
• Ages (18 to 62)
• Recruited from newspaper advertisements
• Paid 200 for completing assessment measures
  participants in intervention paid additional 100

70
Measures Reported Here

• DAS (used Marital Satisfaction item, 0-6)
• Positive Emotions about the spouse (19 bipolar
  adjectives rated 1, negative emotion, to 5
  positive emotion ex friendly to hostile)
• Forgiveness of most serious hurt (0-4)
• Single-item Forgiveness of index hurt (SIF 0-4)
• TRIM-R TRIM-A TRIM-Total (Index hurt)
• Conflict Tactics Scale (low scores better
  conflict tactics)

71
Other Measures Not Yet Analyzed

• Salivary Cortisol (baseline relaxing versus when
  imagining a typical relationship interaction)
• Videotape discussions of (a) a topic which you
  disagree about and (b) a pleasant topic
• Numerous self-report instruments at dispositional
  level (e.g., trait forgivingness), process level
  (ratings of communication, intimacy, etc.), and
  level of specific interactions (e.g., how deal
  with transgressions)

72
Procedure

• Couple phones in response to ad and is scheduled
  for and attends initial assessment
• Couple is assigned to condition randomly
• Couple attends either FREE or HOPE intervention
  or no treatment
• Couple assessed roughly at post-treatment, 1
  month post-treatment, 6 months post-treatment, 12
  months post-treatment

73
Change in Procedure after Study Begins

• In December 1999, about 14 months after the study
  began, VCUs IRB was shut down, compromising the
  original design of the study by interrupting for
  8 months all research (which played havoc with a
  longitudinal design)
• After resumption (July 2000), to keep from
  losing, almost our first entire round of
  participants, we switched to a yoking procedure
  (using the matching variable of time of test and
  using only three measurement times instead of
  five as planned)

74
Very Preliminary Results for Some Self-report
Variables

• Treatment x time (S) ANOVAs with repeated
  measures
• No main effects for Treatment or time are
  significant
• Following are interactions (Note the pattern is
  similar Control get worse HOPE gets better and
  then loses some FREE gets better continuously)

75
TRIM-Revenge, Index Hurt (plt.05)
76
TRIM-Avoidance, Index Hurt (pgt.10, ns)
77
Single-item Forgiveness of Index hurt (plt.05)
78
State Anger Scale, plt.01
79
How Forgiving Are You, in General, Toward Your
Spouse? (single item), plt.01
80
Forgiveness of Your Most Serious Hurt, plt.05
81
Current Positive Affect toward Your Spouse, 19
bipolar adjectives, plt.02
82
Marital Satisfaction, Single Item, plt.05
83
Discussion

• Forgiveness intervention (FREE) affected
  variables differently over time than did HOPE
• HOPE gave an initial boost to the marriage but
  some effect eroded
• FREE helped people not erode and perhaps improve,
  especially on forgiveness matters
• The implication is that together they should be
  complementary and lasting (which is what
  Worthington et al., 1997, showed)

84
(No Transcript)
85
Questions and Answers
86
Appendixes
87
General Discussion of Forgiveness in
Psychoeducational Formats
88
Ways I Have Done Psychoeducational Interventions
to Promote Forgiveness

• Psychoeducational groups for people recruited
  BECAUSE they want to forgive but have been
  unsuccessful doing so on their own (for specific
  hurt, like divorce, romantic betrayal, etc. or
  for specific group of people with common concerns
  (like parents) or for becoming a more forgiving
  person)
• Psychoeducation with couples (groups of couples
  did not work as well)

89
Ways I Have Done Psychoeducational Interventions
to Promote Forgiveness (cont.)

• Psychoeducational groups for people recruited
  because they want to deal with transgressions
  (even though they might not specifically want to
  forgive) like parents of children who have
  cancer, like groups in a school aimed at violence
  prevention like parents who were court ordered
  to attend groups because they abused or neglected
  their child or children

90
Obviously, it is better not to approach the
interventions in the same way. Not everyone will
value forgiveness.

• When groups contain some people who do not want
  to forgive and others who do, it is best to
  present a range of options for dealing with
  transgressions.
• These could include ways to deal with the present
  struggles (e.g., problem solving, communication,
  conflict resolution, emotional control
  strategies), the future (identifying goals,
  showing how present strategies are not likely to
  meet some important goals, planning other ways to
  meet ones goals), and the past (ways to deal
  with transgressions, such as forgiveness but also
  including acceptance, forbearing, seeking
  positive justice, re-storying, etc.)

91
Dose-Response Relationship between Time Spent
Trying to Forgive and Amount of Forgiveness
Experienced

• If an intervention (the second type) takes 5
  hours of school time, but only two hours are
  spent promoting forgiveness, the likely change is
  ES0.2, which requires lots of participants to
  detect.

92
Intervention Studies

• Target the group at specific targets (like
  forgiving a particular transgression, forgiving
  an index transgression, learning forgiving
  skills, becoming more forgiving as a person)
• Measure what you targeted the group at.
• Expect some generalization, but less
  generalization is found the further you stray
  from the specific target of the group
  intervention.

93
Guidance for Conducting Psychoeducational Group
Interventions

• Several facilitators, each conducting one each of
  the comparison groups
• About 6 to 16 per group (even number of people is
  better)
• Have people know exactly what the group is
  targeted at BEFORE they begin the group
• Have them select a target transgression that
  they will talk about within the group.
• Screen out obvious trauma (but you want people to
  deal with substantial yet not debilitating hurts)

94
Guidance for Conducting Psychoeducational Group
Interventions (cont.)

• You must have a manual for group facilitators
• It is ideal to have a manual for participants,
  which contains the exercises.
• Groups should be run in parallel with their
  comparisons or counter-balanced.