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ELSEVIER Behavior Therapy 43 (2012) 88-98
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Common Factors in the Enhancement of Dyadic Coping

Guy Bodenmann
University of Zurich

Ashley K. Randall
University of Arizona

Heavey, 19,99), and even more, 46-56% of couples

Stress and coping are important constructs in understanding
the dynamics of close relationships. Couple therapy and
marital distress prevention approaches have become in­
creasingly focused on these variables to gain knowledge of
how stress and coping may impact the quality and stability
of close relationships. In this paper, we outline couple's
coping enhancement training (CCET) and the coping­
oriented couple's therapy (COCf); both, couple interven­
tions derived from stress and coping research. We address
specific features of each approach and report data on their
efficacy and effectiveness. We also examine both the
common and specific factors that may play a role in the
effectiveness of these approaches.
Keywords: dyadic coping; couple therapy; commo11 factors; stress;
coping
THE EFFICACY OF COUPLE therapy techniques has
been well documented including substantial mean
effect sizes (Dunn & Schwebel, 1995; Shadish &
Baldwin, 2005) that demonstrate the effectiveness in
relieving couple distress, d= .74-.95 (Shadish et al.,
1993) and d=.50-1.30 (Shadish & Baldwin, 2003).
Prior research has shown that approximately 70% of
couples seeking evidence-based couple therapy report
improvement after treatment (Baucom, Shoham,
Mueser, Daiuto, & Stickle, 1998; Christensen &
Address correspondence to Ashley K. Randall, University of
Ari:t0na, Family Studies & Human Development, 6S0 Park Ave N,
Tucson, AZ 8S721; e-ll\llil: akrandal@enmil.arizona.edu.
OOOS-7f941xxlxxx•xxx/$1.00IO
C 2011 APOC:i.tion for Behavioral 11nd Cognitive Thtl'Q.piCI, Publithct! by
Elscvlt,r Ltd. Al! .rights ttServed.
show a significant improvement at a 5-year follow-up
(Christensen, Atkins, Baucom, & Yi, 2010). Although
the short-term effectiveness of couple therapy has been
well documented, there are conflicting results about its
long-term effects. Indeed, although effect sizes remain
more or less stable in pre- and posttest follow-ups with
regard to appropriate behaviors (d= .52 to .75 within
2 years), effect sizes dropped regarding positive
cognitive changes (d =.08 to .18) and were not
observable for changes in emotions (Heekerens,
2002). Additionally, in only 50% of treated couples
did both partners experience a significant improve­
ment of relationship quality, whereas 3�0% of
remitted couples show deterioration after 2 years or
longer posttermination of therapy (Snyder, Castellani,
& Whisman, 2006). As a result, couple therapy
researchers continue to try to improve outcomes of
couple therapy by proposing new techniques, adapt­
ing and refining existing methods, and suggesting new
integrative approaches (Christensen, 2010; Snyder &
Gasbarrini, 2010).
Stress and coping research on couples has
provided new insights regarding couples' function­
ing, as well as evidence for new therapeutic
approaches. Such research has examined the effects
of daily stress on dyadic interaction, relationship
satisfaction, and the likelihood for divorce (see
Randall & Bodenmann, 2009, for a review). As a
result, new treatments such as couple's coping
enhancement training (CCET) and coping-oriented
couple's therapy (COCT) have been developed.
Despite the development of these novel therapeutic
techniques, empirical evidence suggests that factors
common across therapeutic interventions are more
 COMMON FACTORS IN DYADIC COPING
powerful than approach-specific techniques; thus,
we ask, are new methods and approaches needed
(Christensen et al., 2010; Messer & Wampold,
2006}? In this paper, we examine the important
insights stress and coping research may have on
couple intervention techniques as well as the impact
coping-oriented techniques may have on the ongo­
ing improvement of therapeutic outcomes for
couples. We also discuss how these techniques
may be Jinked to common factors found in other
therapeutic interventions, and further, address
specific factors unique to these new and novel
approaches.
Integrating Findings of Stress Research in
Couple Interventions
Since the 1990s research on stress and coping in
couples has received growing attention in the
literature with findings suggesting significance regard­
ing the development of therapeutic interventions.
Specifically, research has indicated that chronic minor
external stress, defined as daily hassles due to factors
outside the relationship (e.g., stress at work}, can spill
over in the relationship, thus causing less time for each
other (lowered feeling of we-ness} and more negative
interactions between partners (hostility, withdrawal;
see Randall & Bodenmann, 2009, for a review}.
Further, such repeated tensions and conflicts may lead
to alienation and dissatisfaction within the relation­
ship, and may ultimately increase the likelihood for
divorce (Bodenmann, 2000; Bodenmann, Meuwly,
Bradbury, Gmelch, & Ledermann, 2010; Karney,
Story, & Bradbury, 2005; Neff & Karney, 2004;
Schulz, Cowan, Cowan, & Brennan, 2004).
The ways in which couples cope together with
stress (dyadic coping) is an important predictor of
relationship functioning and stability (Bodenmann,
Pihet, & Kayser, 2006; Papp & Witt, 2010). From a
dyadic coping approach, the impact of the stressor
. and coping process is regarded as a circular
sequence in which partner A's communication of
stress is perceived, decoded and evaluated by
partner B, who responds with supportive dyadic
coping reactions. Dyadic coping is aimed at
restoring or maintaining both partners' individual
well-being by reducing the partners' levels of stress
and by promoting couple functioning through
reciprocal trust, mutual closeness, and intimacy
(Cutrona & Gardner, 2006). Although dyadic
coping has some theoretical overlap with social
support in couples, dyadic coping is more broadly
defined in that it includes comn,on dyadic coping,
whereby both partners arc involved in joint coping
efforts (for a detailed comparison see Bodenm.ann,
2005), and focuses on how stressors can have direct
impactS on both partners (e.g., birth of a child or
89
daily hassles concerning both partners at the same
time).
Based on dyadic coping research, two therapeutic
elements in coping-oriented couple interventions
have been proposed: (a) psychoeducation, teaching
couples how external daily stress impinges on the
couple's life and how they can protect the '\
relationship against the negative impact of stress,
and (b) training couples how to cope together
effectively with stressful encounters by means of
the 3-phase method aiming to enhance dyadic
coping and mutual understanding of each other's
functioning (Bodenmann, 2007, 2010). Psycho­
education aims to help couples become aware of
and identify the influence external minor stressors
(e.g., having a bad day at work, annoyance with
neighbors) can have on their lives. Additionally it can
teach couples how chronic daily stress may slowly
"erode" their relationship, which is most often
unnoticed (Bodenmann e� al., 2007). In psychoedu­
cation, partners also learn about how external minor
stressors can trigger personal vulnerabilities and
increases unpleasant partner behavior such as
rigidity, dominance, stubbornness, anxiety, or inse­
curity. These are traits that may be less obvious in
normal or relaxed life conditions, but can be
exacerbated under stressful times. Once such behav­
iors become "activated" in a stress response, these
behaviors and attitudes may be perceived as annoy­
ing and bothersome, disturb dyadic interactions, and
increase dissatisfaction in the other partner. Taken
together, the psychoeducation component, based on
stress and coping research, has two major goals:
(a) to explain to couples how external minor chronic
stress impacts their relationship and increases their
likelihood for arguments, alienation, and dissatisfac­
tion, and how individual and dyadic coping can
buffer this negative effect (Brock & Lawrence, 2008);
and (b) to explain to couples how partners may
differentially react to stress, based on individual
factors such as personality, in an attempt to increase
mutual understanding and acceptance.
Methods of the Coping-Oriented Couple
Interventions
Based on current stress and coping research in couples,
both the CCET (Bodenmann & Shantinath, 2004)
and the COCT (Bodenmann, 201O; Bodenmann et al.,
2008) use classical elements of behavioral and
cognitive behavioral couple therapy such as behav­
ioral exchange techniques (enhancement of positive
reciprocity), communication and problem-solving
training, and cognitive interventions (Baucom,
Epstein, La Taillade, & Kirby, 2008). In addition
to these traditional elements, a specific focus of
coping-oriented interventions is on teaching
90 BODENMANN & RANDALL

couples about how �o deal with the impact of
external minor stress and on how to enhance
dyadic coping. One of the key components of the
coping-oriented approach is the 3-phase method
(Bodenmann, 2007), in which both partners learn
to tell one another about their stressful experi­
ences (first outside the close relationship and later
on in the therapy also related to the partner) and
how to provide dyadic coping. In the first phase,
the therapist facilitates deepened stress-related self­
disclosure in one partner (speaker) and deepened
understanding and empathy in the other partner
(listener). In the second phase, the listening partner
is invited to support the stressed partner mostly on
an emotional level by expressing understanding
and empathy, encouraging the partner, helping him
or her to reframe the situation, and supporting his
or her own adequate coping efforts. In the third
phase, the supported partner provides feedback
about how helpful, effective, and satisfying the
support provision of the partner was experienced
(see Table 1).
Based on the concept of schemata (Beck, Rush,
Shaw, & Emery, 1979), partners learn that external
daily hassles are most often not the actual cause for
continuing stress experience. Rather, daily hassles
may activate personal schemata, which, in tum,
may cause high-stress response. Stress-related
schemas often endure several hours or days and
easily spills over to the intimate relationship. The
3-phase method attempts to promote partner's
awareness of these personally important schemata
(e.g., "I feel only well when I have complete control
over my environment," "J am only okay when I
deliver a great performance," "I am only appreciated
when I am perfect," "I am only valuable when I am
beloved.") by exploring emotions, thoughts, and
physiological reactions that emerge when recalJing
stressful situations. It is important to note that the
3-phase method is only applied when a sufficient
level of mutual positivity, respec. t, and commitment '\
between partners has been reinstalled (usually done
by the enhancement of positive reciprocity and
communication training in highly distressed couples).
Thus, this method is usually applied in a later phase
of couple therapy. In the CCET, where the 3-phase
method is a key element, the trainers are aware of this
problem and regulate the depth of self-disclosure very
cautiously.
THERAPIST'S ROLE
First, the therapist supervises the appropriate
application of the ·speaker and listener rules.
Second, the therapist helps guide both partners in
schemata exploration .for the speaker and allows
the speaker to dive deeper into his or her emotions
by asking open-ended questions such as "How did
you feel?" "What happened to you?" "What did this
mean to you?" "Why was this so stressful?" and
"Why did you fed sad?" Third, the therapist offers a
clear structure with regard to the duration of the
exercise (rimeframe), roles of both partners (speaker
and listener), and setting (dyadic setting where both
partners are sitting in front of each other, allowing
best practice of active listening). During the entire
exercise, the therapist is always coaching both
partners, who are sitting face to face, simultaneously
(che speaker as well as the listener), by joining both

Table 1
The 3-Phase Method
First Phase(30 minutes) Second Phase(1 O minutes) Third Phase(S minutes)
Emotional stress exploration by Provision of dyadic coping by Partner B Feedback from Partner A received by
Partner A Partner 8

• Partner A tells Partner B about a
stressful experience that happened
outside the close relationship (i.e.,
external stress).
• Partner A uses three guidelines:
(a) describes the concrete aspects of
the situation, (b) focuses on emotions
and cognitions felt in the situation, and
(c) seeks lo understand why the
situation was so stressful (schema).
• During this phase, Partner Bis the
listener and applies the following three
rules: (a)active listening, (b)summatizing
important issues of Partner A, and
(c) asking open-ended questions.
• Partner B is invited to support the
partner on the level of emotional
engagement.
• This phase consists of two elements:
(a) emotional support in the form of
empathy, understanding, and reframing
are offered; and (b) when appropriate,
this is followed by practical instrumental
support.
• Partner A tells Partner 8: How satisfied
he or she was with the dyadic coping;
how helpful this support was.
• What else he or she would have
needed to feel better and to cope
more effectively with the stressful
situation.
 COMMON FACTORS IN DYADIC COPING
partners with gaze and verbal reinforcement, or by
prompting both partners in their specific roles. For
the speaker, the therapist prompts him or her to
emotionally self-disclose with regard to personal
schemata triggered by the stress situation by asking
open-ended questions and reinforcing stress commu­
nication. For the listener, the therapist asks him or her
from time to rime to summarize when important
elements of self-exploration were presented by the
speaker, to emotionally connect (first phase of the
3-:Phase method), and to adequately support in the
second phase. All this is done with a smooth and
warm voice in order to make both partners feel
accepted and supported.
EMPIRICAL EVIDENCE FOR
COPING-ORIENTED COUPLE APPROACH
Several randomized controlled trials comparing
coping-oriented couple interventions with waiting
list control groups have shown that coping-oriented
couple interventions (CCET, COCT) yield favorable
relationship outcomes, such as higher relationship
satisfaction, intimacy, positive communication, and
more frequent dyadic coping, with mean effect sizes of
d=.36 (post), d:.32 (follow-up after 6 months), and
d=.44 (after a 1-year follow-up; Bodenmann,
Pihet, Cina, Widmer, & Shantinath, 2006; Randall,
Bodenmann, Molgora, & Margola, 2010). Addition­
ally, research has shown couples' engaging in coping­
oriented interventions report better psychological
well-being (Pihet, Bodenmann, Cina, Widmer, &
Shantinath, 2007) and reduced depressive symptom­
atology (d=-1.3 in a trial comparing COCT with
cognitive behavioral therapy [CBT] and interpersonal
therapy [IPT]; Bodenmann et al., 2008). Currently,
there are two ongoing randomized controlled studies
involving 300 and 200 couples, respectively.
Another study evaluated changes in dyadic
coping and communication behavior after parricipat-
. ing in CCET. Results showed both women and
men reported greater improvement in positive
dyadic coping and higher satisfaction within 2 years
(Bodenmann, Bradbury, & Pihet, 2009). Posttreat­
ment satisfaction levels also increased to the extent
partners made greater changes in dyadic coping
(increase in positive dyadic coping for women and
men, decrease in negative dyadic coping only in
women). Interestingly, post hoc comparisons revealed
a marginally stronger effect for the changes in dyadic
coping than in communication behavior. In general,
results of this study support previous findings on the
positive long-term effects of couple distress prevention
programs (Baucom, Hahlweg, Atkins, Engl, &
Thurmaier, 2006; Halford & Wilson, 2009), and
showed that enhancement of dyadic coping signifi­
cantly contributes to positive long-term outcomes.
91
Mechanisms in the 3-Phase Method
Two studies have been conducted on mechanisms
of change due to the 3-phase method. Schiir, Ditzen,
Heinrichs, and Bodenmann (2007) examined
changes in self-perceived stress emotions and
heart rate during the 3-phase method in a sample
of 18 couples. The results supponed the assumption '\
that during Phase 1 (funnel method with stress­
related emotional self-disclosure), emotional expe­
riences became more intense and emotions such as
sadness, helplessness, loneliness, resignation, and
worthlessness were elicited more frequently by the
speaker. These emotions were paired with an
increased heart rate. As hypothesized, in Phase 2
(provision of supportive dyadic coping by the
partner) the speaker showed an increase in positive
emotions, such as relief and joy, while bis or her
heart rate decreased.
The effectiveness of the 3-phase method was
demonstrated by Schar (2010) using self-report and
cortisol measures in a study involving 70 couples
randomly assigned to three groups: (a) a group
engaged in the 3-phase method, (b) a group received
self-administered intranasal oxytocin, and (c) a
placebo group. The goal of this double-blind
controlled study was to examine effects of the 3-
pbase method (enhancing closeness and intimacy)
on subsequent conflict discussion, which was
videotaped and micro-analytically coded (SPAFF­
coding). As expected, the 3-phase method showed a
positive effect on observed communication (more
interest, less criticism) and had a similar effect to the
oxytocin group. Both groups outperformed the
placebo control group; however, couples who had
engaged in the 3-phase method prior to the conflict
discussion showed a lower intercept of cortisol
(especially in men) at the beginning of the conflict
discussion, in contrast to both other groups (oxytocin
and placebo), indicating a lower stress level prior to
conflict discussion. Furthermore, both men and
women who engaged in the 3-phase method showed
a significant decrease in cortisol during the conflict
(Schar, 2010).
Common Factors in Couple Interventions
Since the 1970s researchers and clinicians have
been questioning what leads to positive outcomes
for psychotherapies (Garfield, 1973). Is the empha­
sis on the basic or specific characteristics of each
therapeutic approach that accounts for these out­
comes (Christensen, 20-10)? Nowadays, many
psychotherapy researchers share the assumption
that common factors and unitiersal processes play
more important roles in explaining psychotherapy
outcomes, rather than specific techniques of differ­
ent evidence-based approaches. The effect size of
92 BODENMANN &: RANDALL
specific factors of evidence-based treatments for
couples is marginal (d= .02; Luborsky et al., 2002).
Although Chambless (2002) states that these
findings do not contradict the suitability of specific
treatments for a specific population/disorder, em­
pirical evidence for general mechanisms is visible in
different approaches. Indeed, Imel and Wampold
(2008) presume that 30 to 70% of treatment
outcomes are due to common factors. Although
different authors propose somewhat different com­
mon factors, most converge considerably.
Common factors are defined as variables that are
associated with positive clinical outcomes that are
not specific to any approach but are shared by several
or all approaches (Sprenkle, Davis, & Lebow 2009).
Christensen (2010) suggests five principles that
various evidence-based couple interventions share:
(a) a dyadic, rather than an individual orientation of
problems; (b) modification of emotion-driven dys­
functional behaviors by teaching partners construc­
tive ways to deal with differences, problems, and
emotions; (c) making both partners aware of
avoided, emotion-based, private behaviors of each
other, and making these internal experiences acces­
sible to each other; (d) enhancement of constructive
communication in speaking and listening; and (e)
emphasis on strengths and positive behaviors.
Sprenkle and Blow (2004) also noted five common
factors among all theories of therapy: (a) the client,
(b) therapist effects, (c) the therapeutic relationship,
(d) expectancy/placebo, and (e) nonspecific treat­
ment variables. The authors offered an additional
three factors that they recognized as common among
marital and family therapies: (a) relational concep­
tualization, (b) the expanded direct treatment system,
and (c) the expanded therapeutic alliance. Recently,
Sprenkle et al. (2009) addressed the importance of
common factors in couple therapy to include the
expanded relationship system, the generation of new
hope in the context of demoralization, a systemic
viewpoint, adapting to client stage �f change, and
intervention strategies that work with emotion,
cognition, and behavior. In addition, the authors
suggest two other important common factors as the
"allegiance effects and the organization or coherence
of the model employed" and "disrupting dysfunc­
tional relational patterns" (p. 32).
COMMON FACTORS IN COPING-ORIENTED
COUPLE INTERVENTIONS
Coping-oriented couple interventions that were
developed on the basis of research findings (e.g., 3-
phase method) have many specific factors that are
associated with their techniques; however, there arc
many common factors present as well. First, we
discuss the role of the three nonspecific factors by
Sprenkle et al. (2009) in coping-oriented couple
interventions: behavioral regulation, cognitive mas­
tery, and emotional experiencing. Then, we focus on
specific properties of coping-oriented couple inter­
ventions. Other common factors such as expanded
therapeutic alliance, relational conceptualization,
and expanded direct treatment system undoubtedly '\
play an important role in this approach but will not
be treated in detail here.
Behavioral Regulation
A main focus of coping-oriented interventions is the
enhancement of individual and dyadic coping
resources, in addition to the enhancement of
communication skills and problem-solving abilities.
The majority of sessions are devoted to training
new behaviors or to fostering and shaping existing
coping skills. On the one hand, skill training focuses
on a more explicit and differentiated communica­
tion of one's stress experience, such as emotional
self-disclosure regarding the question why a partic­
ular stress situation was experienced as so stressful
(exploration of triggered schemata}. On the other
hand, partners learn how to adequately provide
emotion-focused dyadic coping, characterized by
empathy and understanding, rather than premature
problem-focused dyadic coping or lack of under­
standing often characterized by blaming and
devaluating the partner. Thus, behavioral regula­
tion plays a central role in the coping-oriented
approach.
Cognitive Mastery
Coping-oriented couple interventions focus on the
clarification and understanding of why partners are
unhappy with their relationship, and what factors
lead to relationship deterioration. By using the 3-
phase method, the couple learns to clarify and gain
understanding of their own and their partner's
reactions and how their personality traits may
interact with the situation. Understanding why the
parmer behaves in a certain manner is a central goal
of this approach
, to foster intimacy, the sense of
"we-ness,, relationship satisfaction, and stability
(Bodenrnann, 2005). On the cognitive level, couples
learn that daily hassles are not the real reason for
their stress reactions, but that these events only
trigger personally relevant schemata that subse·
quently cause stress. This insight may help partners
to increase tolerance toward each other's reactions
in everyday life and help them gain understanding
in mechanisms that often lead to disagreements,
arguments, withdrawal, or alienation. Partners
learn that their causal attributions of their partner's
negativity should be considered differently in many
situations. Instead of the negative scenario: "If he or
she comes home upset and always in a bad mood,
 COMMON FACTORS IN DYADIC COPING
he or she <loesn'r love me anymore ... fine, when he
01· she is awful to me, then I can also be nasty,"
partners could engage in this scenario: "What
happens to my partner? He or she seems in a really
bad mood. What might have happened to him or
her? Probably he or she had an awful day again. I
should ask about what happened and what caused
his or her negative feelings." Although cognitive
mastery is an important element of coping-oriented
couple interventions, the 3 -phase method focuses
primarily on an emotional experience.
Emotional Experiencing
Emotional experiencing is a main goal of the
coping-oriented coupl.e interventions and a key
component the 3-phase method. The increased
awareness of one's own and the partner's function­
ing by tmderstanding emotional stress reactions,
such as sadness, loneliness, feeling hurt and
misunderstood, anxiety, helplessness, and shame,
are essential. We believe that only emotional
understanding enables partners to provide mutual
adequate support, matching the real needs of the
other. Reacting with felt understanding is necessary
for developing acceptance and tolerance toward the
partner. Thus, helping both partners to realize the
emotional significance of a situation, and to
understand underlying schemata, is fundamental
for the motivation of providing suppol't.
What Is Specific In the Coping-Oriented
Couple Approachl
Although common factors described by Sprenkle
et al. (2009) play important roles in coping-oriented
couple interventions, we believe there are also
specific aspects of this approach that make it
effective in alleviating couple distress. First, it is
important to recall that the coping-oriented couple
approach is not an entirely new intervention, as it
builds upon behavioral, cognitive behavioral, and
. integrative couple interventions, while working
with methods proposed · by cvidepce-based thera­
pies (e.g., enhancement of reciprocal positivity,
communication training, problem-solving training,
cognitive interventions, acceptance work). Nev­
ertheless, the coping-oriented couple approach
adds new techniques such as the psychoeduca­
tion of the role stress plays in relationships and
the 3-phase method based on stress and coping
research and long-standing practices done with
couples (Bodenmann, 2010). Although these
methods represent a novel element and the way the
therapist works with the couples in the 3-phase
method is specific, somewhat comparable techniques
are proposed in other evidence-based couple thera­
pies or marital distress prevention programs. We
briefly review other evidence-based approaches and
93
examine the role that stress and coping play in these
interventions.
COMPARISON WITH OTHER THERAPEUTIC
AND PREVENTION PROGRAMS
For a long time, most couple therapies and distress
prevention programs did not specifically address '\
stress and coping issues (e.g., Halford & Markman,
1997). Internal stress (conflict behavior, negative
feelings or thoughts about the partner or relation­
ship) remains a main focus of many approaches.
Although some approaches may deal with external
stress, there is often a lack of explicit mention of it
and one is not sure whether and how the impact of
external stress on close relationships is addressed
and what specific techniques for improving coping
in couples are proposed. In traditional behavioral
couple therapy (TBCT) there is no specific consid­
eration of external stress and coping issues in
treating couples but a clear focus on the improve­
ment of positivity and communication skills
(Jacobsen & Margolin, 1979). Cognitive behavioral
couple therapy (CBCT) deals more explicitly with
stress, as stress often is directly linked to personal
assumptions, beliefs, and standards; thus, the link
to coping might be more easily done. Although
Epstein and Baucom (2002) propose such inter­
ventions, they do not resemble the 3-phase method
and strengthening dyadic coping seems not to be
directly addressed, except in their therapies for
couples with chronic illness where social support in
dealing with a partner's health problems is
addressed (e.g., Baucom et al., 1998). Integrated
behavioral couple therapy (IBCT) also takes the
basic principles of CBCT and expands them to
emphasize interventions aimed at increasing accep-­
tance. The three components {empathetic joining,
tolerance building, and detachment from the
problem) are all focused at enhancing the couple's
ability to appreciate the differences in their
marriage and deal with internal stress (Jacobson
& Christensen, 1996). However, this approach
would easily permit one to consider external stress
in a more direct way. Acceptance work is a
promising tool to address the impact of external
stress on marriage and to include the question of
what one partner may be able to accept in the other
by understanding his or her stress reactions.
Emotionally focused couple therapy (EFCT) takes
a focus on inner emotional experiences and combines
them with cyclical, self�reinforcing interactions
(Greenberg & Johnson, 1988). Partners are taught
to learn new aspects about themselves and develop a
more functional pattern of interaction with their
partner that is cohesive with their specific attachment
needs. Therapists using this approach try to access
94 BODENMANN & RANDALL
and reprocess the emotional experience of partners'
and restructure interaction patterns between the
partners. Although this approach emphasizes inter­
nal stress ( conflicts between different needs related to
attachment), a link to the coping-oriented approach
could be easily made by considering external stress
triggering attachment schemata. However, tech­
niques proposed by this approach differ significantly
from how the therapist works in the coping-oriented
couple interventions and more precisely in the 3-
phase method.
Integrated systematic couple therapy (ISCT) was
developed based on the notion that "if problem
formation and maintenance (in distress] are seen as
part of a circular process in which well-intended
solution-behaviors maintain the problem, then
alteration of these behaviors should interrupt the
cycle and initiate resolution of the problem"
(Goldman & Greenberg, 1992, p. 962). The specific
goal of ISCT is not to resolve all of the issues
causing distress but rather to instigate a reversal of
the negative interaction. Once more this approach
specifically focuses on internal stress (conflicts
between partners) and does not explicitly consider
external stress or coping issues.
Insight oriented couple therapy (IOCT) focuses
on the interpretation of underlying intrapersonal
and interpersonal dynamics between the partners
contributing to marital distress (Snyder, Wills, &
Grady-Fletcher, 1991). The emphasis here is on
examining developmental issues, interactions, ex­
pectations, and maladaptive relationship patterns.
This approach primarily focuses on intradyadic
conflict patterns (internal stress) between partners
and their underlying psychodynamic mechanisms,
and does not explicitly consider the impact of
external, contextual factors on the couple's func­
tioning. However, similar to the coping-oriented
approach the role of the therapist is to guide the
couple ·to gain a better understanding and clarifi­
cation of their feelings and bdie� that may be
affecting their relationship. However, techniques
differ considerably between methods.
Prevention Programs
A well-known and widespread education and
prevention program is the Premarital-Relationship
Enhancement Program (PREP). Developed by
Markman, Stanley, and Blumberg (1994), PREP
offers couples who are currently mostly satisfied in
their relationship the ability to learn skills to help
prevent problems in their relationship by learning
effective problem-solving and communication tech­
niques. PREP focuses on the improvement of
communication skills in order to maintain relation­
ship satisfaction in the longer nm. While PREP has
a strong focus on internal stress, external stress
plays a certain role in the problem-solving training
where couples try to resolve daily stress in a more
appropriate manner. However, dyadic coping is not
directly considered in this program.
The Couple Commitment and Relationship
Enhancement (Couple CARE) program is another
well-known skill-based relationship education pro­
gram that emphasizes the development of effective
couple communication (Halford et al., 2006).
Specifically, this program focuses on the enhance­
ment of positive communication, conflict manage­
ment, and positive expression of .feelings, as well as
on commitment, realistic relationship expectations,
emphasizing empathy, shared time, and appropri­
ate expression of oneself also in times of distress.
Within its six units, one unit, "managing life
changes," is most related to stress and coping
issues. This program has some affinity with coping­
oriented interventions by its emphasis on life
changes (as external stressors) and particularly a
focus on the enhancement of empathy, a key
variable in the 3-phase method.
While the aforementioned prevention programs
are of a more general nature and are usually offered
in the context of universal prevention, CanCOPE is
a prevention program specific for couples dealing
with cancer (Scott, Halford, & Ward, 2004). This
program has the strongest communality with our
coping-oriented couple interventions and the
CCET. This program also refers to stress and
coping in couples and refers to Beck's theory using
cognitive restructuring by inviting both partners to
identify and help change dysfunctional cognitions.
However, although CanCOPE focuses on major
stressors (severe illness), coping-oriented couple
interventions primarily deal with daily hassles and
their impact on the close relationship. CanCOPE
also addresses internal stress, however, not in the
sense of intradyadic conflicts but as worries for the
partner; thus, external stress is less of a focus for
this approach (e.g., stress from work spilling over
into the relationship). Although these two ap­
proaches share some overlapping theoretical back­
ground, techniques differ significantly between
CanCOPE and CCET or COCT, and the similar­
ities in methods dissolve once both approaches are
studied in detail.
Coping-Oriented Approaches
As this short overview revealed, some couple
interventions indirectly address the impact of stress
on close relationships and dyadic interaction and
some address major stress and strer1gthen coping
skills. However, the focus of most of these pro­
grams lies on internal stress (either conflicts or

96 BODENMANN & RANDALL
based approaches but mainly the theoretical back­
ground grounded in stress and coping research,
psychoeducation, and the 3-phase method. The
theoretical rationale of the coping approach implies
that the training of communication skills is often not
sufficient enough to alleviate distress, as stress often
leads to a breakdown of communication abilities, as
appropriate communication cannot be maintained in
times of stress (Bodenmann, 2005). Thus, the focus on
fostering individual and dyadic coping may help to
ensure adequate communication also in times of
stress. Additionally, the coping-oriented couple ap­
proach also proposes a somewhat different model of
problem explanation than other approaches, by
focusing on external stress and its impact on close
relationships. As problematic behaviors, cognitions,
and emotions are more evident in times of stress,
partners should learn to be more aware of the negative
impact of external daily stress on their couple's life,
and learn how they can protect their relationship with
unified efforts from these adversities by means of
individual and dyadic coping (e.g., Bodenmann,
2005), where especially nondirective coping is appro­
priate (Beach & Gupta, 2006). This alternative
explanation of marital distress, caused by external
factors more than internal problems, is compatible
with the technique of integrative couple therapy
(descriptive view of the problem and unified detach­
ment; Jacobson & Christensen, 1996).
A second specific element of the coping-oriented
couple approach is the 3-phase method (Bodenmann,
2007). This method combines elements of CBCT
(e.g., speaker and listener rules) with elements of
cognitive restructuring (Beck et al., 1979) used and
adapted in a couple setting and enlarged by the
dyadic coping part. It uses nondirective elements of
the therapist (empathy, acceptance, congruence)
combined with high structure regarding setting,
roles, and timeframe (45 minutes of intervention
per partner). The role of the therapist, as noted
above, is very specific. He or she only intervenes as a
coach, facilitating emotional self-disclosure i n the
speaker and empathic listening in the listener in a
dyadic setting, where both partners are sitting face to
face and talk to each other.
We believe that the 3-phase method is an original
way to work with couples to enhance schema-related
self-disclosure with regard to experienced stress in
daily life while improving dyadic coping efforts and
increasing mutual understanding for partner's func�
tioning (according to his or her personal schemata).
Nevertheless, we arc convinced that common facton
previously explained account for a great deal of
variance in therapeutic outcome above the impact of
this method (e.g., Christensen, 2010; Sprenkle et al.,
2009).
r
Conclusions and Future Directions
Importantly, we recognize that external stress spilling
over into the relationship may not be a central focus
for all couples seeking therapeutic intervention, but
we believe that it is a critical issue that impacts
relationship functioning. As coping-oriented elements
in couple therapy have only recently been proposed, '\
there are few empirical studies that provide evidence
for its effectiveness. Therefore, there is an increased
need for empirical studies that show the efficacy of
these interventions as well as the limitations of the
coping-oriented approach. We believe that future
research in this area should examine the following
questions: First, what kind of couples may be most
effectively treated with coping-oriented couple inter­
vention, in what phases of their lives, and with regard
to what problems? Second, how does the funnel
method (deepened s e lf -disclosure during the 3-phase
method) work with individual characteristics, such as
insecure attachment, problematic personality, or
mental disorders, and what are effects and limitations
of the method in these cases? And, third, when would
the 3-phase method not be recommended, and for
whom? To date, there are some empirical studies that
provide some knowledge about these questions;
however, definitively more research is needed.
In summary, although coping-oriented interven­
tions share many common factors with other
therapeutic approaches, we believe that there are
specific elements to these coping approaches that are
valuable, and should be considered in working with
couples. We hope that more clinicians discover the
usefulness of coping-oriented therapeutic tools, and
realize that in many cases external stress may be an
important variable in understanding the deterioration
of close relationships.
References
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 COMMON FACTORS IN DYADIC COPING
worries for the partner in the case of health issues)
and the enhancement of communication and
conflict management. The coping-oriented couple
interventions differ from these approaches in four
ways. First, coping-oriented interventions focus
primarily on the impact of minor stressors (daily
hassles), whereas other couple therapies or preven­
tion programs deal with major life stress such as
severe illness (cancer, chronic arthritis, handicap) or
other critical life events (transition to first parent­
hood). We know from a growing body of research
that coping mechanisms are completely different
facing minor versus major stressors, and also the
impact on the relationships is different (see Randall
& Bodenmann, 2009, for an overview). For
example, chronic minor stressors consistently affect
close relationships in a negative way, whereas
major stressors may have an ambivalent impact
on them by either increasing cohesion, or leading to
a severe breakdown of the relationship.
Second, although coping-oriented couple inter­
ventions focus on both internal and external stress
and teach couples how to cope more effectively
with both types of stress, most other couple
approaches tend to help couples improve their
conflict management in dealing with internal stress
(tensions and conflicts originating within the couple
because of divergent goals, needs, personality
issues, etc.) or internal stress originating from a
severe illness of the partner. Third, the coping­
oriented couple approach pays particular attention
to the role of external stress and its meaning for
couple's functioning by means of psychoeducation,
and offers a therapeutic method (3-phase method)
that explicitly focuses on coping with the stressors
together (dyadic coping), Fourth, the 3-phase
method is different from other techniques in its
structure, content, focus, and the way the therapist
works with the couple in prompting stress-related
. self-disclosure and schemata discovery in one
partner while simultaneously prompting the other
partner in empathic listening (funnel method
during the first phase of the 3-phase method)
and in the second phase of the 3-phase method
in prompting the former listener to adequately
support the partner.
Although other approaches also go beyond com­
munication skills training and aim to enhance social
support or dyadic coping in couples (e.g., CARE;
Halford, Moore, Wilson, Dyer, & Farrugia, 2004;
CanCOPE; Scott et al., 2004.); these approaches only
partially share a similar theoretical background
focusing on stress research as CCET or COCT.
They differ in psychoeducation and most significantly
in the way how skills are taught to couples. In the
coping-oriented approach, the therapist's role is that
95
of a facilitator during the 3-phase method and
combines empathic, acceptant, and congruent behav­
ior with prompting (speaking quietly and with a soft
voice). Additionally, the therapist engages in nondi­
recrive behavior. He or she never offers interpreta­
tions, infers emotions ("Did you feel sad?") or
thoughts (" Did you think that you were worthless?"), '\
nor does he or she lead the self-disclosure in a certain
direction. The therapist never pushes the couple to
deepen self-disclosure (during the funnel method in
the first phase of the 3-phase method) and dyadic
coping (during the second phase of the 3-phase
method), but only offers this possibility, and discreet­
ly stimulates and supports these processes. Last, the
therapist's role is to facilitate self-exploration by
asking open-ended questions, paraphrasing impor­
tant emotions, cognitions, or physiological sensa­
tions, by inviting the listener to summarize and share
emotional experience and by continuing to explore
underlying schemata ("Why did tnis make you so
sad?"). The therapist is cautious in proposing this
method and takes care not to allow or promote
deepened emotional self-disclosure when not both
partners (speaker and listener) are able and ready for
this experience.
Discussion
Coping-oriented couples' interventions (CCET;
Bodenmann & Shantinath, 2004; COCT; Bodenmann,
2007, 2010; Bodenmann et al., 2008) are thera­
peutic methods based on CBT and cognitive restructur­
ing techniques, which integrate recent findings on
stress and coping research in couples. In this contribu­
tion, we examined both common and specific factors in
coping-oriented couple approaches, and whether there
are specific factors that lead to its effectiveness.
Although there is no data available to answer this
question empirically, our theoretical analysis suggestS
that common factors found in most couples' int:erven­
tion and prevention programs are highly relevant in
coping-oriented interventions as well. Thus, we believe
that the impact of this method can partly be explained
by the effect of common factors that are associated with
other therapeutic interventions (Sprenkle et al.,
2009); however, there are specific characteristics to
the coping-oriented couple intervention that may
match some couples' needs above and beyond classcal
CBCT. In addition, we believe that the stress and
coping framework adds to the classical social
learning or cognitive theoretical framework of CBCT,
allowing many couples to better understand the
impact external stress may have on relational out­
comes, which can increase the likelihood fur divorce
(see stress-divorce model by BodenmaM et al., 2007).
What is specific to COCT or CCET is neither the
general goals that are shared with other evidence-
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RFCF.IVFn: August 5, 2010
AccEPTEO: April 18, 2011
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