HANDBOOK OF

MARITAL TIIERAPY
A Positive Approach to Helping li'oubled Relationships
 APPLIED CLINICAL PSYCHOLOGY
Series Editors: Alan S. Bellack and Michel Hersen
University of Pittsburgh, Pittsburgh, Pennsylvania

PARTIAL HOSPITALIZATION: A Current Perspective

Edited by Raymond F. Luber

HANDBOOK OF MARITAL THERAPY: A Positive Approach to Helping

Troubled Relationships
Robert P Liberman, Eugenie G. Wheeler, Louis A.J.M. de Visser, Julie Kuehnel,
and Timothy Kuehnel

A Continuation Order Plan is available for this series. A continuation order will bring delivery of
each new volume immediately upon publication. Volumes are billed only upon actual shipment. For
further information please contact the publisher.
 HANDBOOK OF
MARITAL THERAPY
A Positive Approach to Helping '"froubled Relationships

Robert P. Liberman
University of California
Los Angeles, California
and
Camarillo State Hospital
Camarillo, California

Eugenie G. Wheeler
Oxnard Community Mental Health Center
Oxnard, California

Louis A. J. M. de Visser
Lovola-Marvmount Universitv
· Los Angeles. California ·
and
Santa Clara High School
Oxnard, California

Julie Kuehnel
University of California
Los Angeles, California
and
California Lutheran College
Thousand Oaks, California

and
Timothy Kuehnel
Camarillo State Hospital
Camarillo, California
and
University of California
Los Angeles, California

SPRINGER SCIENCE+BUSINESS MEDIA, LLC

 Library of Congress Cataloging in Publication Data
Main entry under title:
Handbook of marital therapy.
Bibliography: p.
Includes index.
1. Marriage counseling. 2. Family therapy. I. Liberman, Robert Paul
HQ10.M372 362.8'2 79-9103
ISBN 978-0-306-40235-7 ISBN 978-1-4899-0457-7 (eBook)
DOI 10.1007/978-1-4899-0457-7

This limited facsimile edition has been issued

for the purpose of keeping this title available
to the scientific community.

10 9 8 7 6 54 3

©1980 Springer Science+B usiness Media New York

Originally published by Plenum Press, New York in 1980
Softcover reprint of the hardcover 1st edition 1980

All rights reserved

No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the publisher
 Foreword
In the treatment of marital problems, behaviorally oriented and com-
munication oriented approaches have been in conflict and seen as con-
trasting and unlikely bed partners. Many therapists, focusing on com-
munication skills, have felt that behaviorists were too structured and
uncaring; on the other hand, behaviorists have considered humanistic
therapists as being "touchy-feely," vague, and unfocused. However, in
the Handbook of Marital Therapy, Liberman, Wheeler, de Visser, and
the Kuehnels have wedded these two potent approaches into an inte-
grated framework that makes them loving bed partners.
With over a decade of experience in applying behaviorally ori-
ented treatment to couples, Liberman and his co-authors have devel-
oped an educational model that focuses on teaching specific commu-
nication skills to couples. The communication skills they describe have
been used extensively in all types of marital therapy, regardless of the
therapist's theoretical orientation.
The unique contribution of this book is that the authors provide a
step-by-step approach to teaching these communication skills within a
behavioral framework. Each chapter guides the therapist through the
many issues and problems confronting him or her as a change agent.
This highly readable book is enhanced by a liberal use of case exam-
ples. Emphasis is given to homework and structured sessions that focus
on increasing specific communication skills in a sequential manner.
The advantages of working with couples in a group setting are dis-
cussed, and concrete suggestions on how to manage these groups are
clearly presented.
Liberman and his co-authors are to be commended for their effec-
tive blending of communication skills and behavioral therapy. This
book provides a clear and concise descriptive guide for therapists and
marriage counselors on how to enrich marital relationships. Most men-
tal health professionals working with couples could benefit from this
integrated approach to marital therapy.
DAVID H. OLSON
University of Minnesota
St. Paul, Minnesota
v
 Preface

The methods described in this handbook derive from the field of behav-
ior therapy and social learning theory. The authors have adapted the
basic principles of behavior and human learning into techniques useful
for helping married couples change. This work began in 1966, when
the first author began treating married couples and families at the Mas-
sachusetts Mental Health Center in Boston. His work accelerated in
1971, when he became associated with the Oxnard Community Mental
Health Center and joined with the second author in offering marital
therapy to the numerous couples in conflict who sought assistance at
the mental health center. The format and methods changed and were
refined as the authors gained experience. Much of the refinement was
carried out during 1972-1975, when the first author was granted funds
for the Behavioral Analysis and Modification Project in Community
Mental Health, an applied research project supported by the Mental
Health Services Research and Development Branch of the National
Institute of Mental Health (Grant No. MH 19880). Many of the details
and tips in carrying out the methods described in this handbook derive
from our experience in training 1,000 mental health professionals in 60
community mental health centers across the United States as part of a
dissemination grant from the National Institute of Mental Health (Grant
No. MH 26207).
A few innovators in behavioral marital therapy were particularly
influential with the authors. We have borrowed heavily, in terms of
conceptual understanding of marital conflict and satisfaction, assess-
ment, and treatment, from Richard B. Stuart, A. Jack Turner, Robert
Weiss, Gerald Patterson, Hyman Hops, Gary Birchler, Nathan Azrin,
Barry Naster, and R. Jones. Our use of "core symbols" and contingency
contracting derives from Stuart's work. The exercise entitled "Catch
Your Spouse Doing or Saying Something Nice" was developed by
Turner.
The fantasy fulfillment and reciprocity awareness exercises were
described by Azrin, Naster, and Jones. Our emphasis on "love days,"
recreation, and marital activities was primed by the work of Weiss, Pat-
terson, Hops, and Birchler. The fruits of these pioneers' work are
vii
viii PREFACE

clearly seen in the methods described in our handbook, and we owe

them a very large professional and intellectual debt of gratitude.
The authors also wish to express their appreciation to Annelisa
Romero, editor for the Department of Psychiatry and Behavioral Sci-
ences, Neuropsychiatric Institute, UCLA, for her exceptionally skillful
editorial scrutiny and suggestions.

ROBERT P. LIBERMAN
EUGENIE G. WHEELER
LOUIS A. J. M. DE VISSER
JULIE KUEHNEL
TIMOTHY KuEHNEL
 Contents

Foreword, by David H. Olson v

Introduction xi
1 General Guidelines and Principles 1
2 Getting Started 13
3 Planning Recreational and Leisure Time 49
4 Communicating: Awareness of Reciprocity 6.3
5 Communicating: The Arts of Listening and Effectively
Expressing Feelings 89
6 Giving and Getting: Marital Contracts 157
7 Ending 181
8 Solving Special Problems 197
9 Summary 215
10 Suggested Session Outlines for Marital Therapy 225
Annotated Bibliography of Research on Behavioral
Approaches to Marital Therapy 239

Index 259

ix
 Introduction

This treatment manual is a "how-to-do-it" guide for those in the help-

ing professions who are actively concerned with the needs and prob-
lems of married or soon-to-be married couples. The treatment methods
described in this manual cannot and should not be applied by individ-
uals who have had little or no clinical experience. This is not a "cook-
book" to be followed in a mechanical way. Experienced therapists who
possess basic therapeutic attributes, such as warmth, empathy, inter-
view skills, sensitivity, and positive regard for their clients, can put the
approach described in this book to effective use. The detailed methods
will be learned and applied more rapidly by professionals who are
comfortable with an active, structured, and operational style of work-
ing with clients. However, all therapists and counselors-whatever
their clinical style or theoretical orientation-will be able to adapt the
techniques in this manual to their own work with couples.
People who can make use of this book include:

1. Marriage and family counselors who are interested in adding

new and effective techniques to their clinical repertoires
2. Practicing mental health clinicians, such as psychiatrists, psy-
chologists, social workers, and nurses, who must decide
whether individual and/or marital therapy is appropriate for a
particular client and then must offer the preferred alternative
or make an appropriate referral
3. Pastoral counselors and ·other clergy who are called upon to
assist couples with marital problems or who offer marital
enrichment courses to their congregations or communities as
part of their ministry
4. Probation officers, high school counselors, and other social
service personnel who often must understand and cope with
family and marital problems in the course of helping their
clients and students
5. College and high school instructors or counselors who teach
courses in marriage and family living
xi
xii INTRODUCTION

MARITAL THERAPY: WHAT AND FOR WHOM?

The therapy and training methods described in this manual can be

used with couples experiencing moderate or severe marital conflict and
stress, such as those who are on the verge of separation and divorce.
Couples having problems communicating with each other and those
resorting to punishing modes of interaction can benefit from the type
of marital therapy illustrated in this book. This manual can also be used
for couples with relatively minor marital problems who are looking for
"growth" opportunities to make an "OK" relationship better. Such
couples are often bored, feeling stifled, or taking each other for granted.
The methods for acquiring the communication, problem-solving,
and family activity skills needed for marital improvement and satisfac-
tion are highly structured and goal-oriented. These procedures may be
utilized in individual, conjoint, or group therapy formats. The exer-
cises and activities in this guide to marital therapy are based on our
experiences as therapists in schools and universities, social agencies,
mental health centers, and private practice. Research and evaluation
studies conducted by the authors and by others have validated the
effectiveness of these procedures. At the end of this book is an anno-
tated bibliography of research publications that may be perused for
more detailed documentation of the efficacy of our procedures. We did
not want to dilute the clinical utility of the application portion of this
manual with references or descriptions of supporting research; hence,
these are reserved to the annotated bibliography. We do feel that
enough convincing objective research has been done to warrant the
widespread clinical adoption of the techniques reported in this book.
Indeed, we would not have written this book or recommended the pro-
cedures had not sufficient scientific evidence accumulated to support
their use. Social learning principles provided the foundation for these
procedures, but a pragmatic concern for using "whatever works"
guided their development and integration. In developing a workable
marital therapy, we were not overly concerned with the relative partial
contributions to treatment outcome made by each of the components of
the treatment "package" nor with the theoretical purity of the
"package."
Jay Haley (1963) has said that "marital therapy has not developed
because of theory; it appears that people were struggling to find a the-
ory to fit practice" (p. 214). Consequently, a number of "schools" of
marital and family therapy exist that have different assumptions, lan-
guages, emphases, treatment techniques, treatment structures, and
views of psychopathology or needs for growth. Setting the ideologies
aside, we are struck by the common intervention focus of these various
INTRODUCTION xiii

forms of marital therapy. All stress the importance of clear communi-

cation; accurate, empathic listening; the constructive expression of
feelings; and the need for conflict resolution and problem-solving strat-
egies for couples experiencing difficulty in their relationships. The
social learning or behavioral approach to marital therapy described in
this manual addresses each of these needs and thus shares a great deal
with other forms of marital therapy, even though it stems from a differ-
ent tradition. Consequently, several of the components of the proce-
dures explained in this manual are not unique to the behavioral para-
digm but are shared with avowedly "nonbehavioral" forms of marital
therapy.
The general goals of our approach to marital therapy are to
increase the couples' recognition, initiation, and acknowledgment of
pleasing interactions; to decrease the couples' aversive interactions; to
train the couple to communicate effectively; and to teach the couples
to use contingency contracting for negotiating the resolution of persis-
tent problems and dissatisfactions. The procedures described in this
manual follow a behavioral counseling model, which emphasizes:
o Precise goal setting
o Measuring and monitoring progress
o Practicing desired behaviors
o Shaping small steps in adaptive directions
o Reinforcing progress
o Generalizing gains made in the clinic or office by the couples
to their home environment

ORGANIZATION OF THE MANUAL

Chapter 1, "General Guidelines and Principles," provides an over-
view of the general process and techniques of behavioral marriage
counseling. It also discusses the principles and basic assumptions
behind these techniques and briefly covers the empirical evidence on
which they are based.
Chapter 2, "Getting Started," describes the planning activities that
must be carried out prior to commencing marital therapy. Topics cov-
ered include: recruiting clients and obtaining referrals, involving the
reluctant partner, screening and selecting appropriate clients, increas-
ing clients' motivation, setting positive therapeutic expectations, and
contracting for services. These topics are covered for both conjoint and
group forms of marriage therapy.
Chapter 3, "Planning Recreational and Leisure Time," focuses on
xiv INTRODUCfiON

patterns of recreational and leisure-time activities that are typically

present in good marriages. A conceptual framework assists the thera-
pist in guiding couples to more closely approximate satisfying patterns
of recreational and leisure-time activities.
Chapter 4, "Communicating: Awareness of Reciprocity," focuses
on the importance of couples' becoming more aware of the pleasing
and caring exchanges in their relationship. A series of exercises is pre-
sented that can increase the partners' skills in asking for, giving, and
receiving behaviors and events that can please each other. Homework
assignments are provided that can increase the occurrence of these
pleasing behavioral exchanges on a day-to-day basis.
Chapter 5, ''Communicating: The Arts of Listening and Effectively
Expressing Feelings," provides the therapist with a framework for
teaching couples to express feelings directly and spontaneously. A
most important component in this chapter is helping partners learn
how to express negative and angry feelings in a nonaggressive or non-
coercive manner.
Chapter 6, "Giving and Getting: Marital Contracts," covers the use
of contingency contracting as a method of problem solving and resolv-
ing differences through negotiation and compromise. Chapters 3
through 6 are similar in that each chapter takes up the rationale and
techniques for facilitating particular forms of marital interaction or
communication skills. In addition, a series of step-by-step exercises
and examples is provided to assist the therapist in teaching couples
new patterns of interactions.
Chapter 7, "Ending," describes the termination process. Topics
covered include how to structure the final sessions, arranging follow-
up and booster sessions, referring for additional help, and recycling.
Chapter 8, "Solving Special Problems," provides suggestions for
dealing with problems that occasionally occur in this form of therapy.
Suggestions are given for handling couples who are reluctant to engage
in role-play exercises, reacting to partners who do not complete their
homework assignments, and dealing with resistance to a structured
approach.
Chapter 9 is a summary of the manual, and Chapter 10 provides·
some suggested therapy session outlines for individual couples and for
couples' groups. The last section is an annotated bibliography for
professionals and clients.
Throughout these chapters, numerous examples are provided to
illustrate marital therapy with couples experiencing a variety of prob-
lems. In addition, a case example based on a composite of couples we
have worked with is used as a connecting thread throughout the man-
INTRODUCTION XV

ual. This example is referred to in each of the chapters to further illus-

trate the process of acquiring interaction skills and problem solving
that typical couples go through as they proceed from awareness to awk-
ward utilization, to more natural use of skills, and, finally, to an inte-
grated and positive mutual exchange in their daily lives.

REFERENCE
Haley, J. Marriage therapy. Archives of General Psychiatry, 1963, 8, 213-234.