THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 562.7 Guest: Neil Jacobson, Prof. Psychology, Univ. of Washington, Seattle Topic: Changing perspective in marital therapy Producer/Host: Steve Girard

NEMA: Two psychology professors, working on techniques in marital therapy, seem to have made great strides in making the therapy more successful. We're with Dr. Neil Jacobson, of the University of Washington...who partnered a study with Andrew Christensen of the University of California...

JACOBSON: We had been disenchanted with traditional behavior therapy, and most traditional approaches to couples therapy...they seemed to hover around 50% success, and to us, that wasn't good enough. And we came to the conclusion that they were limited because they focused exclusively on change. And by that I mean, a couple comes in with a set of problems, and you try to eradicate them. Getting people to change their behavior...to satisfy one another more completely. That's sort of the way marital therapy has traditionally worked. We gradually came to the conclusion, through our research, that any change oriented treatment was limited, because couples' capacity for change is limited. And if you want to have a complete approach to couples' therapy, you need to incorporate strategies for promoting acceptance, as well as change ... because acceptance is an essential ingredient in maintaining a long term relationship. If you want to stay together for a long period of time with anyone, you have to not only accommodate to the other person's needs, you have to develop the capacity to be compassionate, and in a way, you have to learn to love the things about your partner that are different from the way you would ideally like them to be... as well as those things you already like... and we called our treatment 'Integrative' because it included both acceptance strategies and change strategies. And we compared, under scientifically rigorous conditions, this 'integrative' treatment with the more traditional change-oriented treatments, and not only did we find that it worked better, but we found that it worked so much better, that we were able to achieve success rates that were beyond what we expected, and beyond anything I had seen in the literature on couples therapy research...so we became very exited by these findings, and we wrote a book describing the treatment for other therapists, which is now out....and we've applied for funds to do a more definitive study, to see whether or not what we found in our preliminary study really does mirror reality.

NEMA: You mentioned that about 50% of couples going through traditional therapy survived as couples afterward... what was the rate of success in the trial couples' therapy?

JACOBSON: 90%.....but I mean, we're talking about 9 out of 10, so it's a small number....

NEMA: Very dramatic...tell me more about the book, and where it's available...

JACOBSON: Published by Norton, and it's called Integrative Couple Therapy, by Jacobson and Christensen, and by the way we're also writing a companion book for couples, which is Christensen and Jacobson, which is in the process of being written now, which will be a book for couples... which will be the same approach, but written directly to the couples on how to understand marital conflict, and how to develop a greater capacity to accept and also, incorporate the change strategies that we traditionally use. You have to remember that we have not thrown out the baby with the bath water... we continue to employ the change strategies that we've always used. It's just that they're now only part of the treatments, rather than the entire treatment.

NEMA: What kinds of things happened in the course of your study that really jumped out at you, and helped reinforce your ideas....?

JACOBSON: One of the things that we found was that not only was the 'integrative' treatment more successful at helping couples feel better about their relationship, but we actually got more change in the integrative treatment, than the treatment which directly went after change. So that even though the 'integrative' treatment is acceptance-focused, we were able to get more change in the acceptance-focused treatment, than we were in the change-focused treatment. So acceptance is not only a desirable goal in its own right, but it may be a more effective strategy for getting change than traditional change-oriented strategies. And if you think about that, it's really quite interesting... it means that for couples, sometimes the best way to get something different from your partner is to stop going after it.

NEMA: Is there something about pushing for change, especially in such an emotionally charged situation, that actually defeats the purpose for the therapy....?

JACOBSON: Yes, because when you try to get your partner to essentially do a make-over, which means that you're trying to remold them in terms of your idealized image of what a partner should be like...if the make-over you're trying to do runs counter to the way they want to be, they're going to resist your efforts...and they're likely to become even more different from the person you want them to be...it's a fairly natural reaction, just for someone to resist another person's efforts to change them. Because usually the things that couples fight about are differences between them ...incompatibilities...and when you...so that if you're feeling that the relationship is too intimate...more intimate than you want it to be, you may pull back. And if your partner responds to that by trying to make even greater efforts to draw you in, then you're likely to pull back even further. It's a process that we call polarization. And sometimes, when you let go of the struggle to remake your partner, the pressure's off, and a process occurs whereby people find it easier to accommodate...so you actually get more of what you want - the less you ask for it.

NEMA: How does someone increase their capacity for acceptance and tolerance?

JACOBSON: It's a little bit hard to answer that question. They have to undergo a change in the way they experience their partner...the experience is one of compassion, and a softening toward them, rather than an experience of disaffection or alienation. That's the kind of transformation...so that even if your partner is doing something that you don't like, you experience it differently, you experience it as endearing... or you love it because it's part of who they are. Or you tolerate it even though you'd rather have it not occur, because it's not experienced by you as catastrophic.... the way it was prior to this transformation.

NEMA: We live in a time when everyone wants the quick fix...the wonderful technique to make our relationships perfect. And there are many authors and performers out there who will gladly offer their methods for success to anyone who will listen and buy into it...

JACOBSON: You'd be doing the public a service if you were somehow able to communicate that there are no quick fixes, there are no simple formulas...that they should beware of false prophets who offer them quick fixes and easy formulas...for doing what's really a very difficult thing to do, which is maintain a close relationship over a long period of time. It's something that you don't learn in school, it's something that you very seldom can learn from your parents' marriage. And it's a difficult task, and the quick fixes can often lead to quick disappointments...even if they sound good on paper. And the pop psychology literature is full of false prophets, who don't do research on their approaches, who don't document that they can do better than the 50% figure that I talked about... who don't even document that they can duplicate that 50% figure, but they can sell books because they find a title that catches the eye, and gets the reader to take it off the shelf. And people should be very careful of implementing what they read, because most of what they read is crap. They should ask questions like, what do we actually know about the effectiveness of this approach? Have scientific investigations been done on this approach to demonstrate that it is effective and safe? Or do we have to rely on the opinions of charismatic or catchy orators or writers?

NEMA: The book is called Integrative Couple Therapy, from Norton books, by Andrew Christensen and our guest today, Neil Jacobson. I'm Steve Girard.

SPOT: 15 years in the prevention of heart disease, stroke and trauma - The National Emergency Medicine Association. This show is just part of what NEMA does. We send out millions of pieces of prevention information to people around the country, give grants to organizations in research, public information and emergency service, and have been instrumental in the creation and expansion of the Chest Pain Emergency Room movement. Call 800-332-6362.

NEMA: For a transcript of this or past shows, visit the NEMA home page at:

www.NEMAhealth.org (that's n-e-m-a)

I'm Steve Girard for The Heart of the Matter.