Is it time for the return of Marital Group Therapy?
Monday, January 22, 2024.
It was way back in the 1960-70’s… as the Boomer Generation moved through the bowels of time, that they loved to do Marital Couples Therapy in groups…
It may seem uncomfortably quaint today, but it was accepted as a good idea at the time…
It was a therapy for a less isolated, less atomized time.
Marital Group Therapy, (also known as couples group therapy), was a form of psychotherapy that involved the treatment of intimate relationship issues within the context of an ongoing group setting, often with a predetermined number of sessions.
Unlike the “group intensive” one-off experiences of today, in the 60’s and 70’s there was a palpable cultural enthusiasm for regular, ongoing marital group work.
This therapeutic approach drew heavily on the work of several prominent thought leaders of the time, such as such as J.L. Framo, Dr. Murray Bowen, and Irvin Yalom.
I think it’s important to revisit the notion of Marital Group Therapy because the conflation of psycho-education group experiences into science-based therapy models offerings nowadays (Art & Science of Love, and Hold Me Tight seminars to be specific), have become problematic in a certain sense.
And that is, the personal therapeutic dimension, by practical necessity, must be intentionally marginalized and deferred.
But once upon a time, we had a vibrant culture of Marital Group Therapy, and I’d like to discuss and appreciate the thinkers who encouraged group work for committed couples…
J.L. Framo, was a pioneer in the field of family therapy. He emphasized the importance of systemic and interpersonal dynamics in understanding and treating marital issues. Framo conducted some of the earliest efforts into Marital Group Therapy.
One of Framo’s working ideas was the concept of "complementary schismogenesis," which suggests that couples often engage in patterns of behavior that reinforce each other's negative traits.
In marital group therapy, therapists influenced by Framo's ideas may explore how these complementary patterns contribute to conflicts within their relationships, and compare their outcomes openly.
The therapist might also encourage and encourage couples to help one another to recognize and disrupt destructive patterns of interaction as they occur.
I could also see how “dense” ideas such as memes and couple codes might help foster a beneficent, shared folk wisdom within a marital therapy group.
Here is the most important idea…group therapy allows couples to observe and learn from the experiences of others facing similar challenges.
Framo's systemic approach helps therapists address not only an individual human’s issues, but also the interconnectedness of the entire relationship system within the group.
Framo had an aesthetic for Marital Group Therapy. He believed that couples of similar age and life cycle are best paired together, because similarity fosters rapport. I’ll be discussing the conditions required for conducting effective Marital Group Therapy with more detail in an upcoming post.
Dr. Murray Bowen, known for his development of Family Systems Theory, contributed significantly to the understanding of family dynamics and interpersonal relationships.
In the context of Marital Group Therapy, Bowen's ideas are applied to explore the intergenerational patterns of behavior that influence the couple's dynamics. The connection between Family of Origin dynamics, so essential in Bowen’s theory, and Attachment Theory, can be richly explored in a group therapy setting.
I also can easily see therapists using genograms, a tool introduced by Bowen, to visually map out family relationships and identify recurring patterns across generations.
By understanding these patterns, couples can gain insight into the origins of their conflicts and work towards breaking generational cycles.
Marital Group Therapy influenced by Bowen's approach would offer a keen focus on differentiation. I could easily see how effective Marital Group Therapy could encourage individuals to develop a stronger sense of self while also maintaining the emotional connection with their partner.
Irvin Yalom, is 92, and is, apparently, still going strong. He’s a renowned existential psychiatrist and group therapy pioneer, and has contributed important ideas about the therapeutic factors inherent in group dynamics.
While Yalom's work is more focused on the best processes and practices for group therapy in general, I’m thinking that his principles might be directly applied to Marital Group Therapy, as a lower cost alternative to bad “all-purpose” couples therapy that is so prevalent today.
“Love is not just a passion spark between two people; there is infinite difference between falling in love and standing in love. Rather, love is a way of being, a "giving to," not a 'falling for"; a mode of relating at large, not an act limited to a single person.”
― Irvin D. Yalom, Love's Executioner and Other Tales of Psychotherapy
In a Yalom-influenced marital group therapy setting, I can easily imagine how a therapist might create a supportive and collaborative environment.
The epiphany is the comparative dynamic; couples, as they share their experiences, challenges, and successes, can fostering an emerging sense of intimate universality – the realization that other humans face similar, and sometimes identical issues. This might offer a fountain of validation in their otherwise parched intimate lives.
Yalom's therapeutic factors, such as instillation of hope, universality, and interpersonal learning, would obviously be integral in promoting self-awareness and empathy within the couples.
A retro-inspired marital group therapy would perhaps revisit and integrate the contributions of J.L. Framo, Dr. Murray Bowen, and Irvin Yalom to provide a comprehensive and systemic foundation for addressing relationship issues in a group modality.
The work’s already been done.
It’s just sitting there waiting for the mechanics of capitalism and the community of practice to pick it up, and integrate the latest findings of science-based couples therapies, and neuroscience…
A new, science-based group approach which also included discussions of attachment styles, neurotypes, and a Gottman and/or EFT informed group structure, could perhaps aid more couples more quickly, at a lower overall cost.
By exploring patterns of behavior, understanding intergenerational influences, and leveraging group dynamics, couples therapists might help more couples gain insight, develop coping strategies, and strengthen their relationships within a supportive community of peers, during a particularly testy time in history.
Integration of diverse approaches, but also different scientific disciplines can enhance a Marital Group Therapy experience…
I’d love to see a retro resurgent interest in ongoing Marital Group Therapy.
The recently retired Dr. Judith Coche described herself as an Interpersonal Architect who helped clients optimize the space between them so that they can thrive. Her work seeks a group dynamic that becomes a viable, simple and powerful living library.
She is the Founder and Director of The Coche Center, LLC, and has dedicated her career to transforming lives for individuals, couples, and families with children, adolescents and adults.
Unlike our earlier approaches, we now have the additional benefit of neuroscience, along with science-based, dyadic couples therapy to inform a syncretic Evidence-based Marital Group Therapy Model, as Judith Coche suggests.
In 1990, Judith and her late husband Erich published Couples Group Psychotherapy, a clinical practice model. It is a magnificent inclusive clinical model for group couples therapy that is superbly thoughtful as it is comprehensive.
Group work bring unique insights to the complex dynamics of relationships. In other words, we’ll have to be humble and learn the best practices of Marital Group Therapy instead of winging it.
Therapists, hopefully, will also draw from Framo's systemic perspective to analyze current interactional patterns, Bowen's Family Systems Theory to explore intergenerational influences, and Yalom's group therapy principles to enhance the therapeutic process within the group.
The therapeutic process may begin with an assessment of the couple's presenting issues and an exploration of their family backgrounds. Drawing from Bowen's concepts, the therapist may work with the couple to identify multigenerational patterns and emotional cutoffs that contribute to their difficult relationship dynamics.
A new model of ongoing Marital Group Therapy could provide couples a more social therapeutic modality in which to share struggles and successes, while experiencing the neurological luxury of helping to co-create a supportive therapeutic community.
Yalom's therapeutic factors, such as altruism and catharsis, come into play as couples witness the experiences of others and find commonality in their challenges. The therapist facilitates communication exercises, role-playing, and reflective discussions to help couples develop more effective ways of relating to each other.
What might be the benefits of a science-based Marital Group Therapy?
The overarching goals of marital group therapy align with many of principles advocated by Framo, Bowen, and Yalom:
Increased Awareness: Couples can gain insight into their own behavior, emotions, and relationship patterns. This heightened awareness is crucial for initiating positive changes. Therapists will eventually figure out how to provide corrective emotional experiences as they improve their new skills doing group work.
Improved Communication: The therapy process often involves enhancing communication skills, enabling couples to express themselves more effectively and understand each other's perspectives, but not only their spouse’s perspectives, but also other points of view within the group .I could see how a therapist might combine a curated set of neurotypes toward that end.
Breaking Negative Patterns: Through exploration and understanding, couples could conduct hard and hopeful work towards breaking negative interactional patterns that contribute to conflict, dissatisfaction, and meaningless suffering. Growth in group tends to be public, and can trigger a virtuous upward cycle.
Building Empathy: Yalom's principles of interpersonal learning come firmly into play, as couples develop empathy for each other, as the other humans in group validate and recognize shared struggles.
Strengthening the Relationship: Ultimately, the aim is to strengthen the relationship by fostering emotional connection, promoting individual growth, and building a foundation for long-term satisfaction.
Who says we always have to do it alone?
Final thoughts
Marital Group Therapy may face challenges, including the need for a balance between individual and collective focus, addressing sensitive issues within a group setting, and ensuring that all participants feel heard and validated.
If the notion of a new Marital Group Therapy Model finds any wider acceptance, we’ll have to step up to learn new clinical skills, and best practices, to create a safe and confidential space where more than one couple will feel comfortable sharing their experiences.
Additionally, the therapist's skill in navigating the delicate balance between guiding the group process while encouraging couples to take ownership of their own personal and relational growth is crucial.
A therapeutic protocol of ongoing assessments, and adjustments to therapeutic approaches may be necessary to meet the evolving needs of the couples within the group in real time.
While not for everyone, Marital Group Therapy, informed by the contributions of J.L. Framo, Dr. Murray Bowen, Irvin Yalom, and especially the scaffolding and structural work of Erich and Judith Coche might offers a comprehensive and holistic foundation for addressing current relationship challenges in a more effective way.
By integrating systemic Gottman/ EFT clinical perspectives, exploring intergenerational influences through a neuroscience lens, and leveraging group dynamics, couples therapists might empower their client-couples to navigate their issues, enhance communication, and build stronger, more fulfilling relationships more effectively in a group setting, at a lower cost.
Be well, stay kind, and Godspeed.
REFERENCES:
Alger, I. (1976). Multiple couple therapy. In P. J. Guerin (Ed.), Family therapy (pp. 364-387). New York: Gardner Press.
Boas, C. V. E. (1962). Intensive group psychotherapy with married couples. International Journal of Group Psychotherapy, 12, 142-153.
Boszormenyi-Nagy, I. (1987). Foundations of contextual therapy: Collected papers. New York: Brunner/Mazel.
Boszormenyi-Nagy, I., & Krasner, B. R. (1986). Between give and take. New York: Brunner/Mazel.
Boszormenyi-Nagy, I., & Spark, G. M. (1984). Invisible loyalties: Reciprocity in intergenerational family therapy. New York: Brunner/Mazel.
Buber, M. (1970). I and thou. New York: Scribner.
Capuzzi, D., & Gross, D. R. (1992). Introduction to group counseling. Denver, CO: Love Publishing.
Carter, M. M., Turovsky, J., Sbrocco, T., Meadows, E. A., & Barlow, D. H. (1995). Patient drop-out from couples group treatment for panic disorder with agoraphobia. Professional Psychology: Research and Practice, 26, 626.
Coche, J. (1995). Group therapy with couples. In N. S. Jacobean & A. S. Grumman (Eds.), Clinical handbook of couple therapy (pp. 197-212). New York: Guilford Press.
Craske, M. G., Zarate, R., Burton, T., & Barlow, D. H. (1993). Specific fears and panic attacks: A survey of clinical and non-clinical samples. Journal of Anxiety Disorders, 7, 1-20.
Derogatis, L. R., & Savitz, K. L. (1999). The Symptom Checklist-90-Revised, Behavior Symptom Checklist, and Matching Clinical Rating Scales. In M. B. Marush (Ed.), The use of psychological testing for treatment, planning and
Finchman, F. D., Fernandes, L. O. L., & Humphreys, K. (1993). Communication in relationships. Champaign, IL: Research
Flint, A. A., Jr., & MacLennan, B. W. (1962). Some dynamic factors in marital group psychotherapy. International Journal of Group Psychotherapy, 12, 255-361.
Framo, J. L. (1973). Marital therapy in a couples’group. Seminars in Psychiatry, 5, 207-217.
Gladding, S. T. (1995). Group work: A counseling specialty (2nd ed.). Englewood Cliffs, NJ: Merrill.
Gottman, J. (1994a). What predicts divorce? The relationship between marital process and marital outcomes. Hillsdale, NJ: Erlbaum Associates.
Gottman, J. (1994b). Why marriages succeed or fail. New York: Simon & Schuster.
Gottman, J., Notarius, C., Gonso, J., & Markman, H. (1976). A couples guide to communication. Champaign, IL: Research Press.
Gurman, A. S. (1971). Group marital therapy: Clinical and empirical implications for outcome research. International Journal of Group Psychotherapy, 21, 174-189
Hardy, J., & Lewis, C. (1992). Bridging the gap between long- and short-term group psychotherapy, Group, 16, 5-17.
Hargrave, T. D. (1994a). Families and forgiveness: Healing wounds in the intergenerational family. New York: Brunner/Mazel.
Hargrave, T. D. (1994b). Families and forgiveness: A theoretical and therapeutic framework. The Family Journal: Counseling and Therapy for Couples and Families, 4, 339-348.
Hargrave, T. D., & Sells, J. N. (1997). The development of a forgiveness scale. Journal of Marital and Family Therapy, 23, 41-62.
Hendrix, H. (1988). Getting the love you want. New York: Harper Perennial.
Jacobson, N. S., & Addis, M. E. (1993). Research on couples and couple therapy: What do we know? Where are we going? Journal of Consulting and Clinical Psychology, 61, 85-93.
Jacobson, N. S., & Christianson, A. W. (1996). Acceptance and change in couple therapy. New York: Norton.
Jones, L. G. (1995). Embodying forgiveness. Grand Rapids, MI: Eerdmans.
Klein, R. H. (1985). Some principles for short-term group therapy. International Journal of Group Psychotherapy, 35, 309-329.
Lichtenberg, J. W., & Knox, P. L. (1991). Order out of chaos: A structural analysis of group therapy. Journal of Counseling Psychology, 38, 279-288.
Lieberman, E. J., & Lieberman, S. B. (1986). Couples group therapy. In N. S. Jacobson & A. S. Gurman (Eds.), Clinical handbook of marital therapy (pp. 237-251). New York: Guilford Press.
Markman, H. J., Renick, M. J., Floyd, F. J., Stanley, S. M., & Clements, M. (1993). Preventing marital distress through communication and conflict management training: A 4 and 5 year follow-up. Journal of Consulting and Clinical Psychology, 61, 70-77.
McCullough, M. E., & Worthington, E. L. (1994). Encouraging clients to for-give people who have hurt them: Review, critique and research prospectus. Journal of Psychology and Theology, 22, 3-20.
McCullough, M. E., Worthington, E. L., & Rachal, K. C. (1997). Interpersonal forgiving in close relationships. Journal of Personality and Social Psychology, 73, 321-336.
North, J. (1987). Wrongdoing and forgiveness. Philosophy, 62, 499-508.
Papp, P. (1976). Brief therapy with couples groups. In P. J. Guerin (Ed.), Family therapy (pp. 350-363). New York: Gardner Press.
Perelman, J. (1960). Group treatment of married couples: A symposium. International Journal of Group Psychotherapy, 10, 136-142.
Sayger, T. V., Horne, A. M., & Glaser, B. A. (1993). Marital satisfaction and social learning family therapy for child conduct problems: Generalization of treatment effects. Journal of Marital and Family Therapy, 19, 393-402.
Sells, J. N., & Hargrave, T. D. (1998). Forgiveness: A review of the theoretical and empirical literature. Journal of Family Therapy, 20, 21-37.
Sells, J. N., & Hays, K. A. (1997). A comparison of time-limited and brief time-limited group therapy at termination. Journal of College Student Development, 38, 136-143.
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15-28.
Spielberger, C. D. (1991). State trait anger expression inventory. Odessa, FL: Psychological Assessment Resources.
Spielberger, C. D., Jacobs, G., Russell, S., & Crane, R. (1983). Assessment of anger: The State-Trait Anger scale. In J. N. Butcher & C. D. Spielberger (Eds.), Advances in personality assessment (pp. 112-134). Hillsdale, NJ: Lawrence Erlbaum.
Truax, C. B., & Carkhuff, R. R. (1967). Towards effective counseling and psychotherapy: Training and practice. Chicago: Aldine.
Yalom, I. D. (1985). Theory and practice of group psychotherapy (3rd ed.). New York: Basic Books.
