- the Way Forward
Ludwig.F. Lowenstein Ph.D
Southern England Psychological Services
Introduction and Abstract
We bear a great deal to-day about confrontation and most especially
the number of divorces and separations between initially, apparently
well-adjusted and harmonious couples. having dealt with several
hundred of such unfortunate people, I have come to certain conclusions,
that many marital problems, divorces and separations and also acrimonious
relationships that remain together, could be spared such ordeals,
if timely intervention occurred through mediation procedures. It
is unfortunate however that most of the problems to come to psychologists,
psychiatrists and counsellors deal with situations where the acrimony,
hatred and the apparent dissolution of relationships have gone too
far or can only be mended with great difficulty.
V/'hat follows in this paper has been divided into a research of
the most recent literature between 1996 and 1997 followed by the
diagnosis and treatment of ?4 marriage partners or partners without
marriage over a period of five years. The review of the literature
encompasses comparing different therapeutic approaches by therapists
and considering the general value of mediation to-day. ïhere
should be a section dealing with the causes and associated features
of marital problems including gender links, infidelity, power struggle,
violence in the family and other problems. This is followed by diagnosing
the problems of marital and relationship dysharmony and finally
dealing with treatment approaches including the following - role
playing, developing of empathy, eclectic psycho-dynamic treatment,
cognitive behaviour treatment, solution focusing, creating physical
and emotional closeness, education and other approaches.
Recent Research Literature
Family therapy researchers were criticised by Clark & Serovich
(199?) for failing to address themselves to the extent to which
marriage and family therapy does not recognise the importance of
gay, lesbian and bisexual issues.
The literature by Kelly and Halford (1997) attempted to redress
the balance in psychological study of couple relationships by focusing
on what is known about emotion in relationships. Emotional processes
in couple relationships were significant in understanding the quality
of the relationship, and the effect of the relationship on the partner's
psychological and physical health. Most research on emotion within
couple relationships had been cross-sectional in nature, comparing
distressed and non-distressed couples, and these findings were reviewed
in the first half of the article by these researchers, While such
research described differences in emotional processes between distressed
and non-distressed couples, it gave no information on how these
emotional processes developed over time. In the second section of
the article, the authors discussed the implications of these lines
of inquiry for therapy and research. Questions regarding the availability,
use and application of emotion data in clinical settings were addressed.
Current knowledge about how traditional behavioural marital therapy
impacted on emotional distress in couples was reviewed, and several
possibilities for improving traditional behavioural marital therapy
Another research study by Bennun (1997) discussed the literature
on systemic marital relationship interventions with one partner
only. Increasingly, marital therapists and agencies offered services
to distressed couples were seen just one marital partner and needed
to consider methods of treating relationships distress within this
mode. Some of the empirically established methods were described
as are general clinical issues.
1. General Values of Mediation
Whether there is any value on the mediation process is difficult
to establish as there are rarely studies which contain a control
group wherein no mediation occurs and hence comparisons can be made.
Welter (1995) contended that each marriage gad its beginnings and
its ending and a primary meaning of marriage that was often overlooked
by marriage counsellors was the story of the marriage. The counsellor
needed to obtain a family history or the antecedents of the marriage
story, from each of the spouses, then the story of their marriage.
Each partner was to provide information in connection with these
questions and then comparisons were to be made between the two versions.
In the case of divorce mediation and the resolution of child custody
disputes, Dillon & Emery (1996) examined the long term effects
of using mediation to resolve such problems. 25 parents who chose
mediation and 28 parents who chose litigation to resolve child custody
disputes were followed up 9 years after dispute was first brought
to court. Parents were asked whether the child involved in the dispute
had experienced difficulties in adjustment, and whether psychological
treatment was given. Frequencies of both direct and indirect contract
between the child and the non-resident parent were assessed, and
parents rated inter—parental cooperation and conflict. Non-custodial
parents assigned to mediation reported more frequent current contact
with their children and greater involvement in current decisions
about them. Parents in the mediation group also reported more frequent
communication about their children during the period since dispute
Following a decade of divorce mediation research which had focused
on outcome such as settlement rates, cost efficiency, client satisfaction,
effect on levels of conflict and cooperation, psychological adjustment
and compliance, Kelly (1996) still felt that research on the mediation
process and mediation behaviour had received very limited attention.
The main determinants of divorce settlement negotiations between
divorcing spouses and their lawyers, according to Hochberg &
Kressel (1996) was a favourable settlement outcome which led to
cooperative negotiating between the parties. It therefore followed
that psychological adjustment was for all concerned.
The role of children in mediation was studied by Lansky et al (1996).
They examined the actual practice of 324 practitioner members of
the Academy of Family Mediators focusing on the inclusion or exclusion
of children during the mediation process. 31(lf of respondents were
attorneys, 46% had graduate-level mental health backgrounds, and
an additional 7% had both legal and mental health backgrounds. The
survey instrument revealed that 77% of the respondents included
children, either following settlement to discuss the parenting plan
or during mediation as a source of additional Information. Respondents1
reasons for including (i.e. requests by the parents or children
to avoid impasse, due to divergent opinions among parents) or excluding
(i.e. to avoid pressure or loyalty conflicts) children were outlined.
The training of therapists was considered by Latz (1996). She studied
the administration and outcome of an experiential exercise for training
beginning marital and family therapists in language skills, which
aimed to sensitise individuals to the possibility of their own and
clients' idiosyncratic application of words. The exercise consisted
of two parts: Part 1 required individuals to interpret what they
had heard from the audio of a film clip. All those participating
had heard the same sounds and conversation, but each made a unique
interpretation. They expressed frustration and discomfort at having
to interpret only the audio portion. In the second part, the same
individuals were shown the visual clip along with the audio and
asked to share their descriptions. The multiplicity of meanings
and flexibility of actions that was noticed in the first part of
the exercise, disappeared in the second part.
Different kinds of mediation processes were compared by Vansteenwegen
(1997). Differences in the verbal behaviour of two experienced couple
therapists were studied in a videotaped intake session with the
same couple (2 professional actors, trained on a real case). One
therapist worked from an experiential viewpoint (cliënt—centred,
Rogerian) and the other worked from a communicative approach (directive,
problem-oriented). The therapists were both male, 40 years of age,
and had over 12 years of experience as psychotherapists. For all
verbal interventions the instrument utilised was the Pinsof Family
Therapist Coding System. The results suggested that the communication
therapist was more direct and his interventions were more directed
towards the couple rather than towards the individual partners.
At the same time many similarities were found between the two models.
A number of therapists have found that divorce mediation was a
difficult prospect especially when arguments arose within the meetings.
Greatbatch & Dingwall (1997) analysed the management of arguments
between disputants in 121 divorce mediation sessions recorded in
10 agencies in England. It was found that the disputants did not
always rely on mediators to initiate exits from their arguments.
Instead they initiated exits on their own, often closing their argumentative
exchanges without the mediators' assistance. The practices used
to exit arguments in the sessions were prevalent in ordinary conversation,
but their use here exhibited an orientation to conventions associated
with mediation. This limited both the duration of arguments and
the intensity of verbal conflict. These findings raised important
questions about the interactional organisation of mediation sessions.
Finally Worthington et al (1997) founded an approach termed Strategic-hope
focused relationship enrichment. They used a brief eclectic research
based programme to enhance couples' relationships. 51 couples,(16
married 24 cohabiting, 11 engaged) completed 5 sessions of enrichment
counselling. Couples who received enrichment counselling had higher
relationship satisfaction and quality-of-couple skills at post-test
and at the 3 week follow-up than did written assessment only (control)
couples. Conditions did not differ in terms of quality of overall
attraction or 2 measures of commitment. It was concluded that relationship
enrichment using this programme was effective, powerful and cost-effective.
There were relatively few studies in the recent literature dealing
uiith the prevention of relationship problems. Meyerstein (1996)
found the joining of families through re-marriage was a complex
process, particularly when children were involved. A host of ambivalent
feelings, role changes, marital adjustments, and new challenges
had to be faced. The format of brief systemic pre-remarital counselling
offered family members an opportunity to address the feelings and
multiple issues of transition. Within the counselling framework,
therapeutic ritual had been found to be a useful adjunctive technique.
The prevention of marital breakdown was studied by Clulow (1996).
He discussed 3 preventative paradigms commonly used for preventing
divorce. These were policing, medical and educational. A 4th paradigm
was suggested, a consultative approach, which implied a cyclical
rather than a linear view of life experience. The consultative paradigm
had the potential to integrate -not only the preventative paradigms
but also the concepts of prevention and cure that so often were
pursued as if they existed in separate compartments.
Finally, Fraenkel et al (1997) studied the rationale for a preventive
approach to helping couples in marriage. Uhile divorce rates were
high and many other couples remained together, but miserable, this
was surely not what couples desired from the outset. The conflict
and breakdown of these crucial relationships contributed to mental
and medical health problems for adults and children, behavioural
disturbances in children, problems in worker productivity, and serious
economic difficulties for families and societies, Too many couples
sought help only after significant, often irreversible, damage had
occurred. It did not have to be that way. A variety of approaches
were available that were capable of being used to teach couples
the skills, behaviour0! and attitudes of good relationships before
they encountered damage to their union. Here, one particular cognitive
behavioural approach was used, along with a review of the research
on the effectiveness of such approaches and a description of some
of the strategies of this model. A list of common roadblocks to
the work of prevention was discussed, along with a couple of brief
case examples. It was felt that there was reason to believe that
couples could benefit a great deal from prevention.
Causes and Associated Features
In this section we will discuss the causes and associated features
with marital disharmony and the need for mediation. These included
gender links, infidelity, power struggles, lack of fertility in
one or both partners, work addiction, violence between partners,
physical handicaps with one or both partners, alcohol mis-use and
lack of communication between the partners.
1. Gender Links
Several studies allude to gender links as important aspects in
mediation processes. O'Donohue & Crouch (1996) discussed whether
communication training programmes in marital therapy had been sufficiently
sensitive to gender—linked factors in communication, through
a research review. Communication was often a treatment target in
marital therapy. Although existing data indicated that individuals
tended to hold stereotypes of gender differences in language, many
of these differences had not been supported in empirical investigations.
Gender influences variables such as amount of conversation elicited,
length of utterance, use of qualifying phrases, swearing and compliment
style. Effective communication therapy had to be facilitated by
evaluating each partner's gender-based expectations of his/her own
communication behaviour and those regarding communication of the
other partner. It was feit that a number of personality and situational
variables moderated some of these effects, and need to be considered
Gregory & Leslie (1996) examined the effect of the race and
gender of 63 clients and therapists, aged 20 - 40+ years, on their
male (aged 21-52 years) and female (aged 21.57 years) partners'
assessments of an initial and subsequent family/marital therapy
session. The individuals, belonging to Black & White families,
evaluated the first and fourth therapy sessions using the Session
Evaluation Questionnaire, which evaluated therapy smoothness. A
strong effect for race was found, with Black females rating the
first sessions with a White therapist more negatively than White
females. Black males had a more positive response than Whites to
the first session, regardless of the therapist's race. The therapist's
sex had no significant effect on the client’s session assessment.
The effect of the therapist's race decreased over time. Only the
Black females with White therapists experienced an increase in smoothness
A comparison was carried out between levels of sexism and feminism
in the clinical decisions made by marriage and family therapists
who had no training in gender issues with those who had such training,
either through a separate course or by integrating gender issues
throughout the curriculum. (Les l ie &•. Clossick, 1996).
150 entry-level marriage and family therapy students or therapists,
aged 21-64 years) were assessed for the type of gender training
received and whether the gender course was taught from a feminist
perspective. Levels of feminism and sexism in clinical assumptions
and interventions of the individuals were evaluated using clinical
vignettes. Of the 102 individuals with some gender issue training,
64%- had received it from a feminist perspective. Though gender
training alone did not influence levels of sexism and feminism in
clinical decision making, levels of sexism were significantly lower
for individuals who had received gender coursework from a feminist
Finally, .Stabb et al (1997) found differential treatment by gender
had been an on-going area of concern and uncertainty both in society
at large and in clinical research. In this investigation, the attributions
of a 50 year old white male marriage and family therapist were coded
and analysed over the course of therapy for three different married
couples to determine if cause for positive and negative events was
assigned differentially to females and males,
Additionally, the stability and globality dimensions of the therapist's
attributions about the couples were examined for stereotypical gender-related
patterns. The results indicated no gender differences in locus of
causal attribution but some gender-related patterns in stability
and globality dimensions.
2. Infidelity as a factor
Despite the commonness of infidelity in marital problems only two
studies in recent years existed. Atwood & Seifer (1997) discussed
the sociocultural definitions of extramarital sex that influenced
the reasons couples constructed for involving themselves in extramarital
sex. Information was presented on their typical psychological reactions,
taking into account current research. The article presented a review
of what was known and the research on extramarital sex and then
concentrated on marital meaning systems -their development and maintenance
- focusing on social constructionist themes and therapy which served
to shift the focus of a problem-oriented approach towards a search
for the strengths of the extramarital sex couple. A 4-stage constructionist
therapeutic model was proposed. The stages included (1) joining
the family meaning systems, (2) inviting the couple to explore their
present meaning systems, (3) inviting the couple to expand their
meaning systems, and (4) stabilising the new meaning systems. This
approach allowed the couple to construct new meanings around the
extramarital sex issue so that they were able to find a workable
Using cross-cultural perspectives to understand infidelity in couples,
Penn et al (1997) found that all marital therapists encountered
a couple who had been or who were affected by infidelity. The literature
on infidelity lacked an understanding of its impact on cultural
perspectives. This article discussed the ways in which infidelity
was viewed within the context of three ethnic minorities in the
United States: African Americans, Hispanic Americans, and Asian
Americans. The authors provided an overview of infidelity according
to religious traditions.
3. Mediation of power struggles
Only one study referred to power struggles, this being of Gray-Little
et al (1996). It examined the association of marital power type
to (1) marital adjustment, and (2) response to behavioural marital
therapy. A behavioural measure was used to classify 53 distressed
couples into egalitarian, husband-dominant, wife dominant or anarchic
power patterns. Marital adjustment was assessed by measures of marital
satisfaction, desired relationship change and two communication
indexes. At pre-treatment, egalitarian couples showed the best overall
marital adjustment and anarchic couples showed the worst; at post-treatment,
egalitarian and wife-led couples reported the highest marital satisfaction,
and anarchic couples reported the lowest. Wife dominant couples
improved the most, reporting increased marital satisfaction and
demonstrating improved communication. The discussion considered
the special treatment needs of anarchic couples for whom improved
communication occurred in a context of continued marital dissatisfaction.
4. Fertility Problems
Only one study, that of Jones and Hunter (1996) concerned itself
specifically with infertility experiences. they studied three couples1
experiences of fertility problems in the early stages of investigation;
men and women were interviewed together and separately and their
accounts of infertility were analysed using a discourse analytic
approach. The method involved examining the narrative text for theses
relevant to the question, identifying accounts used by participants
to explain their experiences and hypothesising about the functions
of this accounting practices. The participants reported that non-conception
was not always a problem to them, but that this varied depending
on time, biology, life plans, relationships within which it was
being discussed. The subjectivity of people with fertility problems
appeared to be less consistent and more contextually contradictory
5. Work Addiction
With the increased tendency towards the work ethic, work was considered
an important aspect of marital problems by Robinson (1996). He studied
the relationship between work addiction and family functioning.
A theoretical model was presented which suggested that a relationship
existed between work addiction, family of origin, and family functioning
in adulthood. A review of the pertinent literature was presented
followed by a case example and clinical implications for the practice
of marriage and family therapy.
6. Violence within the relationship
Although a conmon issue, violence within the relationship only
received one piece of research over the past years. Ehrensaft &
Vivian (1996) used questionnaires and clinical interviews to reveal
that over 6Cf?> of couples seeking marital therapy experienced
physical violence in their relationship. However, fewer than 10°£
of these couples spontaneously reported or identified the violence
as a presenting problem. Spouses' explanations for not spontaneously
reporting couple violence were examined in 1J6 clinic couples. The
top three reasons were as follows: (1) it was not a problem, (b)
it v/as unstable or infrequent, and (c) it was secondary to or caused
by other problems. There were no gender differences in this regard.
Further, there were no differences regarding explanations offered
for failure to report partner violence versus own violence. However,
differences were found between mildly and severely aggressive spouses
and between husband to wife and wife to husband violence.
7. Physical Handicap and marital problems
Speziale (1997) examined the changes in couples living with multiple
sclerosis, particularly when sexual, cognitive and affective functioning
had been affected. Two case studies of couples in whom the female
partners had M.S. were presented and clinical intervention, divorce
and extramarital relation-ships among couples living with MS were
discussed. The author recommended a pre-requisite clinical assessment
of how the intrusion of MS disrupted the roles, rules, and boundaries
of the marital and sexual relationship, and the larger social systems
in which partners participated (including personal and familial
histories of physical and psychosocial losses, life crises, stigmatised
social identities, and socioeconomic hardship, It also included
unresolved grief, depression, shame, and family secrets. The author
suggested that the partners benefited from knowledge about MS, prescribed
drugs and symptom management techniques,
8. Alcohol Mis-use and relationship problems
Again only one study in recent years discussed the importance of
alcohol mis-use leading to marital disorders (Hotunda & O'Parrell,
1997). Clients with alcohol and other substance use disorders were
routinely encountered by practitioners in various treatment settings.
This article traced the rationale for using marital and family therapy
with alcoholics and described an ongoing behavioural marital therapy
programme that exemplified an integration of clinical practice and
research in this area. Specific treatment suggestions were offered
and practical considerations for therapists working with families
struggling with alcoholism were discussed including the role of
self-help groups in family treatment, the danger of having preconceived
notions about "alcoholic families", and the necessity
for clinics and clinicians to possess the capacity to assess and
treat comorbid psychological disorders as well as addictive behaviours.
9. Lack of communication within marital relationships
Deterioration in communication patterns had been empirically linked
to eventual separation and divorce in married couples, (Hoss and
Estrada, 1997). This article drew on this research in describing
a clinical intervention for use with couples in conjoint therapy.
The intervention involved the use of a brief videotaped interaction
task, which was completed by the couple at the outset and repeated
periodically through the course of marital therapy. The potential
utility of this intervention as both a clinical assessment and treatment
tool with a wide range of couples was discussed and a brief case
example of the intervention was provided.
The question of what makes relationships last or not last was considered
by McCarthy (1997). Rather than an indication of lifetime commitment,
the predominant form of marriage in western societies had become
"companionate". It was held together by personal and emotional
consideration rather than by traditional influences. The pursuit
of personal satisfaction was an essential factor in marital relationships
and, as a result, marriage had become less secure. One result of
this was the growth of counselling services which aimed to assist
couples through the process of negotiating relationships or in coming
to terms with the emotional distress of failing to do so. This research
attempted to address some of the concerns about the supposed lack
of research on the impact of counselling. It focused on evaluation
of marriage counselling provided by an agency operating in the field
of relationship counselling. The evidence suggested counselling
was able to help couples re-negotiate their relationships and help
them through the personal anxieties connected with relationship
problems. It clearly had a role to play in helping people through
the complexities of companionate marriage, although it did not work
for everyone and many couples who started counselling did not complete
The Diagnosis of Marital Mediation Processes
The importance of not merely assessing situations or problems relating
to marital relationship difficulties, there should be the assessing
of individuals especially in a relationship conflict, (Lowenstein,
1994) Marital mediation or therapy must involve the individuals
and Lowenstein discussed the position of the big "T" and
little "t" i.e. those who seek thrills and likely to be
very extroverted personalities and those who do not seek such excitement
and may be more introverted. Little "t" individuals are
more eager for harmony and are conservative in their personality
traits. While opposites attract in a relationship, the more the
individuals have in common, the more likely the marital relationship
will work except in one area, that of seeking control or dominance.
Areas where there are likely to be difficulties between big "T"
and little "t" individuals are in the rate of infidelity
where big "T" may predominate, also in sexual dissatisfaction
and problems, attitudes to love, marital abuse and spouse abuse.
Sometimes there are additional difficulties between extroverts and
introverts or big "T" and little "t"'s in relation
to caring for children, dealing with household chores, division
of labour, recreation interests, religious differences and the handling
of money. It is vital when carrying out mediation processes to make
each partner aware of their strengths and weaknesses and to discuss
these individual differences in the diagnostic sessions.
Attributions and behaviour in functional and dysfunctional marriages
v/ere studied by Bradbury et al (1996). The study examined whether
spouses' attributions for partner behaviour were related to their
own behaviour by assessing their attributions and observing the
problem-solving discussions of couples in which (a) neither spouse
was depressed or maritally distressed, (b) the wife was depressed
and both spouses were maritally distressed, and (c) the wife was
not depressed and both spouses were maritally distressed. To the
extent they made maladaptive attributions, wives displayed less
positive behaviour and more negative behaviour. Husbands' attribution
and behaviour were unrelated, and associations between attributions
and behaviour v/ere not moderated by marital distress and depression.
These results highlighted the need to clarify how partner behaviour
contributed to the attributions spouses made and to is-examine interventions
designed to modify attributions in marital therapy.
Wilson & Wilson (1996) considered that there were multiple
selves operating within relationships. They asserted that the issues
presented by couples in relationship therapy were to be regarded
as an example of negative (dysfunctional) multiple selves. The author
clarified the role of multiple dysfunctional selves and their influence
on each partner within a relationship. It was proposed that this
provided the therapist with specific Information regarding the client’s
diagnosis and intervention strategies. This consisted of 10 selves
(e.g. telic, paratelic, arousal-avoiding, excitement—seeking,
the conformist, negativistic types. Finally Bagarozzi (1997) suggested
a Marital Intimacy Needs Questionnaire. He discussed the construction
of the Marital Intimacy Needs Questionnaire which contained information
on satisfaction with the intimacy in marriage which was thought
to be an important aspect of a successful marriage. For marry clinicians
and family researchers, intimacy had been narrowly conceptualised
as a unidimensional construct and unidirectiorial process. The author,
however, conceptualised intimacy as a multi-faceted construct, and
identified 9 dimensions of intimacy, each having 4 inter-related
components. Clinical assessments of these dimensions and components
were accomplished by the use of the Marital Needs Intimacy Questionnaire.
Treatment Approaches in Mediation
The recent research suggested at least 11 approaches for the treatment
of marital or relationship dysharmony. They included the following:
(1) role planning, (2) developing empathy; (5) Pro-social development;
(4) Eclectic Psychodynamic approaches; (5) Cognitive behaviour therapy;
(6) Solution focus tests; (7) Physical Emotional Closeness Development;
(8) Family of Origin Approach; (9) Involving Clergy; (10) Emotionally
Focused Therapy; (11) Education-type Therapy.
1. Role Planning
Cohen et al (1996) assisted parents by mediation, in the transition
from being a nuclear family to a bi-nuclear family. During the process,
the needs of the children v/ere taken into consideration and the
particular difficulties of the parents, who no longer functioned
as a couple rather as two independent individuals jointly responsible
for rearing their children. A way was proposed to create a common
basis for discussion between the two spouses, who were in a conflictual
situation, in order to jointly plan their parenthood in terms of
times, roles and content.
As a result in the dramatic increase in women's participation in
the work force, more relationship therapists were seeing couples
who were dissatisfied with how domestic labour was divided in their
homes (Rasmussen et al, 1996). This paper was an effort to delineate
some of the complex therapeutic issues such as engaging men in therapy,
exploring emotional issues connected with house-work, and the mechanism
of gatekeeping or the tendency of many wives to resist or manage
their husbands' efforts to increase participation in the home. Also
included was a therapeutic framework for addressing client concerns
about domestic responsibilities.
Another study by Worthington (1996) considered health and productivity
as important values in the 20th century American society. As business
companies had had become more major players in delivery of mental
health services via managed mental health care, the value placed
on productivity had become even more important than in the past.
Here the impact of managed mental health care on marital and family
interventions was discussed. Implications for helping marriages
and families were grouped as follows:
- improvement of effectiveness and efficiency of marital and family
- documentation of effectiveness and efficiency of marital and
- shift to more focus on health and prevention,
- identity of providers of services that helped marriages and
- training of providers of services to marriages and families.
2. Developing Empathy
The inverse relationship between depression and intimacy was conceptualised
as a function of the couple's affective experience, with empathising
as the specific mediating factor. Depression, as a disorder of excessive
self-focusing was amenable to treatment approaches that helped to
shift the focus of concern from self to others, as found by Odegaard
(1996). This shift occurred in couple treatment when the underlying
negative affect of the caretaking partner was accessed and used
to pull the depressed one out of self-absorption and into an empathy,
other-focused experience. Prolonged caretaking and chronic depression
led to a breakdown in a couple's empathising capacity, as the caretaker's
experience of fear, helplessness, or frustration activated old coping
patterns of withdrawal or over—functioning such as use of
control, while the depressed one slipped into further self-absorption.
Unmasking the caretaker's despair activated the other's empathy,
facilitating movement out of the self-absorption. Depression was
in fact, in part, a consequence of under-utilised empathy.
3. Pro-social development
Rudd (1996) considered the communication effects on divorce mediation:
how participants' argumentativess, verbal aggression and compliance-gaining
strategies were used in mediation. She investigated the relationship
among participants' argumentativeness, verbal aggression and the
use of compliance— gaining strategies and their level of satisfaction
with the divorce mediation process. 87 couples who participated
in court-related divorce mediation, specifically to settle child
custody and visitation issues, were interviewed. The results of
a stepwise regression analysis indicated that the more participants
used prosocial compliance-gaining strategies the more satisfied
they were with the mediation. Similarly Lowenstein (1998) studied
Parental Alienation Syndrome and saw a 2-step approach towards a
solution. The first considered motivation towards participation
in the mediation process, having hovering over them, the possibility
of legal or judicial sanctions if this could not be achieved through
mediation. The second step was to use the court procedure for the
purpose of settling those who were unable to benefit from the mediation
process, and most especially that party which failed to cooperate
in that process. In a later study, Lowenstein 1998b in an unpublished
study, the author presented the value of the Expert Witness in dealing
with couples in a conflict situation, often concerning their children
and who should have custody of them. He suggested several approaches
including (1) sectarian approach; (2) the Expert Witness as an Independent
Arbitrator, and presented the results of mediation as compared with
the use merely of the legal system and the courts. It was found
that as many others had found that of those who participated in
arbitration and mediation, they achieved greater satisfaction than
those brought into the legal system and the adversarial system most
particularly using only solicitors within the conflict situation.
4. Eclectic Psycho-dynamic Therapeutic Approaches in Mediation
Schoenewolf (1996) in an article with the intriguing title, "The
Couple who fell in hate", studied couples in which the husband
was passive and the wife aggressive u/ho were a common sight in
to—day's therapy clinics. Such couples u/ere difficult to
work with because they had become addicted to their ritual of hate,
which offered each a secondary gratification. To work with them,
therapists often needed to be creative and utilise eclectic approaches.
In the case described, the therapist used a paradoxical behavioural
approach combined with psychoanalysis.
5. Using Cognitive Behaviour Therapeutic Approaches in Mediation
Cognitive behaviour therapeutic approaches in marital conflict
were used by Cheung (1996). He used the problematic concept of attribution,
which had received increasing attention in cognitive behavioural
marital therapy. Research had found that the attribution dimensions
of source, globality, stability, intent, and voluntariness were
related to the marital distress and conflict behaviours. It was
proposed that there were three levels of events for which a spouse
had to make attributions: the episode level, the behaviour level,
and the global relationship level. Different reattribution techniques
needed to be employed to target attributional change at appropriate
levels of conflict attributions.
Individual behavioural cognitive therapy in marital problems related
to depression were used by Emanuels-Zuurveen & Emmelkamp (1996).
37 depressed individuals, aged 18-65 years, experiencing marital
distrsss were randomly assigned to either individual behavioural
cognitive therapy or marital therapy. The individual treatment condition
focused on depressed mood, behavioural activity and dysfunctional
cognitions, whereas in the marital condition the partner was involved
in the treatment and the focus was on the communication process
in the marital relationship. Multiple analysis of variance revealed
that treatment led to statistically significant improvements in
depressed mood, behavioural activity and dysfunctional cognitions,
an increase in relationship satisfaction and improvement of communication
in patients and spouses. A significant interaction effect was found,
showing that marital therapy had more impact on relationship variables
than the individual treatment.
6. Solution focused mediation therapy
Solution—focused therapy mediation was used by Franklin (1996).
Processes of change were illustrated in a marital case study in
which solution-focused therapy was being applied. This approach
focused on stabilising semantics and politics at level one and on
changing semantics and politics at level two. The individuals made
progress in therapy as indicated by verbal reports and scores on
7. Developing physical emotional closeness in mediation therapy
Durana (1996) used quantitative and qualitative research methods
to evaluate the impact of bonding i.e. physical closeness and emotional
open-ness) and catharsis in the Bonding and Emotional Re-education.
73 adults were assessed by means of measures of marital adjustment,
self-esteem, depression, anxiety, control and support. The results
suggested that Bonding and Emotional Re-education in marital adjustment
led to greater affection, satisfaction and self-esteem. The study
explored differences in changes for males and females. Exploratory
findings indicated that the Practical Application of Intimate Relationship
Skills approach was useful for distressed couples and suggested
that there was a gender difference associated with changes in marital
8. Family of Origin Approach in Mediation Therapy
An example of this was by Kane (1996) who used an experiential
approach to family of origin work with marital and family therapy
students. The incorporation of a day workshop into an introductory
course on marriage and family therapy for graduate counselling students
was described. In this workshop, participants moved through a series
of experiential exercises that invited affective involvement with
family-of-origin dynamics. However, because educators had to evaluated
the work of trainees, they had to avoid engaging students in affective
work for fear of entering into dual roles. By including a therapist
whose only function in the programme was to facilitate the trainees'
family of origin work, training programmes were to incorporate this
component without blurring the roles of instructor and therapist,
A similar approach was used by Framo (1996). He presented a generally
technique for using the family of origin as a therapeutic resource
for adults in marital and family therapy. Marital and family difficulties
were viewed as elaborations of relationship problems of the spouses
in their original families, so sessions with the family of origin
were considered a possible basis for reconstructive changes in the
present family setting.
9. Mediation therapy involving the clergy
Weaver et al (1997) examined the need for greater collaboration
between clergy and marriage and family therapists. Several reasons
for collaboration were outlined including that clergy are frequently
asked to address marital and family problems and religion played
an important role in family and marital coping and support strategies.
This was not accepted by everyone concerned. In addition, marriage
and family therapists acknowledged the highest rates of religious
involvement of any mental health profession, placing them in a unique
position to be involved in the continuing education of clergy. The
authors stressed the need for therapists and clergy to use each
other's resources for training purposes, clinical evaluative and
referral skills, and information on domestic violence and child
abuse, as well as other family issues.
10. Emotionally Focused Couple Therapy
Hannah et al (1997) examined the extent to which a brief, structured
couples therapy programme based on Imago Relationship Therapy was
associated with improvements on the COMPASS scales of individual
psychological functioning as well as on a measure of relationship
satisfaction, the Marital Satisfaction Inventory (MSl). Individuals
were 9 heterosexual couples, all aged 26-58 years, referred for
therapy. An examination of pre to post treatment differences revealed
statistically significant differences on three of the four COMPASS
scales and all 3 MSI scales. The rate of improvement in individual
distress per couples therapy session was approximately equal to
the improvement, found in previous studies, yielded by individual
therapy. The results supported previous findings that couples therapy
was likely to be effective for the treatment of intra-personal difficulties
and suggested that both relationship and individual distress indices
should be utilised in the evaluation of the efficacy of marital
Predictors of success in emotionally focused marital therapy were
examined by Dohnson & Talitman (1997). They examined client
variables expected to predict success in emotionally focused marital
therapy. The relationship of attachment quality, level of emotional
self-disclosure, level of interpersonal trust, and traditionality
to the therapy outcome variables, marital adjustment, intimacy and
therapist ratings of improvement were examined, 34 couples, mean
age 22—60 years participated. The couples were given 12 sessions
of emotionally focused marital therapy. At the end of the treatment
and at a 3 month follow-up, the couples' marital adjustment and
intimacy level were assessed using various rating scales. Overall,
therapeutic alliance predicted a successful outcome; the task dimension
of the alliance in particular predicted couples1 satisfaction. Couples
who made the most gains at follow—up also indicated lower
initial marital satisfaction and included males who indicated lower
levels of use of attachment figure on the attachment measure at
intake. The couples most likely to be satisfied after the 12 sessions
of emotionally focused marital therapy and at follow-up were couples
who made a positive alliance with the therapist and, more specifically,
who saw the task of this approach as relevant to their problems.
11. Education approach using mediation therapy
Arbuthnot et al (1997) studied the patterns of relitigation following
divorce education. Two groups of parents were tracked for two years
following their divorce: a group of 89 who attended a mandatory
divorce education class and a comparison group of 23 who did not.
The two groups did not differ in any assessed demographic or family
characteristics. At the follow—up assessment, the parents
who attended the class had relitigated over all issues, less than
half as often than those who had not attended the class. Moreover,
rate of relitigation was related to mastery of skills learned in
the class. The results were discussed in terms of the needs for
outcome evaluation and design of education programmes for divorcing
Finally, Dohnson (1997) commented on marital therapy and suggested
that the new "gold standard" for outcome in marital therapy
was a 50% success rate. The author contended that the 50^ success
rate in marital therapy, whether success was defined as improvement
or recovery, was in no way accepted by the leading proponents in
the field as an acceptable or sufficient standard of success in
Summary of the Research of Mediation
Virtually all research into the process of mediation and most especially
the process of mediation regarding warring partners and their relationship
indicated positive or more positive outcome than that through legal
channels. It would appear that the mediation process provides not
merely the opportunity of individuals in conflict to solve their
problems through this procedure but even when the relationship has
ended, mediation can play an important part in developing harmony
between the partners. This must be seen as essential especially
in relation to off-springs which both partners share. Numerous mediators
report that frequently individuals in a relationship come too late
to the mediation process. This led to acrimony between the partners
with difficulties which were almost impossible to solve through
mediation procedures. Even here however there is the possibility
of achieving something or much more than through the legal process
of the courts or through solicitors.
The assessment of the research is of fairly recent years and points
to and compares to various therapeutic approaches used by therapists
and mediators with warring partners. Some of the causes or associated
features noted were gender links, infidelity, power struggles, violence
in the family and numerous other problems. The paper their considers
ways of diagnosing the problem of marital and relationship dysharmony
and finally with the therapeutic or treatment approaches such as
role playing, developing empathy, eclectic psycho-dynamic treatment,
cognitive behaviour therapy, solution focusing, creating physical
and emotional closeness, education and other approaches.
If nothing else, the mediation process, if used alongside the legal
process in marital dysharmony can prove to be effective in stabilising
situations that exist between once close partners, and their children.
The research, of course as always indicates the importance of preventing
parental or relationship splits by establishing or re-establishing
communication links after a diagnostic approach to the marital relationship
problem has been completed.
The Mediation Process viz a viz - 100 consecutive referrals to
a thorapeutic centre
Couples often fail to realise they have relationship difficulties
until it is toe late or until there is no way back to the re-establishing
of a relationship. Often partners have sought others outside marriage
or have been so disillusioned with the relationship that they deem
it impossible to seek a reconciliation. There are however instances
when some glimmer of hope still exists wherein both partners, one
often more than the other, seek for the benefit of themselves and
even more for their children, to seek a rescue of their relationship.
V/ha t follows will bc? the delineation of the causes of marital
difficulty and how they were diagnosed and ultimately treated within
Representative Causes Among marital Couples
The representative causes of marital dysharmony and eventual abandonment
of one partner or the other to the relationship are discussed in
Table.5. under frequency of diagnosed cause (problems of dysfunction).
It will be noted that the causes are rarely singular but rather
multitudinous. The most common is a general feeling of malaise or
feeling that the relationship is over and that one or both partners
no longer feel loved or love towards the other partner. This rather
general view needs to be explored carefully in order to ascertain
what are usually other specific causes related to the marital difficulty.
Also important are frequent heeded arguments and sulking within
the relationship, poor or negative communication, sexual problems
Therapeutic Approaches Adopted
The most common therapeutic approach adopted was a combination
of cognitive and behavioural approaches. Rarely were cognitive methods
on their own or behavioural methods used or psychodynamic procedures.
Couples tended to need the feeling that there was a problem which
could only be sorted out with the help of an expert. Often they
relied too heavily on the expert to provide a solution to their
problems and it was made clear to them that without them having
control ultimately over the situation and participating effectively
with the guidance of the therapist, little could be achieved.
Most couples referred themselves for help usually by one partner
encouraging this. Others were referred by General Practitioners
or friends but generally the motivation towards having help was
there, although it varied in intensity. Once it was made clear to
the couples that there was no "magic wand" that could
be waved which would resolve all difficulties, but it had to be
worked at conscientiously, intensively and with the guidance of
the therapist better results were possible, although in some cases,
no positive result was obtained. A number of couples however benefited
from the sessions, even though their marriage could not be saved.
They were able to resolve their conflicts and parted as amicable
as possible. This naturally was beneficial to themselves as veil
as to any children who were present.
The results are delineated in Tables 1-8.
Table 1 indicates that most couples referred themselves for help.
Table 2 shows that most marital problems occurred in the early
years between 18 and 45. 3Ocio-economic backgrounds tended to favour
upper and middle class groups with working class couples being somewhat
less likely to refer themselves of be referred for marital therapy,
Table 4 indicates the motivation to participate in the mediation
process was important although some couples considered that the
mediation process occurred too late or uncertain of its outcome.
After the first session however there was almost immediate change
of view and more positive or optimistic notions were expressed as
to how the process of mediation could work favourably.
The frequency of diagnosed causes or problems in the dysfunctional
relationship showed that the initial number was much higher than
the ultimate number when some success had been achieved.
On the whole, there were relatively few treatment sessions for
most clients. It was unfortunate that 15 of the clients dropped
out before the completion of the sessions for them which might have
improved the results indicated in Table 8, "Immediate Outcomes".
10$ of the couples had a relationship which was dissolved with still
remaining conflict while a good number also had a relationship dissolved
with little outcome conflict remaining. About half of the individuals
were able to rescue their relationship.
Table 1 - Source of Referral
|G.P. or other Professional
|Others e.g. friend
Table 2 - Ages of Clients
Table 3 - Socio-economic background
|Upper and Middle class
|Out of work or retired
|G.P. or other Professional
|Others e.g. friend
Table 4 - Motivation to Participate in Mediation Process
After 1st session
|Expressed feeling it might be too late
Table 5 - Frequency of Diagnosed Cause (problem) of Relationship
After 1st session
|Generally feeling of being out of love
|Frequent heated arguments, sulking etc.
|Poor or negative communications
|Alcohol or other substance abuse
|Mental health problems (depression, paranoid behaviour, manic
|Physical illness or its effects on relationship
|Child rearing difference
*Most couples and individuals gave a number of reasons
Table 6 - Method of Treatment Employed
Table 7 - Number of Treatment Sessions Required
|Dropped out of treatment before completion
Table 8 - Frequency of Diagnosed Cause (problem) of Relationship
Follow-up Outcome 1 year later
|Relationship very much improved
|Relationship somewhat improved
|Relationship dissolved with little outcome conflict
|Relationship dissolved with remaining conflict
The mediation process has a valuable role to play in the dynamics
of resolving marital problems or relationship difficulties between
Even when marriages or relationships are over, mediation processes
can do a great deal to make a reduction of conflict possible
between the individuals in the former relationship.
- Arbuthnot, J.; Kramer, K.N.; Cordon, D.ft.; (1997) Patterns
of relitigation following divorce education. Family & Conciliation
Courts Review. Jul. Vol 35(3), 269-279.
- Atwood, J.D.; Seifer, M.; (1997) Extramarital affairs and constructed
meanings: A social constructionist therapeutic approach. Am. Journal
of Family Therapy, 1997, Spr. Mol 25(1) 55-75.
- Bagarozzi, D.A.; (1997) Marital Intimacy Needs Questionnaire:
Preliminary report. American Journal of Family Therapy, 1997 Fal.
Vol 25(3), 285-290.
- Bennun, ].; (1997) Systemic marital therapy with one partner:
A reconsideration of theory, research and practice. Sexual and
Marital Therapy, 1997, Feb, Vol 12(1 ), 61-75.
- Bradbury. T.N.; Beach. S.R.; Fincham. F.D.; Nelson, G.M.; (1996)
Attributions and behaviour in functional and dysfunctional marriages.
Journal of Consulting & Clinical Psychology; 1996 3un. Vol
- Cheung, S,; (1996) Cognitive behaviour therapy for marital conflict:
Refining the concept of attribution. Journal of Family Therapy,
1996, May, Vol 18(2) 183-203.
- Clark, W.M.; Serovich, J.M.; (1997) Twenty years and still in
the dark? Content analysis of articles pertaining to gay, lesbian
and bisexual issues in marriage and family therapy journals. Journal
of Marital & Family Therapy, 1997, Jul, Vol 23(3), 239-253.
- Clulow, C.; (1996) Preventing marriage breakdown: Towards a
new paradigm. Sexual and Marital Therapy, 1996 Nov. Vol 11(4)
- Cohen, P.; Dattner, N.; Luxenburq A.; (1996) Planning parenthood
in the divorce transition - through-mediation. American Journal
of Family Therapy, 1996, Sum, Vol 24(2), 181-188.
- Dillon, P.A.; Emery, R.E.; (1996) Divorce mediation and resolution
of child custody disputes: Long term effects. American Journal
of Orthopsychiatry, 1996 Jan, Vol 66(1) 131-140.
- Durana, C.; (1996) Bonding and emotional re-education of couples
in the Pairs training: Part II. American Journal of Family Therapy;
1996 Win. Vol 24(4) 315-328.
- Ehrensaft, N.K.; Vivian, D.; (1996) Spouses1 reasons for not
reporting existing marital aggression as a marital problem. Journal
of Family Psychology, 1996 Dec. Vol 10(4) 443-453.
- Emanuels-Zuurveen, L.; Emmelkamp. P.M.G.; (1996) Individual
behavioural-cognitive therapy v marital therapy for depression
in martially distressed couples. Br. Journal of Psychiatry, 1996,
Aug, Vol, 169(2),181-188.
- Fraenkel, P.; Markman, H.; Stanley, S.; (1997) The prevention
approach to relationship problems. Sexual and Marital Therapy.
1997 Aug. Vol 12(3), 249-258.
- Framo, J.L.; (1996) Family of origin as a therapeutic resource
for adults in marital and family therapy: "You can and should
go home again". Therapie Familiale, 1996 Vol 17(3), 367-390.
- Franklin, C.; (1996) Solution-focused therapy: A marital case
study using recursive dialectic analysis. Journal of Family Psychotherapy.
1996 Vol 7(1), 31-51.
- Gray-Little. B.; Baucom. D.H.; Hamby. S.L.; (1996) Marital power,
marital adjustment, and therapy outcome. Journal of Family Psychology,
1996, Sep. Vol 10(3), 292-303.
- Greatbatch, D.; Dinguall, R,; (1997) Argumentative talk in divorce
mediation sessions. American Sociological Review, 1997 Feb. Vol
62(1 ), 151-170
- Greqory, N,A»; Leslie, L.A.; (1996) Different lenses:
Variations in clients' perception of family therapy by race and
gender. Journal of Marital and Family Therapy, 1996 Apr. Vol 22(2)
- Hannah. N.T.; Luguet. W.; McCormick, J.; (1997) COMPASS as a
measure of the efficacy of couples therapy, American Journal of
Family Therapy. 1997 Spr. Wol 25(1), 76-90.
- Hochberg, A.M.; Kressel, K.; (1996) Determinants of successful
and unsuccessful divorce negotiations. Journal of Divorce and
Remarriage, 1996, Vol 25 (1-2), 1-21.
- Johnson, S.M.; Talitman, E.; (1997) Predictors of success in
emotionally focused marital therapy. Journal of Marital and Family
Therapy. 1997, Apr. Vol 23(2), 135-152.
- Johnson, S.: (1997) A critical review of marital therapy outcome.
Canadian Dournal of Psychiatry, 1997 Apr. Vol 42(3) 323.
- Jones, S.C.; Hunter, M.; (1996) The influence of context and
discourse on infertility experience. Journal of Reproductive and
Infant Psychology. 1996. May, Vol 14(2) 93-111.
- Kane, C.M.; (1996) An experiential approach to family of origin
work with marital and family therapy trainees. Journal of Marital
and Family Therapy, 1996, Oct, Wol 22(4), 481-487.
- Kelly, J.B.; (1996) A decade of divorce medication research:
Some answers and questions. Family and Conciliation Courts Review.
1996, Jul. Vol 34(3), 373-385.
- Kelly, A.B.; Halford, U.K.; (1997) Couples in therapy: Assessing
the heart of the matter. Sexual and Marital Therapy, 1997, Feb,
Vol 12(1), 5-21.
- Lansky. D.T.; Swift, L.H.; Manley, E.E.; Elmore. A.; et al,
(1996) The role of children in mediation. Medication Quarterly,
1996, Win. Wol 14(2), 147-154.
- Latz, M.; (1996) On an exercise for training beginning marital
and family therapists in language skills. Journal of Marital and
Family Therapy, 1996, Jan, Vol 22(1) 121-126.
- Leslie, L.A.; Clossick, M.l .; (1996) Sexism in family therapy:
Does training in gender make a difference? Journal of Marital
and Family Therany; 1996 Apr. Vol 22(2) 253-269.
- Lowenstein, L.F.; (1994) Marital Therapy: The importance of
the assessment of the individuals on personality tests. Counselling
Psychology Quarterly, Vol.7. No.2. 1994, 99-104.
- Lowenstein, L.F.; (l998a) Mediation in Parental Alienation Syndrome.
- Chapter in Book, Paedophiles, The Sexual Abuse of Children –
lts Occurrence and Treatment. Published by Able Publications,
- Lowenstein, L.F.; (l998b) Parent Alienation Syndrome - A Two
step approach towards a solution. Chapter in Book, Paedophiles,
The sexual Abuse of Children - its occurrence and Treatment. Published
by Able Publications, 1998.
- McCarthy, P.; (1997) Mediating modern marriage: A role for marriage
counselling? Sexual and Marital Therapy, 1997 Augf Vol 12(3),
- Meyerstein, I.; (1996) Pre-marital counselling and the problem
box ritual. Journal of Family Psychotherapy, 1996, Vol. 7(4) 63-70.
- Oldegaard, P.; (1996) Empathy induction in the couple treatment
of depression: Shifting the focus from self to other. Families,
Systems & Health, 1996 Sum. Vol 14(2), 167-181.
- O'Donohue, W.; Crouch, J.L.; (1996) Marital therapy and gender-linked
factors in communication. Journal of Marital and Family Therapy,
1996 Jan, Vol 22(1) 87-101.
- Penn, C.D.; Hernandez, S.L.; Bermuda?, 3.M.? (1997) Using a
cross-cultural perspective to understand infidelity in couples-therapy.
American Journal of Family Therapy, 1997 Sum. Vol 25(2) 169-185.
- Rasmussen. K,S.; Hamkins, A.J.; Schwab, K.P.: (1996) Increasing
husbands' involvement in domestic labour: Issues for therapists.
Contemporary Family Therapy - An Int. Journal, 1996, 3un. Vol
- Robinson, R.F.; (1996) Relationship between work addiction and
Family functioning: Clinical implications for marriage and family
therapists. Journal of Family Psychotherapy; 1996, Vol 7(3), 13-29.
- Ross, S.A.; Estrada, A.; (1997) An empirically driven marital
therapy intervention. Journal of Family Psychotherapy, 1997 Vol
- Rotunda, R.J,; O'Farrell. T.J.; (1997) Marital and family therapy
of alcohol use disorders: Bridging the gap between research and
practice. Professional Psychology: Research and Practice, 1997,
Dun, Vol 28(3), 246-252.
- Rudd, J.E.; (1996) Communication effects on divorce mediation:
How participants' argumentativeness, verbal aggression, and compliance-gaining
strategy choice mediate outcome satisfaction. Mediation Quarterly,
1996 Fal. Vol 14(1), 65-78.
- Schoenewolf, G.; (1996) The couple who fell in hate: Eclectic
psychodynamic therapy with an angry couple. Journal of Contemporary
Psychotherapy, 1996 Spr. Vol 26(1) 65-71.
- Speziale, B.A.; (1997) Couples, sexual intimacy, and multiple
sclerosis. Journal of Family Psychotherapy, 1997, Vol 8(1), 13-32.
- Stabb, S.D.; Cox, D.L.; Harber. J.L.; (1997) Gender-related
therapist attributions in couples therapy: A preliminary multiple
case study investigation. Journal of Marital and Family Therapy;
1997, Jul. Vol 23(3), 335-346.
- Storm, C.L.; York, C.D.; Keller, J.G.; (1997) A genderist philosophy
transforms an MFT proqramme. American Journal of Family Therapy,
1997 Sum. Vol 25(2) 151-168.
- Vansteenweqen, A.: (1997) Do marital therapists do what they
say they do? A comparison between experiential and communication
couples therapy. Sexual and Marital Therapy, 1997 Feb, Vol 12(1),
- Weaver, A.J.; Koenig, H.G.; Larson, D.B.; (1997) Marriape and
family therapists and the clergy: A need for clinical collaboration,
training and research. Journal of Marital and Family Therapy,
1997 Jan, Vol 23(1), 13-25.
- Welter, P.R.; (1995) Meaninq as a resource in marriage counselling.
Int. Forum for Logotherany. 1995, Fal. Vol 18(2), 109-113.
- Wilson, R.; Wilson, L.: (1996) Multiple selves operating within
relationships. Journal of Family Psychotherapy, 1996, Vol 7(2)
41-51. Worthington, E.L.; (1996) Speculations about new directions
in helping marriages and families that arise from pressures of
managed mental health care. Journal of Psychology and Christianity.
1996. Fal. Vol 15(3), 197-212.
- Worthington, E.L.; Hight, T.L.; Ripley, 3.5.; Perrone, K.M.;
Kurusu, T.A, & .Jones, D.R.; (1997) Strategic hope-focused
relationship enrichment counselling with individual couples. Journal
of Counselling Psychology, 1997, Oct, Vol 44(4) 381-389.