Mark H. Butler

A meta-analytic update of research on the couple communication program

The Couple Communication (CC) program is a communication skills training program that uses brief didactic presentations, directed practice or role playing, and homework exercises. Skills include self-awareness, speaking skills, listening skills, conflict resolution skills, and styles of communication. This study is a meta-analysis of 16 recent CC studies. Outcome measures were classified as observational or attitudinal, and attitudinal measures were further grouped into measures of marital satisfaction, communication skills, or other relationship qualities. Meaningful effect sizes (ES) were observed for CC training on all types of measures, indicating clinically relevant positive outcomes for CC training. ES of observational measures of communications outcomes were greater than ES for attitudinal measures. CC training appears to be effective in improving communication but not substantially more effective than other communication training programs. Communication gains deteriorated substantially by follow-u...

The Process of Couple Healing Following Infidelity

Abstract Infidelity can have a devastating effect on marriages and individuals. This qualitative study explores the process of healing from infidelity and therapist behaviors that facilitate this process. In-depth client interviews suggest that healing occurs as couples pass through a seven-step process: (1) exploration of emotions and thoughts surrounding the infidelity, (2) expression of these to their partner, (3) development of empathy, (4) softening of emotions, (5) acceptance of personal responsibility and reduction of blame, (6) establishment of accountability, and (7) restoration of trust. While initially these factors occur sequentially, the process gradually becomes non-linear. Therapist behaviors which facilitate healing from infidelity are discussed.

Couples' Experience of Enactments and Softening in Marital Therapy 1

Softening is empirically related to therapy outcome. enactments are conceptualized as an effective mechanism for relational mediation and a potentially useful tool for fostering softening. Recent scholarly work has expanded upon existing operationalization of enactments by sequencing them developmentally and adapting them to varying levels of couple reactivity and volatility (butler & gardner, 2003). This research utilized qualitative methodology to test questions raised by this developmental model of enactments. Results indicated that volatile couples generally viewed carefully structured, enactments with micro-process intervention more positively than they viewed free-form enactments with therapist coaching. Less volatile couples, however, accommodated both kinds of enactments and reported advantages for each. overall, findings provide tentative support for the appropriateness of a component additive approach to enactments, as described in butler and gardners developmental model. 1In the execution of this research, the analyses, and the write-up, each co-author contributed uniquely and equally. Order of authorship as listed on the publication is alphabetical, but no primacy or hierarchy of authorship is implied.

Unraveling Change in Therapy: Three Different Process Research Methodologies

In response to repeated calls for process research on couple and family therapy, three different process research methodologies - grounded theory, change events analysis, and experimental manipulation - are presented and evaluated. A process research conceptual framework outlining some of the important issues in process research is presented. To illustrate each methodology, three completed process studies are briefly described, and a sample of results is provided. The strengths and weaknesses of each methodology are discussed, along with their role in generating and testing clinically relevant change theories. It is argued that each of these methodologies can provide researchers with important tools for unraveling the processes of change in couple and family therapy and should be used more frequently.

Facilitated Disclosure versus Clinical Accommodation of Infidelity Secrets: An Early Pivot Point in Couple Therapy. Part 1: Couple Relationship Ethics, Pragmatics, and Attachment

A critical and potentially polarizing decision in treating infidelity is whether facilitating partner disclosure or accommodating nondisclosure is most beneficial following private disclosure of infidelity to the therapist. Given couple distress and volatility following disclosure, understandably some therapists judge accommodating an infidelity secret both efficient and compassionate. Employing Western ethics and an attachment/intimacy lens, we consider ethical, pragmatic, and attachment intimacy implications of accommodating infidelity secrets. Issues bearing on the decision to facilitate disclosure or accommodate nondisclosure include (a) relationship ethics and pragmatics; (b) attachment and intimacy consequences; and (c) prospects for healing. We conclude that facilitating voluntary disclosure of infidelity, although difficult and demanding, represents the most ethical action with the best prospects for renewed and vital attachment intimacy.

Common Pitfalls of Beginning Therapists Utilizing Enactments

Empirical data, clinical observation, and theoretical rationales support use of enactments as a fundamental mechanism of change in relationship therapies. Yet beginning therapists may lack an adequate conceptual framework and operational training essential to effectively utilize enactments. Inadequate training may contribute to ineffective execution, and in turn to negative results, which could lead to abandonment of enactments. This study sought to identify proficiencies and nonproficiencies of beginning therapists in conducting enactments. Twenty beginning therapists from three Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE)-accredited programs were briefly trained in an indirect therapy style that incorporates enactments. Twenty-six therapist enactments were coded using a comprehensive observational measure designed to assess proficiencies and nonproficiencies in executing enactment phases, component tasks, and subcomponent operations. Results suggest that beginning therapists struggle with numerous clinical operations conceptually linked to the successful engagement of relationships in marriage and family therapy. In light of these findings, specific recommendations for additional enactment training in COAMFTE-accredited programs are offered.

Infidelity Secrets in Couple Therapy: Therapists’ Views on the Collision of Competing Ethics Around Relationship-Relevant Secrets

Infidelity is a common presenting problem in marriage and family therapy, and infidelity secrets are its common companion issue. When confronted with infidelity secrets, therapists encounter tension between the offending spouses privacy and confidentiality rights and the non-offending spouses right to relationship choice, which entails access to all relationship-relevant information. Professional ethical codes for relational therapy affirm both confidentiality considerations and equal advocacy for all persons in therapy. A relational therapy practice policy about disclosure of infidelity secrets is both critical and simultaneously fraught with tensions among competing accountabilities. A survey design was employed to investigate therapists’ attitudes concerning the relational impact of infidelity secrets and their judgments concerning how they should be handled in relational therapy. Findings reveal that relational therapists’ clinical judgment is that healing and attachment security are best promoted by disclosure, and that therapists support facilitated disclosure of infidelity in a context of informed, voluntary consent.

The Attachment Relationship in Recovery from Addiction. Part 2: Substantive Enactment Interventions

Previously (Butler & Seedall, 2006), we discussed the potential benefits of integrating the pair-bond attachment relationship (Hazan & Ziefman, 1999) into treatment for sexual addiction. We outlined a five-stage (Butler & Gardner, 2003), three-component (Davis & Butler, 2004) enactment model designed to circumvent attendant emotional reactivity and volatility while directly accessing the pair-bond attachment relationship in sponsoring both recovery and relational healing. This article complements the foregoing conceptual framework by delineating a variety of attachment-anchored, enactment-based interventions that may be adapted to the varying recovery and relationship needs of couples. Each intervention will be set forth conceptually and operationally, followed by an explanation of the value added when facilitated within an enactment context.

A Primer on the Evolution of Therapeutic Engagement in MFT: Understanding and Resolving the Dialectic Tension of Alliance and Neutrality. Part 2—Recommendations: Dynamic Neutrality Through Multipartiality and Enactments

Therapists’ model and practice of therapeutic engagement is fundamentally linked to process and outcome in therapy. The working space and the working relationship of therapy are profoundly and equally important. Neutrality promotes the working space of therapy, and alliance the working relationship. In theory and practice, however, the therapeutic alliance and clinical neutrality coexist in an often unrecognized dialectic tension. Reconciling alliance operations and neutrality operations is essential to positive process and outcome and exponentially more complex in relational therapies—characterized by clients’ diverse and colliding perspectives and experiences that the relational therapist must navigate and mediate. A model is needed to help therapists meet the unique challenges of multilateral therapeutic engagement in relational therapies. Various evolutionary iterations of relational therapy have experimented with different neutrality-alliance hybrids in the attempt to provide a working resolution that sustains multilateral alliances and clinical neutrality (Brimhall & Butler, 2011). Building on a historical retrospective and critique of neutrality in relational therapies (Brimhall & Butler, 2011), we identify distinct dimensions of neutrality and then propose a new approach to therapeutic neutrality. Operationalized through multipartial therapist interaction and multipartial enactments, a new, dynamic neutrality represents an evolutionary advance of neutrality responsive to the ecological pressures of relational therapy. Through multipartiality, a dynamically engaged neutrality and relationship advocacy are realized, allowing alliance and neutrality to coexist harmoniously rather than antagonistically in the ecological system of relational therapy. Thereby, both the working space and working alliances are sustained and the dialectic tension between alliance and neutrality is resolved.

Facilitated Disclosure Versus Clinical Accommodation of Infidelity Secrets: An Early Pivot Point in Couple Therapy. Part 2: Therapy Ethics, Pragmatics, and Protocol

In couple therapy, one partners private disclosure of infidelity presents a potentially polarizing issue involving the therapists decision to facilitate disclosure or accommodate non-disclosure. Some therapists may assume accommodating an infidelity secret is the most compassionate and efficient option. We consider this decision in the context of therapy ethics of equal advocacy and confidentiality, implications for individual and relationship healing, and pragmatic aspects of conducting therapy. We conclude that measured disclosure of infidelity, determined by the aggrieved spouse, best resolves the potential collision of multilateral advocacy with confidentiality and offers the best prospects for a working therapy alliance and couple healing and renewal. A clinical protocol for facilitating disclosure of infidelity secrets is presented.