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Checking Up on Marriage

Can regular checkups help prevent relationship problems in couples?

People want their marriages to be happy, but there is certainly no guarantee of that.

According to one recent survey, 39 percent of women and 41 percent of American men aged 50 to 59 report at least one divorce. Even for couples who stay together, domestic abuse and general unhappiness can cause a range of psychological problems including mental illness and substance abuse. About 40 percent of mental patients blame relationship problems for many of their symptoms and the emotional damage linked to poor relationships is hardly limited to the couples alone. Children growing up in disruptive home environments can develop long-term behavioural and emotional problems as well. Some psychologists even suggest that relationship distress should be considered a public health issue.

But what options do a couple in trouble have to mend their relationship problems? Treatment programs such as behavioural couple therapy can certainly help. Efficacy studies have shown that two-thirds of couples going through behavioural couple therapy programs report that their relationships have improved as a result. Unfortunately, most couples with relationship problems never seek counseling and some of the counselors they do approach may not have the necessary training to handle their specific problem.    

Then again, there is the familiar difficulty of getting both partners in a marriage to admit that couple therapy is needed. Though attending counseling can be scary enough for individuals with problems, making sure that both partners agree to counseling can often be nearly impossible. Whether due to their lacking confidence in treatment, worries about the cost of the treatment (especially for people without the health care coverage to pay for it), the shame of seeking treatment, or scheduling conflicts, it is probably not surprising that only 37 percent of divorced people reported seeking some form of counseling before dissolving their marriage. 

Couples who feel that their relationship is in trouble often wait years before seeking treatment, something that typically makes the problem worse than it needs to be. Even those couples who do seek help often prefer to speak to their family doctors or clergy instead of attending couple counseling. While some doctors and clergy may have formal training in therapy, most do not which may delay formal treatment even more. In many cases, couples in distress simply get divorced instead if they feel that their marriage has been damaged beyond repair.  

When dealing with troubled marriages, early detection and education can be the key to staying together. There are already educational programs in place that are designed to help couples improve their relationship skills. These include PREPARE/ENRICH which offers premarital and marriage counseling and PREP: the Prevention and Relationship Enhancement Program.  Though most couples taking part in these programs report positive benefits, other couples with more serious issues may be reluctant to seek help in this way. Still, the option may be a good one for couples who worry that their relationship is deteriorating.

Are there any alternatives for couples who might be reluctant to get involved with prevention workshops or who refuse to acknowledge that their marriage is "in trouble?" How about an annual checkup instead? First developed by James Cordova of Clark University, the Marriage Checkup (MC) is basically a two-session assessment and feedback program done on an regular basis. Cordova suggests that MC is "the marital health equivalent of the annual physical or the every six-month dental visit.” Since MC is intended to be safe and routine, participating couples can avoid the emotional turmoil associated with conventional marital counseling since they are simply receiving feedback about potential problems in their marriage.  

Since divorce is more likely to occur due to problems with poor communication, mutual blame, and arguments, couples participating in MC complete a battery of questionnaires to identify communication problems and points of disagreement. Then comes the face-to-face assessment in which couples talk over relationship problems and communication breakdowns. Two weeks later, the couple receives feedback on the strengths and weaknesses of their relationship. MC can be used at any stage in a marriage, whether with newlyweds or long-married couples. 

In the years since MC was first introduced, research studies have consistently shown that most participating couples respond well to the MC approach. Even at-risk couples have more tolerance for MC when they might avoid traditional couples counseling. Longitudinal follow-up shows that MC couples can show significant improvement in their marriages as opposed to couples who don't receive feedback. Not only do MC couples report significant improvement across a range of different marital health variables, but these benefits can persist for years after going through the MC process.  For those couples advised to seek further counseling after MC sessions, the rate of follow-through is significantly higher than in control couples.  

Part of the reason for promoting MC as a checkup rather than "treatment" is to overcome the strong stigma linked to couples counseling for many people. A new research study published in the Journal of Consulting and Clinical Psychology is just the latest in a series of validity studies showing that MC can be a valuable tool for couples with relationship problems. Conducted by James Cordova and a team of researchers at Clark University, Harbor UCLA Medical Center, and Harvard University, the study examined more than 200 couples (209 opposite-sex couples and six same-sex couples).   Ranging in age from 20 to 78, the 430 participants in the study were selected based on eligibility requirements (married and cohabitating as well as not already in couples counseling). They were then randomly assigned to either the treatment condition or the control group (101 control couples vs. 108 treatment couples). 

Along with completing questionanaires on marital satisfaction, intimacy, and acceptance, couples in the treatment group completed two Marital Checkups along with a two-year followup. The control group was followed for the same length of time. While there were couples dropping out of the study, no significant difference in dropout rate was found between the two groups. The questionnaires were given four times during the course of the study to measure marital changes over time.

The results showed that MC couples reported consistently greater marital satisfaction and relationship intimacy than control couples both immediately after the MC sessions and during the two-year followup. As Cordova and his fellow researchers pointed out, participating in MC appears to: a) reorient couples towards the most positive qualities of their relationships, b) foster acceptance of common issues and differences, c) improve intimacy through greater understanding, and d) improve relationship health.The benefits of MC appears to be strongest immediately after the the MC session with some waning over time. This reinforced the need for regular checkups to ensure that the positive benefits don't fade.

These results are fairly consistent with previous research into MC but highlights the importance of regular "booster" sessions to ensure improvements in relationship quality and intimacy. Considering the mental and physical health problems linked to marital difficulties, more widespread use of MC programs could also help promote better health care overall.  

So why isn't MC or similar programs more widely available? There are some components of the MC process that can be carried out online, but face-to-face visits with MC therapists are still needed to provide feedback and recommend further treatment options. Though Cordova and his colleagues are working on a purely web-based MC program, it is unlikely to take the place of working with actual therapists completely.

Can MC help prevent marital breakups and generally improve the quality of marriages? Perhaps.   While more research needs to be done, especially for people from other cultural backgrounds who might be less receptive to the MC process, results so far look promising. For James Cordova and his co-researchers, the next step is developing a web-based program to make MC more widely available to the general public. That, along with the recently published guide for clinicians, is helping to make marriage checkups a viable alternative to marital counseling for couples with relationship difficulties.  

Ultimately, the idea of regular checkups for people in relationships may well become routine for many couples. Whether this will prevent the relationship problems that can endanger health and well-being remains to be seen.

Romeo Vitelli, Ph.D. is a psychologist in private practice in Toronto, Canada.

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