Applying Hope-Focused Marriage Therapy to Conflict Resolution in Marriage: Case Study

The Hope-Focused Marriage Approach was developed by Worthington (1999) as a brief 5-12 week intervention with couples. The approach incorporates the growing research on beneficial and destructive processes in marriage. The Hope-Focused approach is Christian based, rooted in biblical principles, but can also be used with non-Christian couples if the religious language and biblical references are translated into broadly appealing concepts (Worthington, 1999). The purpose of this case study is to provide an example of how this approach can be applied to conceptualizing and treating clinical cases. A co-therapy team of Patrice Turner, a second year Psy.D student, and Stuart Hall, a second year Master's in Counseling student, met with the couple for an intake and provided three intervention sessions focusing on conflict resolution. The approach is not designed to be so brief, but was necessary due to changes in clinical training rotations. The couple was informed of this at the outset and referred for continued therapy at termination. Identifying information for this couple was changed to protect confidentiality.

The Couple

Mary (27) and Steven (30), married six years, requested brief marriage therapy to learn how to adjust to new Stressors in their marriage. Steven was diagnosed with a terminally ill disease and given less than 5 years to live approximately 6 months prior to intake. The couple also had a 1year-old son. Steven and Mary had long term goals which were abandonded due to the medical difficulties. While the illness left Steven unable to work regularly at the time of the intervention, his cognitive and interpersonal skills were not affected. However, it did mean that Steven and Mary had to move to be closer to relatives for support since neither of them were working. Therefore, the illness and changes in daily family life were both complicating factors in the marriage.

Prior to attending the first session, the couple filled out online questionnaires which assessed the following areas: marital and sexual satisfaction, commitment to the marriage, dyadic adjustment, partner forgiveness, values in marriage (seeing marriage as a covenant versus contractual), attachment style, Stressors in marriage, conflict resolution, depression, and religious values. The couple's assessment profile indicated that they were satisfied in their marriage; however, they had difficulty resolving conflict. During the intake session, the couple was able to identify both the positive and the negative aspects of their relationship. They were presented with several positive aspects to their relationship and some significant areas of growth.

The couple frequently had power struggles during arguments where their goal was to win at any cost and they had difficulty seeing past their own desires to view the other person's perspective. They admitted to pushing their partner's buttons to have the last words in an argument by saying hurtful things like "you're just your mother" or "I wish I never married you." The couple believed that they had good communication skills in general; however, the therapists noticed that Steven frequently spoke over Mary in the intake session.

The couple reported that their relationship with God and their church community was an area of support and comfort. They engaged in religious coping (e.g., prayer, reading scripture, church attendance) on a regular basis. The miracle question was modified for this highly religious couple where they were asked how they would "know that God had done a miracle in their marriage." The couple stated that they would be able to communicate difficult emotions with one another, reduce the use of hurtful statements during arguments, and they would feel more connected when they spent quality time together.

The couple had attended several marriage enrichment retreats; however, they had difficulty applying this knowledge to their relationship. They had also had two previous experiences with marriage therapy during the six years they've been married, both of which they commented were somewhat helpful.

Case Conceptualization

The case was conceptualized using the HopeFocused Marriage Approach which evaluates marriage in terms of Faith, Work, and Love.

* Faith: trust in each other and in your ability to resolve differences in mutually satisfying ways.

* Work: putting energy into maintaining and improving your relationship

* Love: being willing to value and refusing to devalue each other

The couple presented with several life Stressors. The husband was battling a terminal illness, had difficulties working, had recently moved, and the couple also had one young child. Before the diagnosis, one member of the couple had an emotional affair, although the couple felt they had overcome this and forgiven it. They presented as a happy couple that was having some moderate difficulties surrounding the husband's prognosis. During the initial interview and the online assessment it was apparent that the couple also had difficulty communicating during arguments. According to the Hope Focused approach, the couple presented with difficulty in faith and love. They did not have confidence in their ability to resolve conflicts in a mutually agreeable manner and they would purposely say hurtful things which devalue the other person during arguments.

Steve came from a home where avoiding conflict was the most common way of conflict management, while Mary was raised in a home where having loud arguments and confronting conflicts was valued. Both agreed that they did not agree with their parents' way of managing conflict. They did not want their child to repeat their destructive pattern. Therefore, through their experiences in learning patterns of negative conflict resolution with their families, the stress in their lives, and inadequate learned skills the couple was having difficulty primarily in the area of conflict resolution.

The Hope Focused approach emphasizes 9 potential areas to target in intervention: 1) central values, 2) core vision, 3) confession and forgiveness, 4) communication, 5) conflict resolution, 6) cognitions, 7) closeness, 8) complicating problems and 9) commitment. This couple had complicating problems to address, needed to recast their core vision with a shortened life expectancy, but their primary marital Stressor was around conflict resolution. Especially given the brief nature of the intervention the team decided to first address conflict resolution with the couple. Therefore, the goal was to focus on increasing hope for their ability to resolve conflicts more effectively, strategically intervene especially in love and faith, targeting conflict resolution with specific interventions.

The Interventions

The counselors used assessment and feedback, conflict resolution and video feedback with the couple. The assessment and feedback involved a thorough written and in-person assessment of the couples functioning in accordance with the Hope approach to marital interventions. This included a videotaping of the couple communicating for 10 minutes to be used for assessment and intervention. Then the co-therapists wrote a short 3-page report boiling down all of the information from that assessment. The report included the following sections: identifying information, presenting problem, relationship strengths, areas for potential change, and suggestions for improving their relationship, ending in a summary. The second session involved reviewing the report with the couple and discussing goals for their relationship.

The third session focused on conflict resolution with the couple developing their own rules for conflict. To increase motivation to change the couple read the rules to one another out loud during the session. The couple discussed how their parents argued and processed the legacy they desire to leave for their son. They identified the negative patterns they have in communicating and developed rules for conflict to counteract these negative patterns. The couple talked about framing their rules of engagement in a prominent place in their home so that their children, family, and friends would be aware of their desire to protect their "love" (Worthington, 1999). All of this uses pertinent research in motivation and persuasion with making a public commitment to a new behavior to assist the couple in changing a longterm behavior pattern.

In the third session, the couple watched about ten minutes of tape from their first session and to identify things that they could personally do differently to communicate more effectively. Then, in session, the couple was given another opportunity to video-tape a discussion of a difficult topic and correct the issues they noted from the initial video. The husband admitted that he frequently rambled due to being a verbal processor and the wife admitted that she was an internal processor. In watching the tape both partners indicated that they were surprised how they came across during their communication. They were harsher and more self-focused than they perceived themselves being in the moment. Both partners indicated that this intervention was highly motivating to them to change their conflict resolution patterns.

Discussion and Conclusion

At the time of intake, this couple was very motivated and in the preparation stage of motivation for change (Prochaska, DiClemente, & Norcross, 1992). Watching their video during the final session helped propel them into the action stage. Video feedback allowed the couple to have an outsider's perspective and they understood why other people were bothered by their arguments. Their communication was counterproductive and difficult for others to watch. The couple was also able to identify the negative aspects of their communication pattern and they used effective problem solving skills to work on their issues. At the end of treatment, the couple appeared to understand that they were a team and when one of them loses then they both lose. The couple's child was also a motivating factor which fueled their desire to set a good example for him.

It is important to mention the co-therapy dynamics and its impact on the treatment of this couple. In a twist of providence, Stuart Hall, the co-therapist, had been diagnosed with a less severe form of Steven's terminal illness. Stuart disclosed this during the second session and opened the door for the couple to discuss their fears and concerns concerning the illness. While the couple chose not to focus on the terminal illness issue in depth in this brief intervention, the experience of working with a client who was diagnosed with this severe illness was deeply moving to the cotherapy team causing a deepening of the therapeutic experience.

Co-therapy also allowed for the parallel process between the co-therapy team and the couple to be discussed. There would be times when the cotherapists would want to interrupt each other and would be focused on getting our point across. In realizing the power of co-therapy in marital counseling and parallel process the co-therapists were able to consciously model effective communication for the couple. This also opened the door for the similarities and the differences between the therapists and the couple to be discussed in session and supervision. The co-therapists were able to balance each other and we were able to utilize both of our strengths and compensate for weaknesses. The couple enjoyed having a male-female co-therapy team and felt as though they each had someone that would understand their perspective. Even though this approach works with one therapist, this dynamic was important to mention for this case.

If there had been more time, the clinicians would have discussed the couple's vision for their marriage and redefining it due to the husband's illness. During the intake they stated that they were not able to set long term goals due to the husband's poor prognosis. The prognosis also changed the couple's view of their relationship and their goals for their marriage. This caused them to feel as though their dream for their marriage had changed and God had not yet revealed to them the new dream. It would have been beneficial for the therapists to help the couple to discover a new dream so that they could have purpose, meaning, and a sense of direction in their marriage despite his foreshortened future. The couple was encouraged to continue marital therapy to address their emotions surrounding Steven' medical difficulties and develop coping skills to effectively deal with those difficulties.

References

References

Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change: Applications to addictive behaviours. American Psychologist, 47, 1102-1114.

Worthington, E.L., Jr. (1999). Hope-Focused Marriage Counseling: A brief guide to therapy.