Brief Interventions for Couples: An Integrative Review

• Author: David G. Schramm,Jeremy B. Kanter
• DOI: http://doi.org/10.1111/fare.12298
• Published date: 01 April 2018
• Date: 01 April 2018

J B. K University of Missouri–Columbia

D G. S Utah State University

Brief Interventions for Couples: An Integrative

Review

Objective: To review brief couple interventions

(BCIs), with a focus on contributions to theory,

development, and implications for practice.

Background: For decades, scholars have

observed the individual and societal costs of

relationship instability. Due to these costs, state

and federal agencies have invested millions of

dollars in relationship and marriage educa-

tion programs with the hope of promoting the

positive effects associated with healthy relation-

ships. However, the plausibility of many of these

interventions has been challenged, suggesting a

need for renewed focus on different approaches

to promote relationship quality and stability

throughout the life course.

Method: We searched numerous databases to

review brief interventions used in multiple dis-

ciplines. This review resultedin 12 studies rang-

ing from samples of young adults to established

couples.

Results: We found several interventions using

distinct delivery methods and theoretical frame-

works. These interventions targeted numerous

individual and relational processes, such as

self-esteem, distress related to conict,and grat-

itude that promoted healthy relationship func-

tioning.

Human Development and Family Science, University

of Missouri, Columbia, MO 65211 (jeremykanter@

mizzou.edu).

Key Words: Couples, interventions, couple relationship edu-

cation.

Conclusion: We provide evidence that brief

interventions inuence individual and rela-

tional processes by targeting factors relevant

to couples across the life course. We ulti-

mately nd support for the utility of the

vulnerability–stress–adaptation model when

developing interventions for couples.

Implications: On the basis of our review, we end

with numerous practical suggestions for clini-

cians to adopt when developing programsto pro-

mote healthy relationships.

Studies in many countries attest to the desire

for high-quality couple relationships (Hughes,

2015). Indeed, in the past 40 years, more than

70% of U.S. high school seniors have con-

sistently reported expecting to marry in their

lifetimes (Anderson, 2016). Beyond the desire

to have a successful marriage, high-quality

marriages have also been linked to better health

outcomes for adults (e.g., Proulx, Helms, &

Buehler, 2007) and children (Brown, 2010).

In comparison, low-quality marriages have

been associated with poor well-being for adults

(Hawkins & Booth, 2005) and children (Amato,

2010). There is a need to strengthen healthy

intimate relationships in the hope of mitigating

the negative and promoting the positive effects

and outcomes associated with high-quality

romantic relationships. At a time when the

federal and state governments in the United

States are allocating unprecedented resources

(e.g., approximately $1 billion in the past

decade; Randles, 2017) toward strengthening

Family Relations 67 (April 2018): 211–226 211

DOI:10.1111/fare.12298

212 Family Relations

relationships, it is important to explore the

effectiveness of delivering couple relationship

education (CRE) in a variety of methods that

extend beyond traditional weekly group meet-

ings. Accordingly, various brief interventions

have been developed to assist the formation

and maintenance of healthy relationships. The

purpose of this article is to review the efcacy

of brief couple interventions (BCIs), while

providing insight into the theoretical underpin-

nings and future directions of these educational

interventions.

C R E

For decades, scholars have been interested

in CRE as an avenue to strengthen relation-

ships. CRE is broadly dened as programs that

provide skills and principles to help couples

achieve and sustain healthy relationships (Mark-

man & Rhoades, 2012). Most CRE programs

are delivered in a group format where couples

meet together over a predetermined period of

time (Carroll & Doherty, 2003). Many early

developers of CRE created programs that tar-

geted behaviors that distinguished happy from

distressed couples (i.e., risk factors), with a

particular emphasis on problem-solving and

communication skills as these interactions are

predictive of relational stability (Markman,

Rhoades, Stanley, Ragan, & Whitton, 2010).

Many CRE programs focus on teaching couples

scripted statements (e.g., “I” statements) and

exercises (e.g., the speaker–listener technique)

to provide structure during conicted conver-

sations (for a review, see Stanley, Blumberg,

& Markman, 1999). The underlying assump-

tion of focusing on communication skills is

that if interventions can mitigate maladap-

tive couples’ interactions from deteriorating

relational satisfaction, relationships would be

stable and ourish. However, traditional CRE

has produced inconsistent effectiveness in both

large-scale and experimental designs (Johnson

& Bradbury, 2015). Two limitations have been

posited that partly explain the mixed results

of CRE, and thus the emergence of more brief

interventions: access for all couples and the

overall one-size-ts-all approach that many

programs use.

First, many CRE programs struggle to reach

and retain a broad audience. For instance,

the majority of those who attend CRE are

upper-middle-class Caucasian couples (Carroll

& Doherty, 2003). However, some have argued

that these couples may not benet the most from

this education (Rhoades, Stanley, Markman,

& Johnson, 2009). In other words, those who

have risk factors associated with distress are

likely underrepresented in CRE. Participant

homogeneity may be due to the hectic schedules

of couples (e.g., parenting; Ramey & Ramey,

2009; work; Dew, 2009), and high costs of

programs (Cordova, 2009). Time constraints

are particularly challenging given evidence that

CRE is most effective when couples attend 9

to 20 hours of class, which is time that many

couples, particularly low-resource couples, do

not have (Hawkins, Blanchard, Baldwin, &

Fawcett, 2008). Moreover, retention has been

cited as a common issue, particularly with

low-resource couples, and the overall effective-

ness of programs is hindered when sessions are

missed (Wood, Moore, Clarkwest, & Killewald,

2014). Thus, traditional longer programs might

be unrealistic for contemporary couples.

Second, a one-size-ts-all approach, which

primarily emphasizes prescriptive communi-

cation and conict resolution skills, fails to

account for variability in couples’ life circum-

stances. Targeting communication skills does

not account for the potential impact that per-

sonality characteristics and context can have

on interactions between couples and relational

satisfaction. Johnson and Bradbury (2015)

suggested theories that account for individ-

ual and contextual inuences, such as the

vulnerability–stress–adaptation model (VSA;

Karney & Bradbury, 1995), might be better

suited to have a long-term impact on couples’

satisfaction. Specically, the VSA postulates

that adaptive processes (e.g., communication

skills, affection, and support) are inuenced by

enduring vulnerabilities (e.g., family of origin

experiences, beliefs, and attitudes; Bradbury

& Karney, 2004) and external stressors (e.g.,

unemployment and stress at work; Bradbury &

Karney, 2004), all of which interact to inuence

relationship satisfaction and stability. To pro-

mote long-term effectiveness of interventions, it

is imperative to use a theory that accounts for the

specic contexts in which relationships develop,

rather than a one-size-ts-all approach. In other

words, interventions should be delivered that

are contextually appropriate for what couples

are experiencing throughout the life course.

Practitioners have begun to address this by

developing interventions based on a life-course