Couples Relationship Education and Couples Therapy: Healthy Marriage or Strange Bedfellows?

• Author: Howard J. Markman,Lane L. Ritchie
• Published date: 01 December 2015
• DOI: http://doi.org/10.1111/famp.12191
• Date: 01 December 2015

Couples Relationship Education and Couples

Therapy: Healthy Marriage or Strange Bedfellows?

HOWARD J. MARKMAN*

LANE L. RITCHIE*

This paper focuses on issues sparked by the Couples Relationship Education (CRE) field

moving toward a more clinical model to meet the needs of an increasing number of dis-

tressed couples coming to CRE programs. We review the concerns raised and recommenda-

tions made by Bradford, Hawkins, and Acker (2015), most of which push CRE toward a

more clinical model. We address these recommendations and make suggestions for best

practices that preserve the prevention/education model underlying research-bas ed CRE.

The three main issues are couple screening, leader training, and service delivery models.

Our suggested best practices include: conducting minimal screening including the assess-

ment of dangerous levels of couple violence, training leaders with key skills to handle issues

raised by distressed couples as well as other couples who may place additional burdens on

leaders, providing referrals and choices of programs available to participants at intake

and throughout the CRE program, and adding (rather than integrating) clinical services

to CRE services for couples who desire additional intervention. Finally, throughout the

paper, we review other key issues in the CRE field and make recommendations made for

future research and practice.

Keywords: Couples; Education; Therapy; Distress; Prevention; Relationships

Fam Proc 54:655–671, 2015

The topology of the Couples Relationship Education Field (CRE) field is rapidly chang-

ing. Most importantly,there is clearly a movement afoot to move CRE toward follow-

ing a more clinical model, which we call the clinicalization of CRE. The main impetus for

this transition, as described in Bradford et al. (2015), is that a higher number of moder-

ately and highly distressed couples are seeking CRE. Bradford et al. (2015) express con-

cerns about the implications of this change (e.g., the increased burden on service

providers who are trained to deliver an educational program and who are not licensed clin-

icians) and the likely possibility that distressed couples have needs that are not currently

being met in “traditional” CRE. We focus many of our comments on the positions advo-

cated in the Bradford et al. (2015) paper that generally recommends moving CRE pro-

gramming toward a clinical model as a solution to these concerns. We discuss benefits and

challenges associated with those recommendations and provide our own best practices for

*University of Denver, Denver, CO.

Correspondence concerning this article should be addressed to Howard J. Markman, Center for Marital

and Family Studies, 2155 S. Race Street, Denver, CO 80208. E-mail: hmarkman@du.edu

Work on this paper was supported by the Eunice Kennedy Shriver National Institute of Child Health &

Human Development of the National Institutes of Health under Award Number R01HD053314. The con-

tent is solely the responsibility of the authors and does not necessarily represent the official views of the

National Institutes of Health. The authors thank Scott Stanley, Bill Coffin, and Galena Rhoades for their

helpful comments on earlier versions of this paper. Author Howard Markman owns a business that

develops, refines, and sells the Prevention and Relationship Education Program (PREP) curriculum.

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Family Process, Vol. 54, No. 4, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12191

CRE that have the potential to move the field forward while still maintaining its empiri-

cally supported prevention and education roots. We are concerned that moving CRE

toward a more clinical model will blur the distinguishing features of CRE with couples

therapy and thus the distinctive advantages of CRE as a wide-reaching servic e to help

couples may be lost. The key overarching questions that we will address in this paper are:

(1) does the increasing number of distressed couples (and other couples struggling with

clinical issues) coming to CRE necessitate moving CRE to a more clinical model? and (2)

what are the implications of doing so? These questions are critical because we believe that,

once the therapy Pandora’s box is opened, it may become difficult to remove the therapeu-

tic influence from CRE. However, the issues are complicated and the manner in which

they are resolved will set the stage for the future of the CRE field. Using our sliding versus

deciding model of relationship development (Stanley, Rhoades, & Markman, 2006), pa rt of

our intent here is to make sure the field does not slide into the future, but instead decides

where the field ought to go, with clear and empirically based reasons for doing so.

To frame this discussion, we want to first provide some brief contextual information.

Specifically, we will describe the main differences between prevention/education and clini-

cal interventions, mention some caveats about what is and is not covered in this paper,

and provide information about the history of CRE in general and on the senior author in

particular to place these issues in context for what follows.

BACKGROUND

Differences Between CRE and Couples Therapy

Several papers highlight the distinction between CRE and couples therapy (Hawkins &

Ooms, 2012; Markman & Rhoades, 2012). In brief, some of the key differences are: (1) cou-

ples therapy is delivered to individual couples, whereas CRE is most typically delivered to

groups and hence the reach of CRE is far greater; (2) couples therapy is delivered by a

licensed professional, whereas CRE providers only need to be trained in the program they

are delivering and include paraprofessionals as well as nontherapists such as clergy or

other community leaders and agency staff; (3) couples therapy is usually delivered in a pri-

vate practice setting and CRE is most often delivered in a community setting; (4)couples

therapy usually costs money, whereas CRE is typically free or low cost; (5) couples therapy

includes some focus on the past and CRE is generally ahistorical; and (6) couples therapy

involves talking about personal issues with an outsider (the therapist), whereas most CRE

participants are typically told that they will not have to talk about personal issues except

with their partner.

It should be noted that research-based couples therapy programs, including cognitive-

behavioral (Baucom, Epstein, Kirby, & LaTaillade, 2002), integrative cognitive-behav ioral

(Christensen, Dimidjian, & Martell, 2002), and emotionally focused (Johnson, 2002) ther-

apy do include education and skill development to varying degrees. Similarly, innovative

models combining therapy and CRE are being used by Brian Doss (Doss, Carhar t, Hsueh,

& Rahbar, 2010) and James Cordova (Cordova et al., 2005) and walk a fine line between

education and therapy. Although these two programs are particularly thoughtful in their

combination of therapy and CRE, we are concerned about other situations where th e dis-

tinct features of couples therapy and CRE may be blurred without such thoughtful consid-

eration. Part of this blurring occurs because many leaders in the CRE field and many CRE

service providers have a clinical background and often are therapists themselves. This

presents a major risk of unintentionally sliding into a clinical couples therapy approach

without making an intentional choice to do so. We are concerned that if such a slide

occurs, the distinctive advantages of CRE will be lost.

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