Daily Events for Clinical Couples: Examining Therapy Interventions, Positive Events, Arguments, and Exercise in the Beginning Stage of Therapy

• Author: Lee N. Johnson,Megan Oka,Kayla D. Mennenga,Jeremy Yorgason,Rachel B. Tambling,Shayne R. Anderson
• Date: 01 June 2018
• DOI: http://doi.org/10.1111/famp.12301
• Published date: 01 June 2018

Daily Events for Clinical Couples: Examining

Therapy Interventions, Positive Events, Arguments,

and Exercise in the Beginning Stage of Therapy

LEE N. JOHNSON*

KAYLA D. MENNENGA

†

MEGAN OKA

‡

RACHEL B. TAMBLING

§

SHAYNE R. ANDERSON*

JEREMY YORGASON

¶

This study examined the daily association of several events within the beginning phase

of couple therapy. Events examined were as follows: trying something from therapy, an

argument, a positive event, and physical exercise. Participants were 33 couples in a treat-

ment-as-usual setting who completed the Daily Diary of Events in Couple Thera py

(DDECT). A dyadic multilevel model was used to explore the daily associations between

predictor and outcome variables. Results showed when male partners tried somethin g from

therapy at rates greater than the average their female partners reported a more positive

relationship while when female partners tried something from therapy at rates greater

than the average it contributed to a more negative relationship. In addition, resul ts showed

that clients in couple therapy rarely try things from therapy on a daily basis. Finally, rela-

tive to other predictors trying something from therapy had a smaller, but significant rela-

tionship with outcomes.

Keywords: Couples Therapy; Intensive Longitudinal Methods; Therapy Interventions;

Daily Diary

Fam Proc 57:380–398, 2018

INTRODUCTION

Couple therapy has been shown to be both effective and efficacious in many settings

(Lebow, Chambers, Christensen, & Johnson, 2011; Sprenkle, 2012). Despite the over-

all effectiveness of couple therapy, there is variability across couples, with as many as

33% to 50% of couples failing to show improvement (Snyder, Castellani, & Whisman,

2006; Whisman & Snyder, 1997). While outcome studies are valuable in determining

whether or not couple therapy works, they do little to further understanding about how or

why therapy works. Research is needed that is helpful to therapists in creating change in

their clients (Pinsof & Wynne, 2000). Some have suggested that therapy outcomes are not

*Marriage and Family Therapy Program, School of Family Life, Brigham Young University, Provo, UT.

†

Center for Couples and Families, Provo, UT.

‡

Department of Family and Human Development, Utah State University, Logan, UT.

§

Department of Human Development and Family Studies, University of Connecticut, Storrs, CT.

¶

School of Family Life, Brigham Young University, Provo, UT.

Correspondence concerning this article should be addressed to Lee N. Johnson, Marriage and Family

Therapy Program, School of Family Life, Brigham Young University, 240 TLRB, Provo, UT 84602. Email:

lee_johnson@byu.edu.

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Family Process, Vol. 57, No. 2, 2018 ©2017 Family Process Institute

doi: 10.1111/famp.12301

only related to things that occur within therapy, but may be partially attributed to client/

life factors (Lambert, 2013), including things that happen in the daily lives of clients

between sessions and client characteristics (Bohart & Wade, 2013; Duncan, 2014). It has

been reported that 40% to 86% of the variance associated with change can be related to cli-

ent/life factors (Lambert, 2013; Duncan, 2014). Thus, as researchers we have focused on

understanding the approximate 14% to 60% of change that is associated within therapy,

while ignoring the complex client/life factors, such as the daily life experiences of clients

that may affect therapy outcomes for clients.

There have been calls for more process research in the family therapy field (Pankiewicz,

Majkowicz, & Krzykowski, 2012). Process research, with its focus on spontaneous and

transient outcomes or events, is challenging to conduct, as such events often are not acces-

sible by survey research methods. What is needed is a methodology that falls between the

traditional outcome study and a highly involved process study. Daily diary studies have

the ability to answer these unique research questions about couple therapy because they

gather information on participants at more regular intervals (Yorgason, Johnson, &

Hardy, 2014). This study will use daily diary methods to explore the association between

trying something from therapy and the daily relationship of clinical couples. Research has

consistently shown that couple therapy intervention is helpful, overall. However, there is

no research, to our knowledge, that looks at the effects of therapy on a daily basis. In addi-

tion to examining whether there is a statistically significant relationship between trying

something from therapy and the daily relationship of couples, we were interested in the

relative importance of trying something from therapy compared to other daily events that

could influence the relationship. To examine the relative contribution of trying somethin g

from therapy, we examined the association between a couple’s relationship and daily posi-

tive events, conflict, and physical exercise. These variables were chosen because of their

consistent influence on relationships.

Trying Something from Therapy

Most therapy is designed to have an influence on couples between sessions with home-

work or out of treatment activities being a large part of couple therapy (Dattilio, 2002).

Dattilio, Kazantzis, Shinkfield, and Carr (2011) found that close to 97% of therapists use

homework in couple therapy. Research also shows that clients do things on their own to

help improve their relationship (Johnson, Nelson, & Allgood, 1998). These studies show

that clients, either at the request of their therapist or on their own, are likely to try things

related to therapy to improve their relationship. It is important to also remember that

types of homework vary across settings and models of therapy used (Kazantzis & Dattilio,

2010). It can also be inferred that what clients try to implement will also vary depending

on therapist style. Despite nearly all therapists implementing homework in treatment,

there is little information about the influence trying something from therapy has on

relationship quality.

Positive Events

Positive events occur frequently in people’s life (Gable, Reis, Impett, & Asher, 2004)

and are associated with higher relationship satisfaction in couples (Gable et al., 2004).

Positive events also contribute to increased responsiveness from others, increased trust,

and have a positive influence on people who are depressed (Machell, Kashdan, Short, &

Nezlek, 2014; Nezlek & Gable, 2001; Reis et al., 2010). Furthermore, specific types of posi-

tive events such as expressing gratitude (Gordon, Impett, Kogan, Oveis, & Keltner, 2012;

Williams & Bartlett, 2015), forgiving (Fincham, Hall, & Beach, 2006; Gordon, Hughes,

Tomcik, Dixon, & Litzinger, 2009), expressing affection or intimacy (Debrot, Cook, Perrez,

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