vAcknowledgmentsCOMPLETING A VOLUME like this is accompanied by a variety of feel-ings. The main one is relief at being able to take the manuscript offmy desk, although knowing how busy I get, my desk will probablystay clean for a grand total of about 50 seconds. Closely following the re-lief is the sense of gratitude that I feel toward a myriad of people whowere involved in helping me complete this project. I first want to thankDr. Florence Kaslow who encouraged me to develop this edited volume andwho was instrumental in convincing Wiley to publish it. Dr. Kaslow has al-ways been a wonderful role model and professional cheerleader for me.The staff of John Wiley & Sons, particularly Isabel Pratt and PeggyAlexander (who stepped in when the original editor changed positions), aremuch appreciated.During the time I was developing the concept behind the book and invit-ing chapter authors, I was going through a difficult professional transitionand I want to thank all of my friends at the Phillips Graduate Institute whowere my sounding boards and dear, “family members.” I won’t mentionyou all by name, but I think you know who you are, and I hope you knowthat I care about you deeply.Since joining the faculty at Antioch University, Santa Barbara, I havefound a wonderfully supportive group of colleagues and new friends. Iwant to particularly thank Dr. Catherine Radecki-Bush who tolerated mybrief moments of insanity as I completed this task. Cathy also was helpfulto me in my work by asking me to teach a class on couples therapy, knowingperhaps that preparing for the class would crystallize some important rele-vant ideas.Finally, I would like to thank the many couples I have been honored towork with clinically over the years. I have learned so much from you!And to my husband Bruce Antman who has always maintained that anyrelationship is salvageable as long as both members of the couple are will-ing to do whatever it takes to make it work, I say, “I agree.”MICHELE HARWAY, PHD
viiContentsAbout the Contributors ix1. Setting the Stage for Working with Couples 1Michele HarwaySECTION I LIFE CYCLE STAGES2. Premarital Counseling from the PAIRS Perspective 7Lori H. Gordon, Robin Rose Temple, and Donald W. Adams3. The First Years of Marital Commitment 28William C. Nichols4. Couples with Young Children 44Linda Morano Lower5. Couples with Adolescents 61C. Haydee Mas and James F. Alexander6. Therapy with Older Couples: Love Stories—The Good,the Bad, and the Movies 80Thomas H. Peake and Angela E. SteepSECTION II THEORETICAL PERSPECTIVES ON WORKING WITH COUPLES7. Bowen Family Systems Theory as Feminist Therapy 103Louise Bordeaux Silverstein8. Cognitive Behavioral Couple Therapy 119Terence Patterson9. Object Relations Couple Therapy 141David E. Scharff and Yolanda de Varela10. Narrative Therapy with Couples: Promoting Liberation fromConstraining Influences 157Lynne V. Rosen and Charley Lang11. EFT: An Integrative Contemporary Approach 179Brent Bradley and Susan M. Johnson
viii CONTENTS12. Strategic and Solution-Focused Couple Therapy 194Stephen Cheung13. Integrative Healing Couples Therapy: A Search forSelf and Each Other 211Patricia Pitta14. Feminist and Contextual Work 228Roberta L. NuttSECTION III SPECIAL ISSUES FACED BY COUPLES15. Managing Emotional Reactivity in Couples FacingIllness: Smoothing Out the Emotional Roller Coaster 253William H. Watson and Susan H. McDaniel16. Treating Couples with Sexual Abuse Issues 272Michele Harway and Ellen Faulk17. Working with Couples Who Have ExperiencedPhysical Aggression 289Amy Holtzworth-Munroe, Kahni Clements, and Coreen Farris18. Couples and Addiction 313Mark Stanton19. Infidelity: Theory and Treatment 337Don-David Lusterman20. Religious and Spiritual Issues in Couples Therapy 352Ilene Serlin21. Working with Same-Sex Couples 370Daniel J. Alonzo22. Treating Couples across the Socioeconomic Spectrum 386Florence W. Kaslow23. Divorcing Couples 405Joy K. Rice24. What the Research Tells Us 431Sally D. Stabb25. Some Concluding Thoughts about Couples andCouples Therapy 457Michele HarwayAuthor Index 461Subject Index 475
ixAbout the ContributorsDonald W. Adams, PhD, earned his doctorate in clinical psychologyfrom Duke University. After three years as director of Children’sService in a rural North Carolina Mental Health Center and an-other three years as director of Psychological Services at Dorothea DixHospital Inpatient Adolescent Treatment Program, he began, in 1981, fulltime private practice in Cary, North Carolina. Dr. Adams specialized inplay therapy and taught seminars and conducted conference workshops onchild psychotherapy in the 1980s. His practice has been consistently ori-ented toward the healthy adjustment of children and families. He has beenactive in the North Carolina Psychological Association and served as presi-dent in 1995/1996. He and his wife, Jo, a psychiatric nurse specialist, weretrained in PAIRS in 1993. He refocused much of his professional energy to-ward treating troubled relationships and teaching relationship skills. Hehas taught many aspects of PAIRS and has been active in developing andrefining PAIRS programs. He is currently the vice president of the PAIRSFoundation and serves on the executive board and steering committee ofPAIRS. Dr. Adams co-authored a chapter on sensuality and sexuality inBuilding Intimate Relationships.James F. Alexander, PhD, is the progenitor (with B. V. Parsons) of func-tional family therapy (FFT), a nationally and internationally acclaimedand empirically demonstrated intervention model for juvenile delinquents,oppositional and conduct-disordered youth, and substance abusing youth.Since 1968, he has been on the faculty at the University of Utah. He is the2001 recipient of the Distinguished Award for Lifetime Contributions toFamily Therapy Research of the American Association for Marriage andFamily Therapy. Dr. Alexander is the author of over 90 chapters and refer-eed journal articles, two books, and over 150 convention presentations andacademic colloquia. He has also presented at over 300 national and interna-tional clinical training workshops.Daniel J. Alonzo, MA, is a member of the core faculty at Phillips Graduate In-stitute in Encino, California. He is a member of the Society for the Scientific
x ABOUT THE CONTRIBUTORSStudy of Sexuality (SSSS) and has presented papers at the SSSS WesternRegional Conferences and the Los Angeles SSSS Chapter. He is also a mem-ber of the American Association of Sex Educators, Counselors, and Thera-pists (AASECT), and he is an AASECT Certified Sex Therapist. In addition,he is an American Association for Marriage and Family Therapy ApprovedSupervisor and a California Association of Marriage and Family TherapyCertified Supervisor, providing supervision, training, workshops, and con-sultation with mental health agencies in the Los Angeles area. He has beena California Licensed Marriage and Family Therapist for more than 13years, specializing in sexual minority mental health, couple therapy, andworking with same-sex couples.Brent Bradley, PhD, is assistant professor of counseling and director of themarriage and family therapy track in the Graduate Counseling Departmentat Indiana Wesleyan University. He received his doctorate in Marriage andFamily Therapy from Fuller Seminary School of Psychology in 2001. He isa clinical member of the American Association for Marriage and FamilyTherapy. Dr. Bradley has published original research in emotionally fo-cused couples therapy (EFT), and actively researches, writes, and presentsthe approach.Stephen Cheung, PsyD, is an interim core faculty of clinical psychology atAntioch University in Los Angeles. He is teaching Brief Therapy, FamilyTherapy, Group Therapy, and Psychological Testing. Before he joined An-tioch University in 2004, Dr. Cheung had been a program director andclinical psychologist at Asian Pacific Counseling and Treatment Centers(APCTC) in Los Angeles coordinating and supervising their children andadult programs for 12 years. For almost three decades, he has beenproviding short-term and longer-term psychotherapy to a wide variety ofclients. He has specialized in: Eating, Substance-related, Personality,Mood, and Anxiety Disorders; grief therapy; and psychological testing.Since 1996, he has been teaching at Phillips Graduate Institute, CaliforniaState University at Los Angeles, and Pepperdine University. He has alsobeen presenting training in strategic and solution-focused brief therapy,an integrated treatment approach to eating disorders, and psychotheraywith childhood abuse survivors in local, national, and international men-tal health conferences.Kahni Clements received her BA in psychology from the University of Cal-ifornia at Los Angeles. She is currently a graduate student in clinical psy-chology at Indiana University-Bloomington. Her research interests arerelationship violence and couples communication interactions.Yolanda de Varela, PhD Candidate, is a clinical psychologist with a master’sdegree in educational psychology and is completing her doctorate. She has
About the Contributors xibeen president of the Panamanian Psychological Association, a foundingmember of the International Institute of Object Relations Therapy, and direc-tor of the Panama Satellite Program of IIORT. She is author and co-author ofmany articles on object relations and on couples therapy.Coreen Farris received her BA in psychology from Brandeis University. Sheis a graduate student in clinical psychology at Indiana University-Bloom-ington. Her research interests are in substance use and aggression.Ellen Faulk, MA, is a faculty member at Phillips Graduate Institute in En-cino, California. She is a member of the California Association of Marriageand Family Therapists, the American Association for Marriage and FamilyTherapy, and a student member of the American Psychological Association.Ms. Faulk provides training, workshops, and consultation for mental healthproviders on working with adult survivors of sexual abuse. She has been aconsultant to the Los Angeles Police Department and the Los Angeles Fed-eral Bureau of Investigation. Ms. Faulk is a practicing marriage and familytherapist specializing in traumatized populations.Lori H. Gordon, PhD, is founder/president/training director of the PAIRSFoundation, Inc. and serves as chief executive officer of the executive board.She conducts a private clinical practice through the Family Relations Insti-tute, Falls Church, Virginia, and consults through Tequesta ConsultingServices, Ltd. in Fort Lauderdale, Florida. She is the author of three popularbooks: Love Knots, Passage to Intimacy, and If You Really Loved Me. She is alsoco-author of two professional articles on the PAIRS program as well as arange of professional training curricula, articles, and materials. She contin-ues to develop relationship programs through the PAIRS Foundation thatare designed to sustain healthy marriages and stable families. Dr. Gordontrains health care professionals and selected public worldwide to teach therange of PAIRS programs.Michele Harway, PhD, ABPP, is a member of the core faculty in the Psy-chology Department at Antioch University, Santa Barbara. She is also amember of the consulting faculty at the Fielding Graduate Institute andshe maintains a private practice in Westlake Village, California. Dr. Har-way has written and presented extensively on domestic violence, traumasurvival, gender, and family issues. She is the author or editor of eightbooks including Treating the Changing Family: Handling Normative and Un-usual Events and Spouse Abuse: Assessing & Treating Battered Women, Batterers,and Their Children (Second Edition). Active in governance of the AmericanPsychological Association (APA), she is past-president of the Division ofFamily Psychology and current treasurer of the Society for the Study ofMen and Masculinity. She is a fellow of three divisions of APA and is alsoa board-certified family psychologist (ABPP).
xii ABOUT THE CONTRIBUTORSAmy Holtzworth-Munroe, PhD, is a professor of psychology at IndianaUniversity, Bloomington. She received her doctorate in clinical psychologyfrom the University of Washington. For almost 20 years, she has conductedresearch on the problem of husband violence, comparing the social skills ofviolent and nonviolent husbands and examining the marital interactionsof violent couples. Her more recent research focuses on subtypes of malebatterers. She has led batterer treatment groups and worked with a localdomestic violence task force to set up a batterers’ treatment program.Dr. Holtzworth-Munroe teaches a couples therapy practicum for graduatestudents. She is past associate editor of Journal of Consulting and Clinical Psy-chology and Cognitive Therapy and Research and a past member of NIH grantreview panels in the area of family violence.Susan M. Johnson, PhD, is professor of psychology and psychiatry at Ot-tawa University and director of the Ottawa Couple and Family Institute.She received her doctorate in counseling psychology from the University ofBritish Columbia. She is a registered psychologist in the province of On-tario, Canada, and a member of the editorial board of the Journal of Maritaland Family Therapy, the Journal of Couple and Relationship Therapy, and theJournal of Family Psychology. She is one of the originators and the main pro-ponent of emotionally focused couples therapy, now one of the best vali-dated couples’ approaches in North America.Florence W. Kaslow, PhD, ABPP, is in independent practice as a psycholo-gist, coach, family business consultant, and mediator in Palm Beach County,Florida. She is also director of the Florida Couples and Family Institute; anadjunct professor of medical psychology, Department of Psychiatry at DukeUniversity Medical School in Durham, North Carolina; and a visiting profes-sor of psychology at Florida Institute of Technology in Melbourne, Florida.Dr. Kaslow is board certified in clinical, family, and forensic psychologyfrom the American Board of Professional Psychology (ABPP), and in sexol-ogy from the American Board of Clinical Sexology. Dr. Kaslow is a fellow ofDivisions 12, 29, 41, 42, 43, and 46 of the American Psychological Associa-tion, the American Association for Marriage and Family Therapy (AAMFT),and other organizations. She has edited, authored, or co-authored 19 booksand has contributed chapters to more than 50 other books. Over 150 of herarticles have been published in professional journals here and abroad. She isalso on the editorial boards of numerous journals in psychology and familypsychology. Dr. Kaslow has received numerous honors in psychology, familypsychology, and international psychology.Charley Lang, MA, MFT, has a private practice in Los Angeles. He alsoteaches Narrative Therapy at Antioch University, Los Angeles, and super-vises the mental health staff at the AIDS Service Center in Pasadena. Heproduced and directed the award-winning documentary films Live to Tell:
About the Contributors xiiiThe First Gay and Lesbian Prom in America, Battle for the Tiara, and Gay Cops:Pride Behind the Badge.Linda Morano Lower, MS, MA, LMFT, holds masters degrees in both mar-riage and family therapy and ascetical theology from California LutheranUniversity and Fordham University, respectively. She has been in privatepractice as a marriage and family therapist for 17 years in Camarillo andWestlake Village, and she specializes in working with couples at all stages oftheir life cycles. Linda lives in Camarillo, California, where, with her thera-pist husband, she is parenting two teen-aged daughters.Don-David Lusterman, PhD, is the author of Infidelity: A Survival Guide andco-editor of Casebook for Integrating Family Therapy: An Ecosystemic Approachand Integrating Family Therapy: Handbook of Family Psychology and Systems The-ory as well as several other books, book chapters, and articles. He also servesas consulting editor for the Journal of Family Psychology and is on the editorialboard of The American Journal of Family Therapy. He founded the program infamily counseling at Hofstra University in 1973 and served as its coordinatoruntil 1980. He was also the founding executive director of the AmericanBoard of Family Psychology (now part of the American Board of ProfessionalPsychology) and holds an ABPP Diplomate in family psychology. He is a fel-low of APA’s divisions of Family Psychology, Psychotherapy, IndependentPractice, Media Psychology, and Men and Masculinity. He is also a fellowand approved supervisor for the American Association for Marriage andFamily Therapy. He is a charter member of the American Family TherapyAcademy on whose board he also serves. Dr. Lusterman is in private practicein Baldwin, New York.C. Haydee Mas, PhD, did her undergraduate work at the University ofMichigan and her graduate studies in clinical psychology at the Universityof Utah where she was chairperson of the graduate student minority com-mittee. Her research interests and publications have focused on therapist-client communication styles, FFT process studies, support systems inabusive families, as well as family communication and attributional stylesin families with an adolescent. She is currently in private practice workingwith couples and families with adolescents and children, and she conductstherapy in Spanish with bilingual and bicultural clients and families.Susan H. McDaniel, PhD, is professor of psychiatry and family medicine,director of the Division of Family Programs and the Wynne Center forFamily Research in Psychiatry, and associate chair of the Department ofFamily Medicine at the University of Rochester School of Medicine andDentistry in Rochester, New York. She has many publications in the areas ofmedical family therapy, family-oriented primary care, and supervision andconsultation. Her special areas of interest are family dynamics and genetic
xiv ABOUT THE CONTRIBUTORStesting, somatization, and gender and health. She is a frequent speaker atmeetings of both health and mental health professionals. Dr. McDaniel isco-editor, with Thomas Campbell, MD, of the multidisciplinary journal,Families, Systems and Health, and serves on many other journal boards. Sheco-authored or co-edited the following books: Systems Consultation, Family-Oriented Primary Care, Medical Family Therapy, Integrating Family Therapy,Counseling Families with Chronic Illness, The Shared Experience of Illness, Inte-grating Family Therapy, and the Casebook for Integrating Family Therapy. Somebooks have been translated into several languages; an additional volume isexclusively in German.Dr. McDaniel was chair of the Commission on Accreditation for Marriageand Family Therapy Education in 1998, president of the Division of FamilyPsychology of the American Psychological Association (APA) in 1999, andchair of the APA Publications and Communications Board in 2002. Dr. Mc-Daniel was recognized by the APA as the 1995 Family Psychologist of theYear. In 1998, she was the first psychologist to be a fellow in the PublicHealth Service Primary Care Policy Fellowship. She also won the Postdoc-toral Academic Mentoring Award from her medical school in 1998, and in2000 she received the award for Innovative Contributions to Family Ther-apy from the American Family Therapy Academy.William C. Nichols, EdD, ABPP, is a marital and family therapist anddiplomate in clinical psychology, a fellow, clinical member, and approvedsupervisor of the AAMFT; a charter member of both the American FamilyTherapy Academy and the International Family Therapy Association(IFTA); and a fellow of both the American Psychological Association andthe American Psychological Society. He was in full-time private practicefor nearly 25 years and taught and supervised postdoctoral, doctoral, andmasters’ students in MFT programs and postdegree professionals for 35years at Florida State University, the Merrill-Palmer Institute, and else-where. Founder and first editor of the Journal of Marital and Family Therapy,he also edited Family Relations, and currently edits Contemporary FamilyTherapy. He has written or edited eight MFT and therapy books, conceptu-alized and launched MFT accreditation, wrote the first model licensinglaws, co-wrote the national licensing examination, and chaired a state li-censing board for seven years. He has been president of the AAMFT, IFTA,and the National Council on Family Relations.Roberta L. Nutt, PhD, ABPP, is the founder and director of the counselingpsychology doctoral program that emphasizes family psychology andwomen’s/gender issues at Texas Women’s University. She is co-author ofthe “Division 17 Principles Concerning the Counseling/Psychotherapy ofWomen: Rationale and Implementation” and Bridging Separate GenderWorlds: Why Men and Women Clash and How Therapists Can Bring Them To-gether. Dr. Nutt has written and presented extensively on gender and
About the Contributors xvfamily issues, served in a number of leadership roles in psychology includingpresident of the Family Psychology Division of APA and held offices in boththe women’s and men’s divisions. She holds the ABPP diplomate in familypsychology. She is currently co-chairing an APA Interdivisional Task Forcedeveloping new guidelines for psychological practice with girls and women.Terence Patterson, EdD, ABPP, is professor and director of the doctoralprogram in counseling psychology at the University of San Francisco. He isa licensed psychologist and is board certified in family psychology with theAmerican Board of Professional Psychology. His specialties are family psy-chology, ethical issues, and theoretical orientation in psychotherapy. He ison the boards of a number of professional journals and has authored Vol. II(Cognitive-Behavioral) of the Comprehensive Handbook of Psychotherapy, and theCouple & Family Clinical Documentation Sourcebook. Dr. Patterson has servedas president of the Division of Family Psychology of the American Psycho-logical Association and is a fellow of APA.Thomas H. Peake, PhD, ABPP, is professor and associate dean for the Schoolof Psychology at Florida Institute of Technology (Melbourne), and adjunctprofessor in the Department of Aging and Mental Health of the Florida In-stitute of Mental Health of the University of South Florida (Tampa). Li-censed in Virginia, Michigan, Florida, and chartered in Great Britain, he haspracticed clinical, health, and family psychology for over 15 years. He is adiplomate (ABPP) in both clinical and health psychology and is an approvedsupervisor for AAMFT. Dr. Peake’s publication and practice areas includebooks and articles on brief psychotherapies, clinical training and supervi-sion, couples therapy, medical/health psychology, healthy aging, and a bookCinema and Life Development: Healing Lives and Training Therapists.Patricia Pitta, PhD, ABPP, is a board-certified family psychologist. She re-ceived her doctorate from Fordham University and completed postdoctoraltraining in family therapy at the Center for Family Learning, Ryebrook,New York. In addition, she holds a degree in pastoral formation which en-ables her to integrate spirituality with psychology. For the past 10 years,Dr. Pitta has been a professor of psychology in the doctoral and postdoc-toral training programs at St. John’s University. As developer of IntegrativeHealing Family Therapy, Dr. Pitta has published many articles about thetheory and its applications. She has also produced a video entitled “Parent-ing Your Elderly Parents” (published by APA Publications) and is the au-thor of a marital therapy manual (published by Division 42 of APA).Joy K. Rice, PhD, is clinical professor of psychiatry and Emerita Professorof Educational Policy and Women’s Studies at the University of Wisconsin–Madison. She also maintains an active psychotherapy practice with Psychi-atric Services in Madison. Her research activity includes more than 100
xvi ABOUT THE CONTRIBUTORSnational and international presentations and publications on family change,poverty, and mental health. Living through Divorce: A Developmental Approachto Divorce Therapy, written with Dr. David Rice, was honored as a Book-of-the-Month selection.Active in international psychology, Dr. Rice is secretary of the Interna-tional Council of Psychologists, chair elect of the APA Committee on Inter-national Relations in Psychology, and president elect of APA Division 52,International Psychology. She has received numerous awards and honors forher research and social policy work on behalf of disadvantaged families andwomen nationally and internationally. She is a recipient of the EducationalPress Association Distinguished Achievement Award, a fellow of the Amer-ican Psychological Association, and is listed in Who’s Who of Women andthe World’s Who’s Who of Women.Lynne V. Rosen, LCSW, is core faculty and director of the Post ModernTherapy Training Program at Phillips Graduate Institute in Encino, Cali-fornia. She is interested in collaborative education and integrating her pas-sion and commitment to diversity and social justice in training andteaching contexts. Ms. Rosen is co-founder of Women’s Project Los Angeles(WPLA), a community-based project focused on social constructionist andfeminist ideas. WPLA utilizes innovative forms of dialogue in order tobring forward new perspectives and possibilities that can lead to meaning-ful change in women’s lives. She maintains a private practice and has along-standing interest in working with women who are taking their livesback from eating problems, abuse, and trauma and in working with couplesand families.David E. Scharff, MD, is a psychiatrist and psychoanalyst. He is co-directorof the International Psychotherapy Institute, Washington, DC. Dr. Scharffis clinical professor of psychiatry at Georgetown University and at the Uni-formed Services University of the Health Sciences. He is author, co-author,and editor of 15 books including Object Relations Couples Therapy and ObjectRelations Individual Therapy.Ilene Serlin, PhD, ADTR, is a licensed psychologist and a registereddance/movement therapist. Dr. Serlin is a fellow of the American Psycho-logical Association, past president of Division 32 of APA, council represen-tative from Division 32, and has served on the editorial boards of The Artsin Psychotherapy, Journal of the American Dance Therapy Association, and theJournal of Humanistic Psychology. She has taught at Saybrook GraduateSchool and Research Institute, UCLA, Antioch University, and AlliantGraduate School. She has consulted and worked with clergy, and is the au-thor of: Therapy with a Borderline Nun, A Psycho-spiritual Body Approach to aResidential Treatment of Catholic Religious, and The Last Temptation of Christ.
About the Contributors xviiShe is currently in private practice in San Francisco and Sonoma County,California.Louise Bordeaux Silverstein, PhD, is associate professor at the FerkaufGraduate School of Psychology at Yeshiva University, Bronx, New York,where she has taught courses in family therapy and the social constructionof gender since 1992. Dr. Silverstein is a past president of the AmericanPsychological Association’s Division of Family Psychology. She is co-founder, with Dr. Carl Auerbach, of the Yeshiva University FatherhoodProject, a qualitative research study of fathering from a multicultural per-spective. Dr. Silverstein’s publications focus on fathering, feminist theory,and the social construction of gender. She is the co-editor (with ThelmaJean Goodrich) of Feminist Family Therapy: Empowerment and Social Locationand co-author with Carl F. Auerbach of An Introduction to Coding and Analyz-ing Data in Qualitative Research. Dr. Silverstein is a family therapist in pri-vate practice in Brooklyn, New York.Sally D. Stabb, PhD, is a licensed psychologist and associate professor ofcounseling psychology at Texas Woman’s University. Her research interestsinclude women’s issues, emotion, couples, and multiculturalism. Dr. Stabbteaches courses in process and outcome research, qualitative research meth-ods, psychotherapy theories, professional issues, and practicum.Mark Stanton, PhD, ABPP, is professor of psychology and chair of the De-partment of Graduate Psychology at Azusa Pacific University. He is a diplo-mate in family psychology, American Board of Professional Psychology, anda licensed psychologist in the state of California. He is the editor of The Fam-ily Psychologist and 2005 president of the Division of Family Psychology of theAmerican Psychological Association.Angela E. Steep, PsyD, is a postdoctoral fellow in primary care at the Uni-versity of Oklahoma Health Sciences Center. She did her intern-ship at the Medical College of Virginia, graduate work at Florida Instituteof Technology, and her undergraduate work at the University of NorthCarolina at Chapel Hill. Particular areas of interest include mind-bodymedicine, medical/health psychology, primary care psychology, and motiva-tional interviewing.Robin Rose Temple, MA, MSW, CAC II, is a master teacher and trainer forthe PAIRS Foundation, where she has been teaching for eight years. Sheholds post-master’s certification from the Gestalt Institute of Denver andthe Family Therapy Training Center of Colorado, which recently awardedher the Alumnus of the Year Award for her work teaching PAIRS in theFront Range of Colorado. She is also certified as a Colorado addictions
xviii ABOUT THE CONTRIBUTORScounselor and contributing author to the book Bridging Intimate Relation-ships. Ms. Temple has been working with families for 25 years. She is a de-voted mother of three, and she is passionate about healing relationships ofall sorts. It is in her own marriage that she has learned the most about beingpart of a couple.William H. Watson, PhD, is associate professor of psychiatry (psychology)and neurology at the University of Rochester School of Medicine andDentistry/Strong Memorial Hospital. He is senior training faculty of theFamily Therapy Training Program and is the family psychology consultantto the Strong Epilepsy Center. Areas of interest include spirituality in psy-chotherapy, family systems in the workplace, couples therapy, and a familysystems understanding of mind/body problems.
1C H A P T E R 1Setting the Stage forWorking with CouplesMichele HarwayIN THE FAIRY TALE, the Prince and Cinderella fall in love, get married, andlive happily ever after. Our culture abounds with similar stories. In eachcase, the story seems to end at the moment of commitment and we areseldom privy to the adjustments that the couples must make in beginning alife together. And yet, the adjustment must be great or more couples wouldsucceed in celebrating their Golden Wedding Anniversary (Kreider &Fields, 2002, based on U.S. Census data, cite only 5% of married couplesreach at least their 50th anniversary). The same authors report 10% of mar-ried couples divorcing within 5 years of marriage and 20% of married cou-ples divorcing within 10 years of marriage. There are no parallel figures forsame-gender couples or cohabiting couples. But clearly the track record isnot good.Some professionals (Nichols, Chapter 3) suggest that the first year ofmarriage (or of living together) is actually the most difficult year of a rela-tionship. This makes sense: Even when the couple has a similar culturalbackground, they have grown up in different families, whose daily livinghabits may differ on the most mundane issue (how to put the roll of toiletpaper on the holder) to the somewhat more important issues (who is re-sponsible for what tasks in the home). These two individuals may have dif-ferent expectations of a relationship and different values on a wide varietyof subtle and not-so-subtle topics. The differences may multiply when, inaddition, the two come from different cultural groups. Faced with the com-plexities of ironing out those differences and the lack of support from theculture at large, it is not surprising that many couples simply give up.Some, however, seek out psychotherapy, often as a last-ditch effort.
2 SETTING THE STAGE FOR WORKING WITH COUPLESThis book focuses on couples therapy and the interventions that mentalhealth professionals implement in helping couples develop the tools tomake a successful dyad.Yet, many psychotherapists begin seeing couples without extensivetraining in how to do couples work. The intention of this book is to fill inthose gaps in mental health professionals’ repertoire.While much of this book focuses on heterosexual couples (often mar-ried), many of the issues we consider affect same-gender couples, as wellas heterosexual cohabiting couples. Because there are issues with whichsame-gender couples struggle that are unique to their relationships, wehave included a chapter that specifically addresses these couples. Recogniz-ing that cultural issues are very powerful determinants of couple inter-action, we have woven cultural issues into each chapter rather than havinga separate chapter on this topic.We have considered work with couples from three perspectives: a develop-mental one, a theoretical one, and a situational one. Section I of this booklooks at couples at different stages of the life cycle, since clearly different is-sues affect them at each stage and distinct therapeutic approaches to work-ing with them are appropriate. We have used McGoldrick’s life cycle stages(loosely construed) to guide us in our choices. Accordingly, Section I beginswith couples at the premarital stage (Chapter 2). Gordon, Temple, andAdams describe PAIRS, a premarital counseling curriculum, extensively de-signed to include a multiplicity of interventions to assist couples as theyenter a committed relationship. In Chapter 3, Nichols thoroughly exploresthe first years of commitment. He includes a discussion of the nature of mar-riage, cohabitation, and commitment; an overview of the tasks of the familycycle; and issues related to psychotherapy with couples in the early stages ofthe life cycle. Lower (Chapter 4) considers the difficult life transition to par-enthood and the adjustments that confront couples with young children. InChapter 5, Mas and Alexander explore the four essential features of treat-ment based on clinical, research, and theoretical literature as applied to fam-ilies with adolescents. Highlighting the multiplicity of differences that suchfamilies may bring into the therapy room, these authors focus on cultural di-versity issues. Completing the part on life cycle stages, Peake and Steep(Chapter 6) examine novel ways to intervene with older couples capitalizingon their lived experience and using popular films and other resources as ad-juncts to psychotherapy.Section II of the book focuses on different theoretical approaches to work-ing with couples. Silverstein (Chapter 7) considers the application of Bowenfamily systems theory to work with couples and provides a supportive femi-nist critique of the theory. In Chapter 8, Patterson argues that common con-ceptualizations of cognitive-behavioral approaches to couples therapy do notalways provide an adequate integration of these two traditions. Focusing onthe separate foundations of behavioral approaches on the one hand, and cog-nitive theories on the other, Patterson provides an understanding of the
Setting the Stage for Working with Couples 3melding of these two traditions into cognitive-behavioral couples therapy.Scharff and de Varela (Chapter 9) describe how object relations therapywould be applied to couples. Shifting from more traditional approaches ofworking with couples to postmodern thinking, Rosen and Lang (Chapter10) introduce key aspects of doing narrative therapy with couples. In thefirst of several integrative approaches to working with couples, Bradleyand Johnson (Chapter 11) present emotionally-focused therapy, an inte-gration of collaborative client-centered, gestalt, systems approaches, con-structivist thinking, and understandings derived from attachment theoryand the empirical literature. Cheung (Chapter 12) proposes the integrationof strategic family therapy and solution-focused approaches to workingwith couples. In Chapter 13, Pitta describes integrative healing couplestherapy that uses psychodynamic, behavioral, communication, and sys-temic theories in understanding the couple’s functioning. Concluding thispart, Nutt (Chapter 14) describes feminist and contextual approaches toworking with couples.Section III approaches couples’ interventions from the perspective ofcommon presentations in therapy. Thus, Watson and McDaniel (Chapter15) describe the work with couples who are confronting medical concerns.The interface of the biological and the emotional provide the framework fortheir work in medical settings. In Chapter 16, Harway and Faulk considerhow a history of sexual abuse in one member of the couple may affect theoverall couple’s functioning and may lead to difficult therapeutic concerns.A common concern in couples therapy is the existence of physical violence.Holtzworth-Munroe, Clements, and Farris (Chapter 17) discuss the implica-tions of intervening with these types of couples. Addiction is another diffi-cult issue that couples bring with them into therapy. Stanton (Chapter 18)reviews key elements of couples therapy for the treatment of addictive be-haviors. Infidelity is said to affect a large number of couples and presentsparticular challenges. In Chapter 19, Lusterman explores issues related toworking with couples who have been touched by infidelity and proposes aneffective model for intervention. Psychotherapists are often uncomfortablewith exploring spiritual issues in therapy. Yet, spiritual and religious differ-ences, like other forms of cultural difference, contribute to some couples’dissatisfaction with their relationship. Serlin (Chapter 20) considers how tointerweave spiritual concerns in the course of psychotherapy. While couplescomprised of two same-sex partners share many of the same issues as het-erosexual partners, Alonzo (Chapter 21) describes some unique issues forgay or lesbian couples. Kaslow (Chapter 22) examines the impact of socio-economic factors on couples’ functioning and describes some approaches toworking with money issues in therapy.Not all couples presenting for psychotherapy are there to improve thecouple’s bond. Some couples initiate therapy to provide a smoother transi-tion to divorce, while other couples initiate therapy in the hopes of sav-ing their relationship but ultimately decide instead to focus on marital
4 SETTING THE STAGE FOR WORKING WITH COUPLESdissolution. Rice (Chapter 23) considers special issues in working with di-vorcing couples.Finally, while many of the chapters interweave empirical informationwith clinical information, in Chapter 24, we consider what the research hasto tell us about the nature of couples functioning and the effectiveness ofour interventions. Stabb reviews both the literature on well-functioningand dysfunctional couples and research that elucidates what is useful incouples therapy interventions. Chapter 25 summarizes the multiplicity ofthreads that have been developed in the many outstanding contributions tothis volume.Couples therapy can be challenging work. Nonetheless, since couplesand families provide the major building blocks of our society, the work thatwe do in shoring up the foundations has impact beyond those we touch di-rectly. As we know from systems theories, the concentric circles of involve-ment of the individuals who comprise our families and couples, within thelarger context of our communities and cultures, makes our impact ricochetfrom its point of impact to the entire pond. As such, couples therapists havethe possibility of being change agents at a much wider scale than they mayhave believed. Good training in doing couples work thus becomes critical.REFERENCEKreider, R. M., & Fields, J. M. (2002, February). Number, timing and duration of mar-riages and divorces: 1996 (Current population reports). Washington, DC: U.S.Department of Commerce, U.S. Census Bureau.
7C H A P T E R 2Premarital Counseling from thePAIRS PerspectiveLori H. Gordon, Robin Rose Temple, and Donald W. AdamsTHE PREMARITAL COUPLE treads a challenging path between falling inlove and solidifying a commitment. Premarital couples seek profes-sional help to prevent or to understand and resolve relationship diffi-culties that may have arisen even before marriage. The status andcircumstances of premarital couples seeking help vary from the young-and-inexperienced to the previously married (with or without children) tolong-term cohabiters who have not committed to marriage. The premaritalcouple is wise to be cautious. Statistics tell us that the likelihood they willfind happiness and longevity in marriage is despairingly low whereas 90%of couples married during the years 1945 to 1949 made it to their 10-yearanniversary. Forty years later, barely 70% of those married during theyears 1985 to 1989 celebrated a decade of wedded bliss—and the statisticscontinue to decrease (Fleming, 2003).Premarital couples seek assurance that they can create a lifelong inti-mate partnership. Each partner needs accurate concepts, conducive atti-tudes, technical knowledge and skills, and practiced competencies tosustain a loving relationship. As in ballroom dancing, the couple relation-ship gains best through co-learning, by acquiring and practicing these in-timate relationship skills together. The couple needs to acquire high levelsof skill to continue dancing lovingly in the face of changing family lifewith its unrelenting and often discouraging economic, domestic, andparental responsibilities. The counselor, who wishes to effectively offersuch knowledge and skills to couples, needs to undertake relevant profes-sional training. Such training is not yet established in most graduate clini-cal programs.
8 LIFE CYCLE STAGESABOUT PRACTICAL APPLICATION OFINTIMATE RELATIONSHIP SKILLSPractical Application of Intimate Relationship Skills (PAIRS) is a curricu-lum for intimate relationship skills training. PAIRS grew from the ashesof marital disaster. The creator and developer of PAIRS (co-authorLori Gordon), on the demise of her own 17-year marriage, set out to findmissing answers. PAIRS is drawn from many emerging humanizing in-terpersonal therapies of the second half of the twentieth century (Satir,Casriel, Bach, Sager, Brandon, Framo, Bowen, Wynne, Perls, Guerney,Brandon, Zilbergeld, etc.). PAIRS has evolved over 30 years. Gordon hasrefined the keys to intimacy and shaped and polished the training exer-cises needed to create deep personal transformative learning by relation-ship partners.PAIRS has been experienced by tens of thousands of couples, manywho were on the brink of divorce (DeMaria, 1998); and by tens of thou-sands of individuals, wanting to develop skills to prevent a repeat of thedevastation of relationship breakup. Gordon’s self-help book for couplesand individuals, Passage to Intimacy (1993), presents the main ideas and ex-ercises of PAIRS that can be learned at home and practiced outside theclassroom. Incisive descriptions and thoughtful discussions by PAIRSMaster Teachers, a review of research about PAIRS, and critical issuessuch as the PAIRS Ethics Code for teachers are brought together in Build-ing Intimate Relationships: Bridging Treatment, Education and Enrichmentthrough the PAIRS Program (DeMaria & Hannah, 2003). The PAIRS experi-ence significantly increases relationship satisfaction, sustainable love,and commitment.A central tenet of PAIRS is that sustained intimacy is required to maintain alasting marriage. When intimacy, the deep emotional experience of lovingconnection, is lost, the ground the marriage is built on becomes shaky.Good will is then lost and the desire (and ability) to solve problems, over-come obstacles, and persist in the face of fear and uncertainty, quicklyerodes. With its emphasis on intimacy, PAIRS goes to the heart and theheat of the matter. Once couples learn to create, re-create, and sustainintimacy, many premarital and marital issues, such as commitment, coop-eration, fidelity, and creative management of differences, are much morequickly resolved.PAIRS is designed to (1) realign attitudes and beliefs about love and re-lationships and about marriage and family life; (2) train and evolve eachpartner’s self-knowledge, emotional literacy, and emotional efficacy; and(3) change ineffective behaviors that diminish intimacy by teaching thosebehaviors and skills that increase intimacy and relationship enhance-ment. The PAIRS curriculum is a theory-based, cohesive, orchestratedbody of concepts and practical activities that is a powerful technologyfor change. PAIRS has, thus far, proven effective in every population,
Premarital Counseling from the PAIRS Perspective 9including disadvantaged youth, middle and high schools, foreign cul-tures, entire families, business groups, faith-based adult education, sepa-rated and divorcing couples, premarital couples, and devitalized couplesin marital doldrums.GOALS AND OBJECTI VES OFPREMARI TAL COUNSELING FROMTHE PAIRS PERSPECTI VEThe PAIRS trained professional (PTP) translates the PAIRS concepts andtools found in the 120-hour experiential PAIRS Relationship MasteryCourse into an effective counseling approach that is titled OFFICE PAIRS.A PTP is a licensed mental health professional who has been trained in thePAIRS professional training program. PTPs have had more than 100 hoursof direct experience with the PAIRS concepts and training exercises. Dur-ing their training, PTPs personally experience the full range of PAIRS exer-cises, usually with their partners. After training, most PTPs teach, practice,and internalize the PAIRS concepts and tools. In OFFICE PAIRS, the PTPpersonally and directly helps the couple learn PAIRS competencies, prac-tice them under an experienced eye, and apply them outside the office andobtain feedback on their “homework.”When working with a premarital couple, the PTP holds in heart andmind an awareness of what is necessary to be an effective partner as well asthose skills, attitudes, and strategies couples need to assure an ongoing sat-isfying relationship, conducive to family permanence. These competenciesfocus on three areas: (1) emotional literacy; (2) conjoint partner skills forbuilding and maintaining intimacy; and (3) practical knowledge, strategies,and attitudes for sustaining positive marriage and family life. Tables 2.1,2.2, and 2.3 list these competencies.The PTP holds these competencies in heart and mind as a standard forwhat is needed to sustain couple satisfaction. When couples seek counsel-ing, the PTP notes which of these competencies are missing and developspriorities and strategies for offering knowledge and training in what isneeded. Effectively addressing what is missing with interventions, new un-derstandings, and the teaching of new skills, especially for the premaritalcouple, can prevent years of confusion, misery, and probable later familydisintegration. Without training in new competencies, the couple cannotadvance far. During the early romantic “illusion” stage of a relationship,moments of hurt, misunderstanding, noting differences, or use of poweroften trigger doubts and fears about the relationship. Those couples inearly relationships coming for counseling are typically experiencing chal-lenges to illusions of perfect fit and unconditional love. This is the optimaltime to develop the knowledge, skills, and strategies needed to build a solidrelationship rather than an illusory one.
10 LIFE CYCLE STAGESTable 2.2PAIRS Competencies: Conjoint Couple Skills to Create and Maintain Intimacy1. Confide in one another regularly with emotional openness and empathic listening.2. Complain to one another regularly (without attacking) including requests for change.Can listen to complaints without defensiveness.3. Resolve differences and conflicts by seeking to learn rather than to prevail. Use fairfighting that involves confiding, empathic listening, complaining with requests forchange, and contracting, effective win-win solutions, all without manipulation and dirtyfighting.4. Agree on areas of autonomy, areas of consultation, and areas of mutually shared own-ership and decision making.5. Clarify hidden assumptions and unspoken expectations to minimize misperceptionand misunderstanding.6. Help one another heal pains and disappointments, resolve emotional allergies, andclarify hidden assumptions. Conjointly heal and resolve emotional allergy infinity loops.7. Meet basic needs for sensuality, appropriate sexuality, physical closeness, bonding,and intellectual and emotional sharing with one another.8. Follow clear, equal, negotiated boundaries regarding what is private and not sharedwith others outside the relationship.9. Initiate change when the status quo (division of roles, responsibilities, and privileges)is not satisfactory. Follow through on negotiated changes.Table 2.1PAIRS Competencies: Emotional Literacy1. Comfortable with the names and manifestations of the five basic emotions, i.e., pain,fear, anger, love, and joy. Identifies and expresses these emotions and can listen em-pathically to them.2. Recognizes defensive overreactions as emotional allergies based on painful memo-ries. Takes responsibility to reduce, control, and change inappropriate responses.3. Recognizes being emotionally open vs. emotionally closed. When feeling attacked,threatened, or denied, evaluates reality by checking out speaker’s meaning and in-tent, rather than assuming and reacting defensively via rationalizing-explaining-justifying, withdrawing, avoiding, or fighting back.4. Expresses pain, fear, and anger without attacking or blaming.5. Listens without interjecting self-concerns. Creates and maintains emotional safety forothers.6. Uses anger constructively to assert self, set limits, define boundaries, and effectivelysolve problems. Expresses anger appropriately and safely to release suppressedemotions.7. Believes in one’s own value. Feels lovable and good enough without having to be per-fect. Accepts having healthy needs and actively pursues getting them met, includingthe biological needs for physical closeness and emotional openness in an intimaterelationship.8. Experiences and expresses emotions of a type and at an intensity that appropriatelyfits and that sustains action in accord with one’s purpose, intention, and circum-stances (emotional efficacy).
Premarital Counseling from the PAIRS Perspective 11THE PAIRS PREMARI TAL ASSESSMENTThe format Gordon developed for the PAIRS premarital assessment beginswith a two-hour joint interview with couples to explore their history to-gether, establish the context of their relationship, and set initial goals andplans for the assessment. It involves questions such as:• How did you meet?• What drew you together?Table 2.3PAIRS Competencies: Attitudes and Strategies forSuccessful Long-Term Relationships1. Affirm the essential role of regular bonding with an abundance of physical closenessand emotional openness to sustain intimacy. Satisfactorily blend sensuality, sexual-ity, and bonding in marriage.2. Choose play, pleasure, recreation, creativity, and humor for the relationship to bal-ance the necessary duties and hard work required to maintain the relationship,home, family, and economic security.3. Express important hurt, fear, or irritation directly to each other in words, asking to beheard and understood with empathy. Recognize that what is left unsaid in a relation-ship is often more harmful than what is said.4. Seek forgiveness for hurts inflicted in the relationship by taking responsibility fortransgressions, repairing and restoring damages, and expressing regret for pain ex-perienced by partner. Partner, in believing the pain is understood, feels assured thattransgressions will not easily reoccur, restores trust and forgives. Let go of grudgesand choose to forgive.5. Give up being right. Invite and express diversity. Welcome differences as sources ofvigor, perspective, and healthy growth of a relationship. Choose to learn from eachother.6. Choose trust, truth, mutual respect, and fidelity as the foundation of a lasting, lovingrelationship.7. Extend goodwill and positive intent. Do what is pleasing and satisfying to partner.Choose to engage in caring behaviors. Be a good leader or a good follower aseach fits.8. Know each other’s pleasure and pain buttons. Refrain from triggering negativereactions.9. Develop a strong sense of “we.” Have intentional rituals, customs, and styles thatcreate a unique relationship and family identity.10. Encourage connecting to friends and community to assure each has adequate auton-omy, independence, and breathing room. Balance the intense closeness and needfulinterdependence that is at the center of a permanent passionate relationship.11. Maintain active connections with extended family and other couples and families toprovide community, perspective, and support for the relationship and family.12. Regularly express gratitude, appreciations, blessings, wishes, hopes, and dreams.Positive expressions focus couple and family on desire, fulfillment, and happiness,rather than on victimization, deprivation, scarcity, outrage, or despair.
12 LIFE CYCLE STAGES• What made you decide to commit to this relationship?• What are family responses and reactions to this relationship and yourreactions to each other’s families?• What are you seeking from this counseling?• What are your questions of the counselor?• What are your vocations and how does your work and work communi-cation styles affect your relationship particularly during times of stress.This longer session is needed to grasp the fabric and playing field of therelationship. The 50-minute hour simply cannot build the trust, connected-ness, and collaboration needed for this initial inquiry.Next schedule two-hour individual interviews with each partner: Thistime provides an opportunity to discuss what might be uncomfortable toshare in a joint session. These sessions gather the individual social andemotional histories—family conditioning, early beginnings, models fromthe parental marriage, sibling relationships, decisions and experiences re-garding love, trust, caring, criticism, competition, power, communicationstyles, and marital role expectations, including their hopes for the futureas well as fears. Beliefs, expectations, experiences, and life decisions thatmight affect the couple’s relationship are tracked, including invisible loy-alties, changes through time in previous relationships, a history of previ-ous marriages or engagements and what led to their dissolution, children,job changes, communication and power impasses, disappointments andhow they were handled, and personal hopes and dreams. The individualsessions generate an attitude of openness and growing curiosity on thepart of each participant about unique histories, and the conditioning eachhas brought to the relationship including how differing styles and expec-tations may mesh or clash. These individual sessions open windows tonew understandings that have not previously been realized or considered.Next, a two-hour joint interview for feedback is scheduled. The PTP in-quires about and carefully listens to new thoughts or questions that mayhave arisen from their exploration of issues. The PTP then reviews perti-nent data that has been collected and offers specific significant relation-ship concepts and skills as applicable, such as the PAIRS Dialogue Guide, acommunication tool for complaining without blaming. Or a listening skill.Or an exercise designed to uncover mind reading. Or hidden expectationsthat in PAIRS are called Love Knots, such as, “If you loved me, you wouldknow . . .” A nonblaming attitude is maintained throughout. Humor, asappropriate, is often included along with pertinent wisdom and insights.The PTP relabels and reframes many past behaviors and intentions, point-ing out how blame is often not the issue. The PTP demonstrates how enor-mous misunderstandings have often arisen from a lack of information,which if asked for and then given, would clarify misperceptions and hid-den assumptions.
Premarital Counseling from the PAIRS Perspective 13In this joint session and, if needed, in one additional joint session, the PTPprovides possible explanations of issues that have become tangled or diffi-cult in the relationship. The PTP then discusses formats for acquiring spe-cific relationship knowledge, relationship skills, or specific competencies foremotional literacy. These formats might include PAIRS courses and/or OF-FICE PAIRS counseling sessions. These suggestions may also include booksto read, specific exercises to practice, and brief workshops to attend thathave proven to be effective.MORE ABOUT RECOMMENDATIONSVery often PTPs recommend and encourage premarital couples to partici-pate in the four-month PAIRS Relationship Mastery Course developed forthe specific purpose of practicing, improving, and sustaining healthy mar-riage relationships. This semester-long course is recommended because itnot only fully addresses relationship fundamentals, it also addresses emo-tional literacy, understanding one’s history and oneself, as well as ad-vanced topics such as pleasure (sensuality and sexuality) and relationshipreconstruction.Alternatively, when appropriate and available, the PTP may recommendthat the premarital couple attend one of the shorter PAIRS programs. Theseinclude the one-day PAIRS JumpStart, If You Really Love Me . . . , and theJewish, Catholic, or Christian PrePAIRS programs; the two-day Passage toIntimacy Workshop; or the three-day Christian PAIRS or PAIRS First pro-grams. The PAIRS website, www.pairs.com, provides descriptions, sched-ules, and location information about these programs. The short programscontain a careful selection of pieces from the full PAIRS curriculum tailoredto specific target groups. Most of the short courses begin with understand-ing the PAIRS Relationship Road Map, learning basic communication andconfiding skills as well as how to complain constructively to effect helpfulchange. Each program adds further PAIRS pieces that are appropriate for itspurpose. The PrePAIRS and PAIRS First programs were originally designedfor couples in the early years of relationship commitment. These courses arehighly appropriate for premarital couples seeking to strengthen their rela-tionship through learning intimate relationship fundamentals.The premarital couple with moderately high ego strengths, emotionalliteracy, and openness to learning often finds that the 6- to 10-hour as-sessment, by itself with the new insights and brief but specific skills andconcepts offered, is sufficient to gain renewed confidence in the relation-ship and in plans to marry. The PTP may also recommend one of theshorter PAIRS workshops to provide elaboration, practice, and consolida-tion of the new concepts, skills, and strategies that have been developed inthe assessment. An invitation is issued for them to return when needarises in the future, indicating the PTP’s interest and availability as well
14 LIFE CYCLE STAGESas the normal inevitability of the need for continuing attention to thework of a relationship.For the majority of premarital couples (considering that about half of allmarriages end in divorce) and especially for those who are emotionally illit-erate, ignorant about successful relationships, and unskilled at intimacy,PTPs routinely recommend the 120-hour Relationship Mastery Course. Thisprogram affords the breadth, depth, time, and practice needed to change de-structive attitudes and behaviors. This Mastery Course is recommended forthose who already have complex issues, are possibly in mutual allergy, maybe embarking on a second or third marriage, or are on the verge of breakupbut not ready to give up. Typically, the PTP will remain available to the as-sessment couple for evening 90-minute office sessions to oversee extra prac-tice with the PAIRS skills during their participation in the course, and thenagain after the course for any “RePAIRS” that may be needed to refresh theconcepts, practice the tools, or help the couple get quickly unstuck shouldthey again become negatively entangled.When a course or workshop is not immediately available, the PTP maycounsel premarital couples in need of more training via OFFICE PAIRS untilthey can participate in a PAIRS program. The PTP selects concepts, exercises,and experiences thought to be most cogent to their missing competenciesand then teaches these in a series of 90-minute sessions. In locations wherethere are no available PAIRS courses or workshops and when a couple cannottravel to one in another location, the PTP may contract to lead the couplethrough the content of one of the shorter PAIRS curriculums in a defined se-ries of 90-minute sessions. When engaging a PAIRS curriculum, each pur-chases a participant’s handbook for the selected course and a copy of ThePassage to Intimacy book, which provides a deeper presentation of the ideas,skills, or attitudes under study. In such OFFICE PAIRS activities, couples re-ceive homework assignments and are expected to practice daily the skillsthey are learning. OFFICE PAIRS is not undertaken lightly. Teaching theseskills is usually easier and more natural in a group setting than in the office.THE PAIRS RELATIONSHIP MASTERY COURSEThe full PAIRS curriculum is divided into six main sections:1. Communication and problem solving;2. Clarifying assumptions;3. My history and unique self;4. Emotional reeducation, emotional literacy, and bonding;5. Pleasure—sensuality and sexuality; and6. Contracting—clarifying expectations.The following summary highlights specific PAIRS exercises and key con-cepts in italic.
Premarital Counseling from the PAIRS Perspective 15COMMUNICATION AND PROBLEM SOLVINGPAIRS begins with a presentation of the Relationship Roadmap, the basic PAIRSmodel of how relationships succeed or become stuck and fail. Couples learn ofthe essential role of confiding in intimacy and then how to listen and speak inways that deepen their level of confiding. They are taught the Daily Tempera-ture Reading, in which they are expected to confide in one another each daysharing Appreciations, New Information, Puzzles, Complaints with Requestfor Change, and Wishes, Hopes, and Dreams. Participants then read andpractice Virginia Satir’s (1988) The New Peoplemaking and discover how thestyle one uses can be a far greater problem than the actual issue under dis-cussion. When stressed and communicating in stress styles (Blaming, Placat-ing, Computing, and Distracting), the underlying problem goes unresolved.Couples are then taught the Leveling Style of Communication practiced in thecongruent position (face to face, hands in hands), which is a foundation forthe subsequent confiding work in the course. They cultivate the skill to slowdown communication using Empathic Shared Meaning, taking turns being thespeaker and the listener with feedback to assure understanding. They nextlearn how to confide a negative reaction to their partner’s behavior all theway through in safety using the PAIRS Dialogue Guide. The Dialogue Guideleads the speaker through a sequence of 18 “I-Statement” sentence stems re-garding this negative reaction. Maintaining eye contact, holding hands whilethey speak, giving verbatim feedback, and not answering the complaint orintrojecting defensiveness helps couples to stay connected to one anotherand avoid misunderstandings. They discover how to speak so that the otherperson really wants to listen, and how to listen with empathy so that theother feels deeply heard and understood.One of the many paradoxes of PAIRS is how direct and skillful engage-ment of conflict builds greater closeness, trust, and confidence in the rela-tionship. Couples are taught safe and structured ways to move into theintense emotion regarding a conflict as a first step toward resolving an issue.The Emotional Jug is one of the core metaphors of PAIRS. When emotions arecut off or suppressed, it is as if they are poured into a jug and stopped upwith a cork—a cork that becomes the “stiff upper lip” of indifference. Part-ners are taught how to safely remove the cork and “blow their lid.” An initialexpression of anger quickly gives way to more vulnerable feelings like fear,pain, or grief, which is followed by relief and then gratitude for their part-ners’ listening and acceptance. This process can occur relatively quicklywhen couples master the tools and are not fearful of each other’s emotions.By learning how to express fully one’s fear, pain, and anger in safe and non-destructive ways, and to do so in the arms of their beloved, and/or with thesupport of peers, the bond between intimate partners powerfully deepens.The Emptying the Jug Exercise is also taught as a prenegotiation release and asan emotional confiding tool that may be used like the Daily TemperatureReading.
16 LIFE CYCLE STAGESThe PAIRS anger and conflict management tools were adapted largelyfrom the work of George Bach (Bach & Wyden, 1969). They include the AngerRituals (the Haircut, and the Vesuvius) in which one partner asks permissionof the other to vent in a time-limited fashion with as much intensity as ispresent. The Anger Rituals help to contain anger in those who explode orspeak caustically and to give permission to be angry and assertive to thosewho rarely allow themselves to do this. Once suppressed emotions aroundan issue are released, couples can then productively engage the Fair Fight forChange, another Bach ritual adapted by PAIRS for use as a structured negoti-ation. Here, couples learn to fight for the relationship, rather than againsttheir partner. Peer couple coaches guide the partners through the fight for-mat, prohibit dirty fighting, and enable reflective evaluation of the partners’emerging healthy fight styles. Peer coaches learn as much about the FairFight process when coaching as they do when negotiating their own issues.Through a Shared Art Exercise in class and Follow-the-Leader Dates as home-work, issues related to power and control, leadership and followership, flex-ibility versus rigidity of power roles, as well as the impact of unspokenassumptions are all brought to the surface and examined. Couples discoverthat they can remain connected while disagreeing and that they can growcloser through successfully addressing their differences. A potent sense of“we,” a sense of shared competence, higher self-esteem, and greater gen-erosity and goodwill ensue from safely and successfully finding a real, mu-tually satisfying, win-win solution to conflict.CLARIFYING ASSUMPTIONSPartners’ expectations of one another, conscious or unconscious, are largelyformed by long-past experiences. Unspoken assumptions and hidden ex-pectations lead to great misunderstanding. A Mind Reading tool is taught forrespectfully checking out assumptions rather than proceeding withoutknowing what is true for the partner or with mind reading without permis-sion. To help couples become more aware of their hidden assumptions,Gordon catalogued the common Love Knots, or unexamined beliefs, that sab-otage intimate relationships. (See If You Really Loved Me . . . , Gordon, 1996.)Couples learn to recognize knots and to untangle them so that they lose theirpower to sabotage the relationship.MY HISTORY AND UNIQUE SELFA study of family systems, through psychodramas enacting Family SystemsFactories and what happens with the addition of children (Dyad-Triad) leadsinto the study of each person’s own family of origin. Genograms, a three-generation family map, allows exploration of influences in the family oforigin and reveals the invisible rules, scripts, and loyalties that may be af-fecting current relationship. Participants also revisit their personal history
Premarital Counseling from the PAIRS Perspective 17through Guided Visualizations and Intensive Journaling to discover the impactof early messages and past decisions, especially regarding love, adequacy,and worth. They uncover their Revolving Ledgers, the emotional bills ofdebts owed from the past that, as they walk through the revolving door oflife, they hand to whomever is there. Participants identify intense over-reactions to relatively minor behaviors of their partner that indicate thepresence of Emotional Allergies (another concept unique to PAIRS). These al-lergies are acute sensitivities to whatever now reminds a person of pain orthreats from the past. Allergic responses are accompanied in the present byprotective reactions (ideas and emotions) and protective behaviors thatwere used to manage the pain long ago.Tools for healing allergies and past painful experience include the Heal-ing the Ledger Exercise and the Museum Tour of Past Hurts and Disappoint-ments. Here, partners confide previous painful or frightening experiencesto one another. This confiding helps the listener to understand and havemore compassion for the partner, and it helps the speaker to express painsafely to a comforting, validating, and supportive partner. Partners areshown how to hold each other in a nurturing way, while they are express-ing and releasing old pain. Participants may use the Letting Go of GrudgesLetter as a journaling and/or confiding tool, for finding relief and freedomin working through grudges (hurts held in angry resentment to protectfrom risking being hurt again). Through these experiences, participantsclear up misunderstandings of one another by reclaiming their personalhistory rather than continuing to project and blame their partner. They re-connect with suppressed early experiences and decisions that have beeninterfering with their ability to trust or be intimate with their partner. Part-ners also learn they can help to heal instead of hurt one another.Couples also find that Emotional Allergy Infinity Loops underlie many oftheir unresolved conflicts. Such a loop occurs when a person’s behaviortriggers an emotionally allergic reaction in his or her partner. The partner’sallergic reaction then triggers an allergic reaction in the first partner,whose reactive behavior then retriggers the second, and so on, ad infini-tum. In the throes of an Emotional Allergy Infinity Loop, each partneroften re-experiences the worst pains of childhood and the helpless reac-tions of a small child. Typically each feels, “if it is like this, then I cannot behere!” Each forgets to see his or her partner as a friend and experiencesthe partner instead as the enemy. Each becomes lost in a reactive state ofbelieving the worst about self and partner and of using primitive protectiveactions. Devastating distance can grow.Couples now develop concepts and a language to understand and explainwhat they are experiencing when they are conjointly in the grip of suchemotional intensity. As participants begin to understand and discuss theirLove Knots, Early Scripts and Decisions, Ledgers, Grudges, Emotional Al-lergies, and Emotional Allergy Infinity Loops, they become capable of tak-ing responsibility for their own reactions, rather than blaming the other.
18 LIFE CYCLE STAGESCouples are helped to strategize together to devise “emergency exit ramps”from their loops and to work together to escape those slippery slopes.Through empathy for the partner’s “child responses” and revision of beliefsabout the meaning of the partner’s behavior, the Emotional Allergy InfinityLoop can be transformed into a Loop of Vulnerability and Empathy (LOVE).To help see their unique self and inherent personality differences, partic-ipants rate themselves on the Meyers-Briggs type indicator (Kiersey-Bates).Through the use of exercises to illuminate the differences between the polesof the four basic personality preference scales, couples begin to see howmany of their disagreements and conflicts are better understood as differ-ing styles of decision making, problem solving, information gathering, andstyle of interaction. Differences, which had appeared to be threatening andperceived as personal attacks, can now be reframed as temperament differ-ences. This often allows individuals to accept their own preferences andstyles, and helps couples approach their personality differences with asense of humor and even with compassion, instead of frustration, resent-ment, or fear. Additionally, couples begin to appreciate how their differ-ences can be complementary in accomplishing life tasks together.Participants also learn the “PARTS of Self,” a system of classifying andunderstanding the various aspects of their own unique personality. Drawnfrom the work of Virginia Satir, participants learn to identify and give mean-ingful names to their subpersonalities, usually names of renowned figuresin culture, history, or literature. Disowned or suppressed PARTS of a per-son’s psyche tend to act outside of a person’s control. Coming to know anddiscover the positive value in each PART of Self allows each person to bettercoordinate, utilize, and, if necessary, transform these PARTS so that they areacting in harmony with personal goals and life choices. Their PARTS can beperceived as resources. In a series of PARTS parties, classmates act out thePARTS of one individual, and later the PARTS of a couple. The PARTS partyplayers help individuals or couples discover new and more creative combina-tions of PARTS that the couple can use in conflict and stress or even romance.Following these PARTS parties, individuals and couples explore their owninner cast of characters and experiment with ways to rearrange the PARTSthey tend to use the most. In doing so, they discover how to better use alltheir resources and uncover new possibilities for interactions with their part-ners that are more harmonious and productive.EMOTIONAL REEDUCATION, EMOTIONAL LITERACY, AND BONDINGPAIRS dives even more deeply into emotion via the PAIRS Bonding Week-end Workshop. PAIRS adapted the New Identity Process (Casriel, 1972) tothe couple orientation of PAIRS, calling it Bonding Work. Casriel, arenowned specialist in the treatment of drug and alcohol addiction intherapeutic communities, originally developed this expressive process totreat character disorders. Paul MacLean’s (1973) A Triune Concept of the
Premarital Counseling from the PAIRS Perspective 19Brain and Behavior is presented as a model to understand emotional mem-ory that, when activated, does not know time and place and is experiencedas reoccurring now. Participants learn several different positions for hold-ing their partner while he or she is expressing intense emotions. Partici-pants learn how to progress from less intense emotions to more intenseexpression, to the reexperiencing of emotions in full measure. In this in-tense emotionally open state, emotional reeducation can occur. Once indi-viduals have emptied old pain, they become open to receive positive,comforting, and affirming messages about themselves from their partnersand the group. When ready, they are assisted in construction affirmationsof their own value, rights, and entitlements. They replace old or toxicchoices with new, healthy attitudes and decisions.During this process, couples develop deep empathy and compassion forone another. They discover that, not only can they handle their partners’ in-tense emotions, but they can also offer their partner comfort through hold-ing and touch when they are in pain. Over the course of this weekend,participants commonly lose their fear of both their own and their partners’emotional intensity. They experience directly and observe in others how anintimate relationship generates intense emotions about bonding, belonging,needing one another, never leaving, and being loved for oneself. They learnthat the expression of these powerfully intense emotions cements theirbond at the deepest of levels and can restore passion to their relationship.The culmination of this workshop is the Death and Loss experience inwhich participants enact saying goodbye to their deceased loved one. Theyare led to speak what would need to be expressed to say goodbye. Musicand the use of carefully chosen sentence stems make this an emotionallycharged and deeply meaningful exercise for partners. They experience thedepth of their bond in the “experience” of losing one another throughdeath. This exercise also allows communication about the meaning of theirlives together. Rest-of-life wish-baskets are shared between partners.PLEASURE—SENSUALITY AND SEXUALITYCouples explore how they can expand the range of pleasure that they sharetogether. PAIRS recognizes three special biological needs (sources of pleas-ure) that require physical touch met by the married couple: Sensuality, Sexual-ity, and Bonding. The Pleasure Weekend Workshop is devoted to removingbarriers to pleasure and enhancing skills and understandings that enablecouples greater pleasure, joy, and fun through stimulation of the senses,touch, and physical closeness. Same gender groups explore: (1) early experi-ences and messages that have impacted one’s development as a sensual andsexual being; (2) playful exploration of gender differences in romantic turnons and turn offs; and (3) sexual saboteurs and stereotypes, myths, and fal-lacies about sex. Cross-gender conversations and guided visualizationsabout early experiences with sex development help generate more empathic
20 LIFE CYCLE STAGESunderstanding between partners and more acceptance for their biologicallybased differences.Sprinkled throughout the weekend are exercises designed to open the fivesenses, as well as guided massages where couples practice giving and receiv-ing pleasuring touch with feedback. The Guided Face Caress and Foot Massageare among the most enjoyable moments of the entire PAIRS program.Along with these sensual exercises, an explicit film on lovemaking isshown that re-focuses the couple on intimacy and pleasure, and helps to re-lieve performance anxieties. Participants fill out detailed and explicit in-ventories to help identify romantic, sensual, and sexual preferences,dissatisfactions, and wishes for change. Couples are guided through a safeprocess in which they share their pleasure inventories with each other anddiscuss their reactions and feedback. Often, a lack of communication or abuildup of resentment or fear of hurting or embarrassing one another hasblocked giving and receiving pleasure freely. Sensual and sexual pleasuredates (McCarthy & McCarthy, 1990), which are assigned for homework,give couples permission to experiment in new and creative ways with bothgiving and receiving pleasure. Couples usually leave the weekend with arenewed sense of hope and excitement about their sex life, and frequentlydescribe breakthroughs in the following weeks from having been able toenjoy each other based on leveling about their physical and sexual needsand preferences.The roots of jealousy—the downside of natural sexual possessivness—areexamined. Participants are shown how the Web of Jealousy, comprised offear, shame, pain, guilt, and rage, negatively affects self-esteem and trust.Jealous reactive behaviors to stem the pain and control outcomes oftenmake matters worse, creating a Jealousy Infinity Loop. Through a JealousyJournaling Exercise with guided discussions with partner, couples come tounderstand one another’s jealous reactions and vulnerabilities to jealousreactions. Betrayal and love triangles are discussed. The essential steps toprevent jealousy are presented using guidelines developed by Shirley Glass(2003).CONTRACTING—CLARIFYING EXPECTATIONSBased on Clifford Sager’s work (1976), the PAIRS curriculum culminates inan integration and application of all the tools and concepts learned in theproceeding months toward a revised relationship contract. To prepare for theContracting Weekend, the Powergram (Stuart, 1980) is examined as a modelfor understanding how power is shared and decisions are made in each re-lationship. Using this model, couples address where and how to change thedivision of power and responsibilities so that both are satisfied with theirdegree of input, influence, and responsibility, and areas of autonomy in de-cision making. Couples use the Museum Tour of Past Decisions, to review andlearn from past decisions about which there may remain a residue of re-sentment or hurt.
Premarital Counseling from the PAIRS Perspective 21Participants extensively journal to clarify expectations and needs in theirrelationship. They examine all areas of life—work and career, leisure time,money, housework, children, in-laws, religious observances, sexuality—andrank areas of importance or dissatisfaction in order of urgency. Couplesalso identify their core expectations or Walking Issues—the ones that arenonnegotiable. Couples work together to make a priority list of those issuesthey agree need adjustment through negotiation. They are coached in Con-tracting Sessions by other couples using the Fair Fight for Change as the basicstructure for contracting. They also use any of the other tools they havelearned in PAIRS.Through contracting, couples discover that seemingly impossible differ-ences can be bridged with goodwill, hard work, and support. They now pos-sess the self-awareness and necessary skills to continue this recontractingwork after the course on an on-going basis at home using the full range ofskills in their PAIRS Tool Kit. Issues that have not yet been resolved are iden-tified and prioritized for homework, and couples have a network of peercoaches on whom they can draw if they need assistance. Lifetime friendshipsare commonly forged in the group, and there is a profound sense of trust andcommunity that group members enjoy. It is typical for class groups to con-tinue to meet on a regular basis and continue to provide a network of supportto one another. They form a caring community. Some groups have met formany years following the Relationship Mastery Course.In contrast to individual growth activities, such as individual counselingor therapy, PAIRS highlights the importance of the couple as a crucible fromwhich healing, personal growth, and the development of higher capacitiescan emerge. Thus, sustained intimacy and pleasure are assured and the re-lationship becomes a lasting source of authentic love, mutual respect, andtrust between two growing and evolving partners. Premarital couples inPAIRS courses find enormous support from veteran couples. They acquirementors, role models, support figures, and (for the younger premarital cou-ples) new surrogate mothers and fathers to support them and reparentthem toward successful marriage. Couples considering a second marriagefind opportunities to explore what went wrong for each earlier and take re-sponsibility for their part so that the old maladaptive patterns do notreemerge in their new relationship. Many divorced individuals who takePAIRS as singles have vowed never to reenter another relationship untilthey understand what happened and acquire the skills to assure a differentoutcome the next time around. PAIRS training provides the strongest op-portunity for the newly committing couple to acquire the skills, concepts,understandings, self-knowledge, and strategies for building deep intimacyand assuring a lasting, healthy marriage.PREVENTI VE MAINTENANCE PROGRAMSAt the close of the semester program, participants often wish to continuetheir group learning and practice in a preventive maintenance format.
22 LIFE CYCLE STAGESThey often request monthly meetings with the support of their PAIRS in-structor or the PTP. Requests from class groups often include a desire forperiodic weekend workshops, usually once or twice a year. Repeating theBonding Weekend Workshop is most often requested because it helps tomaintain access to the core emotional openness needed for bonding andintimacy.A PAIRS Three-Year Preventive Maintenance Program is under develop-ment for graduates to sustain their strong foundation for loving, healthymarriage and family relationships. This program provides opportunitiesfor those who have had PAIRS experiences (including premarital assess-ment and OFFICE PAIRS) to refresh and practice a wide range of skills,such as the Fair Fight for Change with Peer Coaches, PARTS Parties, Dia-logue Guides, Daily Temperature Readings, and Genograms. Options inthis program include continuing monthly three-hour classes, periodic six-month one-session check-ups, and twice-yearly day-long seminars. Fees forthis program vary by the options chosen by each couple. Based on years ofexperience conducting PAIRS programs, relationships clearly benefit froma psychoeducational program in knowledge and skills in building and sus-taining intimacy in relationships and this benefit can be sustained withregular preventive support.SUMMARYPAIRS premarital counseling and training offers premarital couples richresources that will enhance not only their intimate relationship but also en-rich and emotionally deepen their personal and family lives. Research doc-uments that the PAIRS experience results in achieving far higher levels ofself-worth, emotional literacy, emotional maturity, and relationship satis-faction. Love and community are well documented to be potent healingpowers that create longer, healthier, more joyful lives (Ornish, 1990). Thischapter presented premarital assessment, counseling, training sequences,and preventive support from the PAIRS perspective, as applications of apowerful technology for healing, building, strengthening, and sustaininghealthy marital and family relationships.The PAIRS technology is available to train counselors and through themtheir clients in how to build lasting, satisfying, healthy, successful relation-ships. With successful lifelong marriages, there will be healthier childrenand reduced suffering in successive generations. It is the profound hope ofthe PAIRS network of leaders and trained professionals that PAIRS, as aneducational and counseling resource, will become an essential part of thetraining for all those who provide therapy, counsel, assist, and train cou-ples, particularly premarital couples. This knowledge base needs to be cul-turally incorporated as a universally expected foundation for every newcouple considering a permanent commitment to building a lasting, stablemarriage and healthy family life together.
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