Table of Contents | Previous | Next |
CHAPTER III
APPROACHES TO MARRIAGE AND RELATIONSHIP EDUCATION
A variety of services, programs, and curricula has been developed in the past 30 years to impart skills and provide support to couples to help them prepare for and sustain healthy and satisfying marriages. In contrast with earlier approaches, such as individual couples therapy and counseling focused primarily on repairing troubled relationships, these newer marriage and relationship education programs generally take a preventive approach. They seek to prevent marital distress and dissolution by educating couples in relationship skills. Interest in marriage and marriage education has evolved into a movement with gathering momentum in recent years, largely in response to high divorce rates and the rising tide of family breakdown. Practitioners, lay persons, and clergy members are increasingly being trained in various marriage education methods (Sollee 2000). In 1997, the Coalition for Marriage, Family and Couples Education began gathering program developers at an annual conference to raise awareness of the new approaches and to provide training opportunities for a wide variety of practitioners.
These marriage and relationship education programs form one of two broad strategies to strengthen families and promote healthy marriages. The other broad strategy is community-wide marriage initiatives. Community-wide initiatives focus on building public support and changing community norms and attitudes toward marriage. Media campaigns can be a major part of such efforts, as in the First Things First initiative in Chattanooga, Tennessee, and the Greater Grand Rapids Community Marriage Initiative in Michigan. Collaboration with community-based organizations or schools to encourage development of relationship-skills programs is usually a critical component of community-wide initiatives. Marriage commissions and statewide conferences or workshops provide additional visibility. These community initiatives can be an important part of long-term strategies to reduce the prevalence of divorce and the number of children who grow up without one of their parents.
It is likely, however, that the approach to encouraging healthy marriages among unwed parents will need to be more focused because of their special characteristics. Therefore, this study focuses on targeted marriage and relationship education programs rather than community-wide initiatives. The curricula of these targeted programs may serve as an important resource in the design of interventions to strengthen relationships and encourage healthy marriage among unwed parents. Although most marriage programs have not been used with low-income populations and were not designed for unmarried couples with children, they could be adapted or modified for use with this more specific population. One advantage to modifying existing programs and curricula, instead of designing new programs from scratch, is that many existing programs are based on a substantial foundation of research.
Marriage education programs have been developed for or used with individuals or couples in various stages of relationship. Programs exist for (1) youth who may or may not be currently involved in romantic relationships, (2) engaged couples, (3) married couples, (4) couples making the transition to becoming parents, and (5) married couples in distress. Selecting programs and curricula that match the needs of the target population is likely to increase program effectiveness. This chapter discusses, in Section A, subgroups of the low-income population and the general types of services that (perhaps with some modification) would be most likely to benefit them. Section B describes existing program approaches to marriage and relationship education. Programs designed to help couples strengthen their relationships during their transitions to parenthood are discussed in some detail, because new unwed parents are the families of most interest in this study. Section C reviews research findings about several program models that could form the basis for interventions with low-income unmarried parents, and Section D discusses how these programs might be adapted or applied to that population.
A. TARGET POPULATIONS
To maximize the potential for effectiveness, it is important for program planners to think clearly about whom they plan to serve, what program models are most likely to help the target population, and how a particular program model should be adapted to that population. Couples go through stages of life and changing circumstances, but programs must define outreach and intervention approaches that fit as closely as possible to the participant circumstances they are likely to be addressing.
A convenient way to define potential target groups for programs to strengthen low-income families is to distinguish families based on a combination of marital and parental status, the nature of their couple relationships, and their ages (Figure III.1). The broadest potential target population, at the top of the figure, is all individuals who are at risk for nonmarital births or single parenting. Some of these individuals already are parents (married and unmarried), and others are not yet parents. Unmarried parents, the focus of this study, may or may not be romantically involved with one another, and may be either teens or adults.
The shaded boxes in Figure III.1 represent the population of most interest
for this study—unmarried adult parents who are romantically involved.
This target population may offer the best chance of success for interventions
focused on relationship and marriage education, especially if services are
provided around the time of childbirth, when parents are mostly likely to
feel positive about their relationship and hopeful about marriage.
|
[D] |
While this study focuses on unmarried-parent couples, interventions to strengthen families also could be provided to individuals who are (1) at risk of having an out-of-wedlock birth but are not yet parents or (2) married but at risk of divorce (indicated by the unshaded boxes in Figure III.1). Interventions for these groups might differ from those for unmarried-parent couples in the following ways:
- Unmarried Nonparent Couples. Interventions
for individuals and couples who are not yet parents could focus on the
prevention of out-of-wedlock births, including services to change attitudes
and expectations about marriage and out-of-wedlock births, abstinence
education, pregnancy prevention services, and general relationship-skills
education. Services to improve marriageability may be effective in promoting
healthy marriage before couples have children.
- Married Parents. Interventions for married couples could focus on strengthening relationships and reducing the likelihood of divorce. Standard marriage education, focusing on communication and conflict resolution, could be combined with other services, where appropriate, to strengthen low-income couples’ abilities to provide for their families.
Special circumstances may pose particular challenges and call for still different services. Two other boxes in Figure III.1 indicate subgroups of the low-income population that may require services tailored to their specific situations:
- Parents Not Romantically Involved. Interventions
promoting healthy marriage between parents are unlikely to be effective
or desirable for parents who are not romantically involved with each other
when their children are born. These single parents and their children
may benefit from services that encourage coparenting and father involvement,
discourage further nonmarital births, and strengthen general relationship
skills to increase the likelihood of a later healthy marriage with someone
other than the other biological parent.
- Parents Younger Than 18. Because teen marriages are much more likely than other marriages to end in divorce, it may not be appropriate for interventions to encourage healthy marriage among this population. Interventions could focus on teaching the value of healthy marriage, preparing teens for making good marital choices, improving parenting behavior, promoting father involvement and coparenting, and discouraging further out-of-wedlock births.
Despite these distinctions among potential target groups and the interventions relevant to them, program designs must take into account the likely transitions that couples might make during the course of their participation. Parents romantically involved at program entry may terminate their relationship or reveal a violent side. Estranged couples may renew their romantic interest. Couples not yet parents may find themselves expecting a child. Program planners may plan interventions around a general definition of the population they expect to recruit and serve but also must think in advance about how they will react and adapt when their participants present different issues.
B. MAJOR APPROACHES TO MARRIAGE EDUCATION
Targeted and intensive interventions to strengthen couple relationships and encourage healthy marriages—the topic of this report—focus on providing direct services to a specific and identifiable group of individuals, such as low-income, unmarried parents. For couples who choose to participate, such approaches would rely on direct services aimed at strengthening relationships that could develop into healthy and stable marriages. This section reviews major approaches that provide direct services that strengthen the relationships of premarital or married couples, with the assumption that some of these approaches could be modified to serve unmarried parents.
Although marriage education programs differ, most begin with two assumptions: there are identifiable patterns of interpersonal behavior that can seriously undermine and damage good relationships, and most individuals can be taught to avoid these behaviors. Examples of these patterns (found to be highly predictive of divorce in descriptive research on marriage) include: conflict escalation, withdrawal/avoidance, and criticsm/contempt. Many programs take an educational approach involving a classroom format, seminar, or workshop, and, unlike traditional therapy or counseling, most do not require participants to share personal issues or feelings. Programs also differ in their modalities, emphasis, and other characteristics. A few promising programs have been designed specifically for married couples about to become parents. These programs are especially relevant for planning interventions with unmarried couples around the “magic moment,” when the partners often are hopeful about their future together.
Marriage and relationship education programs vary across dimensions related to their general approach and intended audience (Table III.1). Programs can be classified by their modality (class format, mentoring, or inventory approach), specific elements (such as having faith-based aspects or components for social/emotional support), and by their experience with dissemination (multiple providers and locations). The specific population for which each program is designed or with whom it has been used is shown in Table III.1 (singles, engaged couples, married couples, expectant or new parents, and distressed married couples). The following section discusses each of these program dimensions or elements, using specific programs as examples.1
Although it is generally best to select program curricula that have been empirically derived, rigorously evaluated, and continuously updated based on new research (as recommended by Stanley, Markman and Jenkins 2002), none of the programs identified here was designed for or evaluated with the target population of low-income unmarried parents. So, while the curricula have the potential to form the foundation for interventions with this population, they will probably need to be adapted, and further research will be needed to determine the effectiveness of the resulting interventions with this population. For this reason, we briefly describe a wide variety of program approaches and curricula, regardless of whether they have been rigorously evaluated.
Table III.1. Characteristics of Private Marriage Education Programs
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1. Modality
Although some programs combine methods in ways that defy simple categorization, three main modalities or vehicles for delivering marriage or relationship education distinguish them: (1) programs that primarily take a skills-based educational approach, involving couples in classes, lectures, seminars, or workshops, (2) approaches that use couple-to-couple mentoring, and (3) methods that use an assessment or inventory of couples’ compatibility either as an instructional device or as a beginning point for other forms of intervention.
Skills-Based Classes, Workshops, or Lectures. These focus on specific communication skills, strategies for resolving conflicts, and other interpersonal behaviors considered important for the success of intimate relationships. Most of these programs involve a series of classes that include active participation, such as skills practice or role-playing, while a few involve one-time seminars or lectures. Services typically are provided to a group of married or engaged pairs in a classroom format. The focus is on instruction rather than on pressing participants to share or discuss personal issues or problems they may be facing or have experienced in the past. Many programs have their roots in research on the correlates and predictors of marital satisfaction or dissolution, and most follow a specific curriculum. Educators, counselors, clergy, or social workers often teach these programs. One advantage of this approach is that many of these programs can be taught by paraprofessionals or lay leaders who have been properly trained. Four specific skills-based programs are described below.
- The Prevention and Relationship Enhancement Program (PREP)
teaches strategies for lowering risk factors associated with relationship
distress dissolution and while simultaneously raising protective factors
to strengthen marriages. The primary goal is to prevent divorce by teaching
skills associated with successful marital adjustment before problems develop.
PREP aims to help couples: (1) develop and use constructive communication
and conflict resolution skills, (2) clarify and modify unrealistic beliefs
and expectations about relationships, (3) maintain and enhance fun, friendship,
and spiritual connection in intimate relationships, (4) develop ground
rules for handling disagreements and conflict, and (5) develop skills
to enhance and maintain commitment. A key feature of PREP is the “speaker-listener
technique”—a structured way of communicating that can help
couples avoid such negative behaviors as escalation and withdrawal. Skills
are taught and demonstrated in a classroom format and then practiced in
situational role-playing, with coaching by instructors. Services can be
scheduled in a variety of formats but most often are delivered in six
weekly two-hour sessions or a weekend workshop. PREP was designed for
middle-income, nondistressed, engaged or married couples. A broad range
of individuals can be trained to lead the program.
- The Couples Relationship Enhancement Program (RE)
uses a psychoeducational approach based on learning theory and research
to help couples develop empathy and mutual understanding. The primary
purpose is to enable participants to deal effectively with the inevitable
difficulties that arise from differences in family members’ beliefs,
feelings, needs, and desires. RE teaches two fundamentals, Expressive
Skill and Empathic Responding Skill, which correspond to the two major
aspects of communication: speaking and listening. Partners are taught
to express themselves clearly, openly and honestly, minimizing the chance
that their partners would feel blamed or criticized. They are taught to
listen and respond in a way that makes partners feel understood and respected,
thereby deepening their self understanding and encouraging further self-disclosure.
RE also teaches skills it calls discussion/negotiation, problem/conflict
resolution, partner facilitation, self-change, generalization, and maintenance.
Skills are taught through short lecture, group discussion, demonstration,
practice, and individualized feedback. The program can be offered in a
two-day or multi-session format. Alternatively, the core skills can be
taught in an abridged one-day format. RE has been used with premarital,
married, and cohabiting couples and with special populations, including
recovering alcoholics, spouse abusers, and mentally ill individuals.
- The Art and Science of Love is a weekend workshop
for couples based on research that followed the marriages of more than
3,000 couples, which identified interpersonal processes and behaviors
that lead to marital success and failure. This workshop teaches relationship
skills that include how to foster respect, affection, and closeness, how
to keep conflict discussions calm, how to strengthen the gains in a relationship,
and how to break through and resolve conflict gridlock. Couples learn
four danger signs of relationship problems and how to address them. Participants
are taught how to assess and build on the strengths of their marriages,
how to create shared meaning, and how to generate greater understanding
between partners. Couples learn what makes marriages change, for better
or worse, how they can apply this knowledge to their own marital situation,
and how to solve problems using four techniques for resolving conflicts.
The workshop is taught through lecture, demonstration, and role-playing,
and couples’ private practice of their new relationship skills in
defined exercises. It is offered most often in a two-day weekend format.
The program is appropriate for distressed and nondistressed couples, but
not couples experiencing domestic violence.
- The Practical Application of Relationship Skills (PAIRS)
program draws on theories and methods from education, psychotherapy, and
psychology to foster self-understanding and promote relationship skills
in a psychoeducational group format. The conceptual model is based on
the developer’s life experience and borrows techniques from experiential,
communication, behavioral and family systems approaches. The approach
goes beyond commitment, communication, and the ability to effectively
manage conflict to focus on how past experiences can affect present marriages
in dysfunctional ways. The PAIRS approach views a couple as a vehicle
through which individuals experience pleasure, healing, and personal growth.
It covers such topics as understanding love and emotion, understanding
the difference between fair and unfair fighting, and communication about
specific family issues, such as children, sex and fidelity, housework,
and money. PAIRS is available as a semester-long course and as intensive
one-day or weekend seminars. Adaptations are available for specific populations,
including an eight-week program for premarital couples and newlyweds (PAIRS
FIRST), a program for adolescents (PEERS), and Christian PAIRS.
- Couple Communication (CC). Couple Communication is one of the oldest marriage education programs available. It focuses on helping couples communicate skillfully, resolve conflicts effectively, and build satisfying relationships with family, friends, co-workers, and others. The program is based on concepts and processes from communication and systems theory. Two programs are available: CC I teaches a practical set of talking and listening skills, using the Awareness Wheel and the Listening Cycle; CC II, a more advanced version of the program, applies the skills introduced in CC I to various aspects of relationships, including managing and responding to a partner’s anger, understanding phases of relationships, and communicating collaboratively.
Couples Mentoring. Churches and other religious institutions often have programs that provide couple-to-couple mentoring. This approach is intended to create a more positive culture for marriage and to benefit couples providing the mentoring as well as those they mentor. Mentoring can be combined with other strategies, such as the use of an inventory tool for premarital couples, weekend retreats for married couples, and support groups for stepfamilies. Some mentoring models focus not only on a specific congregation but on the broader community. Some programs, for example, span several congregations in a collaborative effort to achieve a community-wide reduction in the incidence of divorce. Mentoring programs are widespread and sponsored by many different denominations. Two widely used programs are:
- Marriage Savers. This program goes beyond the single weekend marriage retreat offered by many congregations to provide ongoing couple-to-couple mentoring. Volunteer mentor couples are trained to provide premarital preparation for engaged couples, typically including the Facilitating Open Couple Communications, Understanding and Study (FOCCUS) inventory. Marriage Savers congregations encourage a minimum of four months of marriage preparation. Mentor couples work with married couples to strengthen their relationships. Couples who have survived a difficult period in their marriages provide guidance to struggling couples.
- Caring Couples Network (CCN). This model relies on a team approach to provide services to couples having difficulty and to prepare engaged couples for marriage. Clergy and professional counselors work as a team with mentor couples. The United Methodist Church developed a handbook for CCN explaining how to recruit and train mentoring couples, identify couples in need, and initiate a local network.
Inventory-Based Methods. An alternative approach to premarital and marriage education involves the use of an inventory or assessment that identifies each partner’s relationship strengths and weaknesses. The inventory and discussion of its results can be the core of an intervention, although an inventory could be used as a first step in a more extensive intervention. The inventory-based method requires participants to complete questionnaires covering such issues as communication, attitudes, parenting, personality traits, conflict management style, self-confidence, and flexibility. The inventories are scored and discussed with participants. They can be used to assess compatibility in premarital couples or to identify goals for attitude or behavior change among married couples.
Several assessment tools are available, and some have been empirically examined for their reliability and validity (Larson and Holman 1994). Two commonly used tools are:
- FOCCUS was first designed for Catholic premarital preparation courses
but now is available in general and Christian non-denominational editions.
Non-professional volunteers can be trained to administer the assessment
and lead discussions with engaged couples. REFOCCUS is a similar inventory,
for use with married couples.
- PREPARE is a premarital inventory composed of 165 agree/disagree questions, while the parallel ENRICH Couple Satisfaction Scale is used to assess marital satisfaction. Both inventories are designed to be used with a PREPARE/ENRICH trained counselor or member of the clergy.
2. Specific Elements or Features
Programs vary along a number of dimensions. Two of the more prominent ones include the degree to which programs incorporate faith-based or emotionally supportive elements and the special populations—such as students and youth or distressed married couples—on which they focus.
Faith-Based Elements. Marriage enrichment and premarital counseling (for example, Marriage Encounter and Engaged Encounter) have been offered in churches for many years. Couples are encouraged to examine their relationships through open and honest discussion, most often led by clergy in weekend retreats. Other programs that take a more educational approach have been adapted for use in religious contexts, including Christian PREP and Christian PAIRS. Couple-to-couple mentoring is a popular approach in many churches and faith settings. Couples being mentored typically receive ongoing guidance, prayer, and encouragement from a more experienced mentor couple. They may receive instruction in biblical roles, following religious doctrines regarding marriage, divorce, and moral behavior.
Emotionally Supportive Elements. Most marriage and relationship education programs take an instructional approach in which specific skills are taught to program participants, who then “bring the skills home” to resolve specific issues. In contrast, other programs supplement or replace classes with emotionally supportive elements that allow participants to discuss problems they are facing and to process their feelings in an emotionally safe environment. The emotionally supportive element may be a couples support group, a one-on-one counseling session, or discussions in a private setting, such as a retreat. Such elements are most often present in programs that target couples in generally in crisis or in stressful transition, such as becoming parents for the first time (the couples support groups in Baby Makes Three and Becoming a Family are good examples). Besides providing an opportunity for couples to discuss and resolve issues, couples support groups can both reinforce relationship skills over time and allow couples to learn from one another. While this element is sometimes therapeutic in nature, it should not be confused with psychotherapy. Psychotherapy is usually reserved for individuals who have mental health conditions, and is best provided by a psychologist or psychiatrist. Marriage programs that include a supportive element, but not psychotherapy, take care to avoid using the term “therapy” and related words because of the stigma sometimes attached to mental health treatment, which could discourage couples from participating.
Special Populations. Some programs are designed specifically to address the developmental needs of particular populations. For example, high school students and other youth are less likely than older groups to be married or in a long-term committed relationship. Programs intended for engaged or married couples may therefore be less appropriate for youth than programs that help them learn skills for making good marital choices. Similarly, couples in distress may be less likely to benefit from a preventive approach than one that helps them repair their relationships.
- Students and Youth. Programs geared specifically
to middle- and high-school students focus on developing the skills and
behaviors that set the stage for healthy relationships and marriages.
Programs based directly in the schools are becoming more popular; in 1998,
Florida mandated marriage skills training for all high school students
in the 9th and 10th grades. Examples of school-based programs include
Connections, Relationship Intelligence, Art of Loving Well, PARTNERS,
and PEERS.
- Distressed Married Couples. Fewer marriage education programs target distressed couples directly, and those that do are typically faith-based. For example, Retrouvaille targets couples on the brink of divorce because of infidelity, gambling, or alcoholism. Couples are counseled in a private weekend retreat by clergy and facilitator couples who themselves have experienced similar problems and almost divorced. The retreat is followed by support group meetings to reinforce the messages conveyed in the retreat. One secular program, the Art and Science of Love, provides an education-based workshop to distressed and nondistressed couples but excludes couples in physically abusive relationships, referring them for individual couples counseling. Divorce Busters and IMAGO are other program examples that target married couples who are in crisis or distressed.
3. Experience with Program Dissemination
The developers of some marriage education programs have deliberately planned for and promoted the dissemination of their program models in order to reach a broad audience. Some of the programs listed in Table III.1 have developed methods for training other professionals or lay people to provide services. Several skills-based programs, such as PREP, require their staff to participate in one to three days of training from program developers. The annual Smart Marriages conference provides a forum for training a large group of practitioners at once. Other program developers provide training opportunities throughout the year at multiple locations. Most curricula cannot be purchased separately but are provided to those who go through practitioner training. Fees for marriage education training vary substantially, as do the program materials (such as workbooks, videotapes, and texts) that trained practitioners would need to apply the curricula. Mentor and faith-based approaches are perhaps more easily disseminated because congregations provide a ready supply of potential mentor couples and practitioners.
4. Focusing on Relationships During the Transition to Parenthood
This section describes several promising program approaches to intervening with new parents around the time of their child’s birth. Researchers have studied the transition to parenthood for more than 40 years, and most conclude that although the period around a child’s birth often is joyful, the weeks and months afterward typically are stressful and sometimes result in the beginning of maladaptive behavior patterns, even among low-risk middle-income families (Cowan and Cowan 1995; Jordan et al. 1999; Belsky and Pensky 1988). For 40 to 70 percent of couples, the transition involves a drop in marital satisfaction and relationship quality and a rise in conflict. Stress factors associated with the birth of a child that can start the couple on a downward trajectory include marked shifts in the division of labor, in the amount of time available for the couple, and in the meaning and frequency of sex. Several other less obvious shifts that occur during this period can also affect the relationship, including changes in each partner’s identity, roles, and patterns of behavior (Schumacher and Meleis 1994; Belsky and Pensky 1988). In addition, changes in the psychological well-being of each of the parents can strain not only the individual but also the marriage and potentially the parent-child relationship (Cowan et al. 1985). It is estimated that as men and women become parents, more than one-third experience significant depression (Jordan 1999).
As noted earlier in this report, chronic unresolved conflict can undermine and damage good couple relationships and marriage. Marital conflict can be detrimental to children and to the parent-child relationship as well. It can affect the bond between parents and their infants (Owen and Cox 1997). Moreover, high levels of parental conflict are associated with greater behavior problems in children (Cummings 1998; Cummings and Davies 1994; Grych and Fincham 1990), and chronic conflict is harmful to both the physical and emotional well-being of children (Emery 1999; Gottman and Katz 1989). Therefore, the knowledge and skills obtained through marriage education classes are important not only to the quality and stability of the marriage but also to the well-being and development of the child. The discussion below covers four approaches to facilitating the transition to parenthood.
Becoming Parents Program (BPP). This educational approach focuses on providing couples with the communication and conflict resolution skills needed to navigate the stressful period after childbirth and to prevent declines in the marital relationship. BPP targets married or committed couples expecting their first child and offers a series of classes focused on helping couples learn skills and knowledge to strengthen their relationships.
BPP is based on principles taught in PREP (Markman, Stanley and Blumberg 1994), but it supplements the PREP curriculum with topics relevant to the unique period surrounding the birth of the first child and other key elements specific to the needs of expectant and new parents. BPP is divided into three fairly equal areas of focus: (1) relationship skills adapted from PREP, (2) issues associated with self-care (managing fatigue, stress, jealousy, anger, and deciding who does what), and (3) an “owner’s manual” for infant care, including how to read infant cues, dealing with crying, and feeding issues. The added components incorporate aspects of two programs to reduce domestic violence. These elements focus on the management of stress and anger and the prevention of physical abuse in intimate relationships.
The program involves 24 hours of classroom time: 21 during pregnancy and a 3-hour “booster” when the infant is 6 to 8 weeks old. Classes typically serve 10 to 15 couples and are held in a variety of settings, including churches or hospitals. Program instructors often are nurses, but paraprofessionals can be trained in the method.
Becoming a Family Program. A somewhat more therapeutic approach to meeting the needs of couples becoming parents is to provide a supportive context in which they can process their feelings and learn from others experiencing the same transition. An example of this approach is Becoming a Family (Cowan and Cowan 1992). This program, not currently in operation, provided a weekly couples support group spanning the transition from pregnancy to a few months after childbirth.
Becoming a Family was designed to provide a safe place for couples to share their concerns about family issues and learn from one another during the transitional period. Group sessions focused on four major areas: couples’ relationships; parent-child relationships; relationships with extended families; and the development of supportive networks. Because agendas were set by group leaders in collaboration with participants, they often focused on actual, ongoing issues. Group leaders raised topics for discussion, including changes in participants’ self-images and perceptions of their relationships, changes in their division of family labor, problem solving and communication, parenting practices, and the influence of their extended families on their relationships and parenting behavior. Although the sessions should not be construed as group psychotherapy, they were therapeutic in the sense that couples received emotional support in confronting real and present issues and making positive adaptations.
Couples met weekly for six months starting in the third trimester of pregnancy, in groups of four couples and two co-leaders. Group leaders were mental health professionals trained to work with couples and parent-child relationships. In a typical couples group, leaders introduced exercises and fostered discussions of real-life issues. Couples were encouraged to share their experiences and feelings and to learn from each other. Parents were encouraged to attempt small changes to bring their relationships closer to their ideals.
Baby Makes Three Program. This approach combines a skills-based component with supportive elements to address the transition to parenthood. Baby Makes Three offers an educational component to strengthen specific relationship skills and to teach parenting and infant development—as well as a series of therapeutic support groups to help couples process changes they are experiencing.
The program is conducted in two stages: a 2-day workshop and 12 support group sessions held over 6 months. The workshop draws on the Art and Science of Love Couples Weekend program and empirical research on the predictors of marital satisfaction and dissolution (Gottman and Silver 1999). The workshop teaches couples the warning signs of relationship problems, how to express anger constructively, and how to build friendship with one another as an inoculation against distress and disruptions. Three areas are emphasized: (1) building fondness and affection for the partner, (2) being aware of what is going on in the spouse’s life and being responsive to it, and (3) trying to solve problems as a couple. The workshop curriculum is modified to prepare couples for the stresses of parenthood, to encourage the positive involvement of fathers in their infants’ lives, and to teach couples about infant and child development. Specific couple issues unique to the transition are addressed, including sex after childbirth and how to manage the sleep deprivation that often comes with a new baby.
The support group sessions draw on the Cowan and Cowan model described above. Participants are encouraged to talk about their thoughts, feelings, and experiences, and to receive emotional support, insight, and understanding from other participants. One of the main purposes is to help couples see the stresses they are experiencing as normal and a part of life’s transitions, rather than evidence that their relationships are in serious trouble. Support groups reinforce information provided in the workshop, including relationship skills and strategies to resolve conflicts, keeping fathers involved with babies, and understanding babies’ normative development. Group facilitators regularly ask couples to check up on how things are going with respect to these goals.
Baby Makes Three is a hospital-based program, and services are provided by trained nurses or childbirth educators. Participants are recruited through birth preparation classes, newsletters, fliers, and small advertisements in local magazines. Ideally, participants begin the program during pregnancy; however, some couples begin shortly after childbirth because the program is small, the workshops are infrequent, and the timing of deliveries is unpredictable.
Marriage Moments Program. This low-intensity program, now being pilot tested in three Utah hospitals, is designed to strengthen the relationships of couples preparing to be new parents. It aims to supplement existing childbirth education classes and capitalizes on the openness and receptivity typical of couples during pregnancy. The curriculum stresses building marriages on a foundation of friendship and partnership with the virtues of loyalty, generosity, and fairness. Primarily a self-guided intervention, Marriage Moments requires couples to view a 5- to 10-minute video presentation and participate in a brief activity led by a childbirth instructor each week for 5 weeks. Couples are encouraged to complete workbook exercises at home. A related curriculum has been designed for use in home-visiting programs with new parents during the first year of a child’s life. Health educators supplement information on infant development and effective parenting with a 5-minute module on marriage virtues to strengthen couple relationships during the transition to parenthood. A brief discussion of the stresses and changes the couples may be experiencing is held during the third monthly visit. Couples are also introduced to an activity guidebook, and invited to do the exercises and read the materials during the coming month.
C. PROGRAM EVALUATION
The designs of several of the major programs discussed in this chapter have been informed by extensive descriptive research identifying the correlates and predictors of divorce and of successful marriages. This research foundation has helped to guide the development of marriage education programs, helping them to focus interventions on efforts to promote the behavioral patterns found in couples who have strong and stable marriages.
Although some important and promising work has been done, a strong foundation of program evaluation demonstrating the effectiveness of interventions is still lacking, for the most part. Evaluation research using random assignment designs can determine whether the interventions whose designs were based on descriptive research actually succeed in changing behavior, and by so doing affect the long-term success of relationships. Some experimental evaluations have been conducted and some are currently underway. However, the findings are partial and limited due to methodological issues, such as selection problems resulting from incomplete random assignment, differential attrition among control versus treatment group participants, and the small, unrepresentative nature of most samples (Karney and Bradbury 1995). In addition, most studies, with the exception of PREP and Becoming a Family evaluations, have assessed outcomes only in the short-term.
This section briefly reviews findings from evaluation studies that randomly assign participants to the program or to a control group, thereby permitting a rigorous test of the program’s impact on positive relationship outcomes, such as marital stability, relationship satisfaction, and communication skills. A small number of quasi-experimental studies are included. Program evaluations that are currently in progress are also described.
Prevention and Relationship Enhancement Program. A longitudinal study conducted by program developers matched and randomly assigned nondistressed premarital couples to PREP or to a control condition. No differences were found at post-test, but positive effects on relationship satisfaction were found for the PREP group after 18 months. This effect was sustained at the three-year follow-up and was accompanied by greater sexual satisfaction and lower levels of problem intensity. Five years after the program ended, intervention couples had higher levels of positive and lower levels of negative communication skills and lower levels of marital violence compared with control group couples. Only about half of the couples randomly assigned to receive the program actually participated in it (Markman et al. 1988; Markman et al. 1993), leaving open the possibility of selection effects due to unobservable factors such as motivation (Bradbury 1995).
An evaluation of a PREP adaptation in Holland used random assignment and found no differences between program and control couples at 9-month and 2-year follow-ups (Van Widenfelt et al. 1996). This study also suffered from methodological limitations, including differential sample attrition, in a way that would have made group differences hard to obtain.
Other researchers have studied PREP in the context of quasi-experimental research designs. A German adaptation showed a small, middle-class group of premarital couples who took PREP had a lower divorce rate than comparison couples at the three-year follow-up (6 program couples had dissolved their relationships either before or after marriage; while 7 couples in the comparison group did so) (Hahlweg, Markman, et al. 1998). A study in Australia examined the effects of PREP compared with a biblioeducational treatment with high- and low-risk couples. At the one-year point, PREP couples in both risk groups had retained their skills, but no differences were found for low-risk couples at the four-year point. High-risk couples who took PREP were more likely to have maintained relationship satisfaction (Halford, Sanders, and Behrens 2001).
Relationship Enhancement. With its focus on empathy building, the RE program has been adapted for use with several populations, including married couples, dating and engaged couples, and parent-adolescent couples; these various forms have been widely researched in short-term random-assignment evaluation studies. For example, in a study of young, dating couples, the program group gained significantly in empathy and problem-solving skills, from pre- to post-test and compared with control group couples (Ridley et al. 1981; Ridley et al. 1982). A six-month follow-up found RE couples had improved in disclosure and empathy compared with a lecture-discussion control group (Avery et al. 1980).
Many experimental evaluations conducted during the 1980s compared RE methods with alternative methods that were thought to be effective, providing a strong test of the method. In random-assignment research designs, RE was found to be superior in effectiveness compared with a traditional therapeutic/preventive program (Guerney et al. 1981), a gestalt treatment (Jessee et al. 1981), and a behavioral program (Wieman 1973). In one study, experienced marital therapists in a mental health clinic were trained in RE; their new clients were randomly assigned to one of two conditions: (1) therapists employed the method they had preferred before RE training, or (2) therapists used only RE methods. At the 10-week follow-up, RE clients had significantly improved marital adjustments, communication, and general quality of their relationships compared with clients who were not treated with RE (Ross, Baker, and Guerney 1985).
Finally, a meta-analysis of 85 studies involving more than a dozen approaches to premarital, marital, and family interventions—including RE, Couple Communication, and Marriage Encounter—found RE studies had by far the largest average effect size (Giblin, Sprenkle, and Sheehan 1985). Most of these studies, including those that tested RE, were short in duration, usually less than a year.
Couple Communication. Most evaluation research on CC has studied the 12-hour structured skills training program, finding significant improvements in the program group’s communication at follow-up (Russell et al. 1984). A review shows positive effects on relationship quality, individual functioning, and communication quality. But the review concludes that the effects on communication diminished over time, and the studies lasted no longer than one year.
Becoming a Family. This program was evaluated in a controlled, longitudinal research design. Participating couples were recruited from clinic and private obstetrical practices. Compared with couples in the no-treatment control group, intervention group couples did not decline in marital satisfaction between 6 and 18 months postpartum. Moreover, 12.5 percent of control group couples had separated or divorced by the time their babies were 18 months old, but all of the treatment group couples remained intact. At 3½ years after the intervention ended, marital adaptation began to wane in the intervention group; still only 4 percent of the program group had separated by this point, compared with 16 percent of control group couples (Cowan and Cowan 1995). A recent reanalysis of program data using Hierarchichal Linear Modeling (HLM) growth curve techniques show the rate of decline in marital satisfaction among intervention couples across the 5½-year follow-up period was one-third that of the comparison couples. Control group couples declined in marital satisfaction .15 points more each month compared with intervention couples (Schulz and Cowan 2001).
Baby Makes Three. This workshop is being evaluated in a three-group random assignment research design that permits studying advantages of the combined approach. The study is enrolling 150 couples who are randomized into groups that (1) receive the workshop only, (2) receive the workshop plus the support groups, or (3) receive no treatment. The evaluation includes a baseline interview and extensive follow-up interviews, which take 3 to 6 hours (conducted in 2 sessions). Marital interaction and parent-child interaction is videotaped and later coded in the laboratory. Direct assessments of infant/toddler social and emotional development are conducted. An extensive paper and pencil questionnaire is administered, focusing on marital satisfaction, physical health, stress and mental health symptoms, and measures of specific behavior patterns taught during the intervention. The evaluation is nearing the end of its first year, and preliminary results are expected to be released soon.
Becoming Parents Program. This program is in the beginning stages of being evaluated in a rigorous 5-year research design. Plans call for enrolling 500 couples; 250 will be randomized into the intervention group, with 250 couples to serve as the control group. Nondistressed married couples expecting their first children are eligible for the intervention and are recruited through prenatal clinics, doctors’ offices, community centers, churches, libraries, and public service announcements. Families can receive up to $1,000 for participating in the program and all follow-up assessments. Couples will be followed through the children’s 5th birthday. Outcomes include marital stability and satisfaction, symptoms of depression and stress, level of domestic violence, and health behaviors. Data on children’s well-being will be collected through observational measures 3 and 6 months post-birth.
Marriage Moments. This program is being pilot tested in three sites. A quasi-experimental research design will be used to examine the outcomes of 100 couples; 50 couples will make up a comparison group. Couples in the treatment group will be assigned to 1 of 2 different dosages of the program: a passive treatment group that only receives a video and workbook or an active treatment group that receives these materials and are briefly introduced to the content in their childbirth classes. Outcomes will measure self and spouse reports of marital virtues, communication and problem-solving, marital quality, maternal depression, and infant adjustment.
D. ADAPTATION TO LOW-INCOME FAMILIES
Nearly all relationship and marriage education programs reviewed in this chapter have been designed for and used with middle-income, educated, and mostly white families who are either engaged or already married. In contrast, the target population in this study is unmarried couples with a new baby, most of whom are low-income. Two well-established marriage education programs, RE and PREP, have had some experience with low-income populations, although most of the couples were either engaged or married, rather than unmarried.
Case studies suggest that RE may be effective for a wide variety of clinical and special populations, including psychiatric patients, alcoholics, spouse batterers, juvenile delinquents, and substance abusers (Accordino and Guerney 2001). However, the program has not been formally evaluated with respect to such populations. Like RE, PREP was originally designed to serve nondistressed, married, or engaged couples but is now being adapted for low-income individuals and couples throughout Oklahoma as part of the Oklahoma Marriage Initiative. In addition, PREP has been used extensively in the military, often serving families who, while not on public assistance, have lower income and education than most participants in marriage education programs. PREP’s effectiveness with these populations has not yet been rigorously evaluated with these groups, although a process study is underway.
This section discusses two ways in which programs could be adapted so that they could more effectively serve low-income unmarried parents. First, teaching methods could be revised to be more appropriate for the target population, and second, the content of marriage programs could be augmented to better meet the relationship needs of unmarried parents. Research on the characteristics of low-income families and actual program experience with disadvantaged populations offer lessons with respect to adapting teaching methods. Guidance for adapting the content of marriage programs for the target population comes from literature on the relationship skills, knowledge, characteristics, attitudes, and beliefs of low-income unmarried individuals as well as basic research on couple relationship dynamics.
Adapting Teaching Methods and Materials. Because conventional marriage education programs cater to a fairly well educated audience, the language used and concepts stressed in program materials may be somewhat sophisticated and abstract. Moreover, the curricula assume that participants are highly motivated to improve their relationships and that they have the time, ability, and resources to complete extensive reading and writing exercises as homework. These program features should be revised for people with lower education, those for whom English is a second language, and for couples who are not likely to have the time or ability to complete written homework. In addition, metaphors, stories, examples, and exercises could be changed so that they are more culturally appropriate for the target population.
Addressing Relationship Needs Unique to Unwed Parents. Aside from the need to adapt the methods and materials of marriage programs to low-income unwed parents, it is likely that the program content may need to be supplemented with material that specifically or more strongly addresses key relationship issues unique to low-income unmarried couples. Skills-based instruction in communication and conflict resolution is likely to be a major component of any intervention that focuses on marriage because these skills are known to be key ingredients in the long-term success of relationships. But unmarried parents may have needs over and above couples who are engaged or already married. Although the vast majority of unmarried parents are romantically involved at the time of their child’s birth and may be interested in marriage, few have concrete wedding plans. Moreover, few such couples have “formalized” their bonds one year after their child’s birth (McLanahan et al 2001; Carlson et al. 2002). Research and practice related to low-income populations suggests that there may be a number of relationship-related issues particular to these populations that stand in the way of marriage.
For example, many low-income unwed parents have had little exposure to healthy marriages in their communities. Although most such parents indicate that they value marriage (at least in the abstract), the motivation to get married could be reinforced if a program clearly explained why marriage is important for them, for their children, and for their community. As another example, it is possible that romantically involved couples who have children together but no plans for marriage may be less committed to their relationship compared with either engaged or married couples. If true, this situation would imply a need for a stronger program focus on the importance of commitment. Finally, ethnographic and quantitative research suggests that a lack of trust in the opposite sex and issues related to infidelity are key barriers to marriage among certain low-income groups, especially among African Americans (Edin 2001; Carlson 2002). To the extent this is the case, program components that focus on building trust, being able to forgive, and understanding the impact of sexual infidelity could be useful.
Given this background, it is clear that program developers should make focused efforts to identify key relationship issues or skills that should be addressed in marriage and relationship programs for low-income unwed parents. Existing knowledge from two streams of research and practice—the characteristics of low-income families and what makes marriages work—suggests that at a minimum, the following issues be considered in developing interventions to help couples interested in marriage move toward their goal:
- Understanding why marriage is important—for themselves, their children, and their communities
- Understanding what a good marriage looks like; adjusting unrealistic
expectations
- Helping men gain a better understanding of who they are and the importance
of their role in the family and in society
- Developing mutual trust on which to build a strong foundation of commitment
to the relationship
- Developing confidence as a couple in terms of feeling prepared to meet the challenges of married life and solve problems together
- Building a vision of a future together
- Learning ways to handle economic strain and other stressors of living in poverty
1Table III.1 lists marriage and relationship education programs reviewed for this project. This is not an exhaustive list of marriage programs. In addition, the appearance or non-appearance of any marriage program in this report does not imply endorsement or nonendorsement by the Department of Health and Human Services or Mathematica Policy Research. (back)
| Table of Contents | Previous | Next |