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ENACTMENTS IN COUPLE THERAPY:

A PROCESS STUDY

by
SCOTT ROLAND WOOLLEY, B.S., M.S.

A DISSERTATION

IN

MARRIAGE AND FAMILY THERAPY

Submitted to the Graduate Faculty


of Texas Tech University in
Partial Fulfillment of
the Requirements for
the Degree of
DOCTOR OF PHILOSOPHY

Approved

Chairperson of the Cowmittee

Accepted

Dean of the Graduate/School

December, 1995
Copyright 1995, Scott Roland Woolley
ACKNOWLEDGMENTS

I am grateful to a number of people who helped make this


dissertation possible. I would like to express my sincere
appreciation and deep respect for Dr. Karen S. Wampler, my
major professor. Her insight, wisdom, patience,
encouragement, and support have been invaluable. She has
stood by me and encouraged me not only through this
dissertation, but also through my doctoral training and
growth as a professional. I would also like to thank Dr.
Richard S. Wampler, Dr. David Ivey and Dr. Tim Melchert for
serving on my committee and for their support with the
project.
Special thanks also needs to go to Dr. Richard S.
Wampler and Kenneth M. Woolley for their financial assistance
and encouragement at critical times during this project.
Without this help, I would probably still be coding.
Additionally, Dr. Richard S. Wampler has provided support and
encouragement and friendship throughout my doctoral studies.
Thank you.
A number of research assistants worked on this project
including Adrienne Metzig, Nancy Malone, Beth Davis, Tina
Redding, Victoria Rouse, David Brito, Ashli Tapp, Mindy
Denny, Rebecca Worley, Leanne White, Lin Shi, Kelly Rosemann-
Rinker, and Twilla Spruell. Each made a very important
contribution, for which I am deeply grateful. I am also

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extremely grateful to the therapists and clients who allowed
their tapes to be used for this project.
Scott Gardner, Mudita Rastogi, Mark Butler, Mark Kunkel
and Gary Williams gave me a great deal of encouragement and
support throughout the project. I am thankful for their help
and guidance.
I am also grateful to my pioneer ancestors. The stories
of their overcoming a hostile wilderness, personal
weaknesses, and bigoted and violent opposition has energized
me and helped me learn to love and endure.
I am deeply appreciative of the support, patience, and
inspiration of our children, Robyn, Eliza, and Grace.
Additionally, my sister Ginger Woolley, and my parents Lowell
and Florence Yancey, and in-laws, John and Margaret Cannon,
have provided much needed encouragement and love.
Most importantly, I want to acknowledge the tremendous
support provided by Cathryn C. Woolley, my eternal companion,
friend, and spouse. She has provided love, encouragement,
and patience throughout this long project and my many years
of graduate studies. She is an inspiration to me.

Ill
TABLE OF CONTENTS

ACKNOWLEDGMENTS ii
ABSTRACT vi
LIST OF TABLES viii
LIST OF FIGURES ix
I. INTRODUCTION 1
Process Research 2
Enactments 4
Definition of Enactments 6
Research on Enactments .... 7
Purpose of Study 11
II. LITERATURE REVIEW 12
Process Research 12
Therapy Outcome Research 14
Clues from Individual Therapy Research ... 15
Clues from the Marriage and Family Research . 18
Enactments: A Common Factor 22
Uses of Enactments 23
A Theory of Successful Enactments 29
Successful Enactments 29
Therapist Interventions 32
Hypotheses 37
III. METHODOLOGY 39
Methodology Steps 39
Overview of Steps Used in This Study .... 42
Sample 44
Definition of an Enactment 44
Enactment Identification 46
Criteria for Inclusion in Final Sample ... 47
Demographic Characteristics 49
Measures 52

IV
Coding Procedures 52
Global Rapid Couples Interaction Scoring
System (RCISS) 53
Therapist Interaction Scoring System (TISS) . 59
Direction of Talk 71
IV. RESULTS 75
General Description of Codes 75
Preliminary Analyses 75
Client Variables 79
Therapist Characteristics 81
Session Characteristics 81
Primary Analyses of Hypothesized Relationships . 82
Regression 84
Multivariate Analysis of Variance 90
Annotated Point Graphs 97
V. DISCUSSION 100
Summary and Discussion of Results 101
Demographic Variables 101
Stepwise Regression Analysis 102
Multivariate Analysis of Variance 109
Descriptive Analyses 112
Implications for Theory and the TISS 115
Implications for Therapy 119
Implications for Future Research 120
Limitations 123
REFERENCES 126
APPENDIX
A. LETTER SENT TO STUDENTS 134
B. ANNOTATED POINT GRAPH CHARTS 135
ABSTRACT

Greenberg's (1986, 1991) analytic method of process


research was used to identify a process in couple therapy
called an enactment. An enactment was defined as a
therapeutic process in which the couple talks directly to
each other and the therapist coaches the couple's
interaction. Observational coding was used to investigate the
use of enactments in couple therapy. The purpose of the study
was to investigate the association between therapist
interventions and positive and negative couple interaction
during enactments. Gottman's (1994) RCISS was used to
measure the dimensions of couple positive and negative
interaction. The Therapist Interaction Scoring System (TISS)
was developed by the author to measure therapist
interventions.
The sample consisted of 36 videotaped enactment segments
of eight therapists and 14 couples. Stepwise regression
analyses revealed significant positive associations between
therapist directives to husbands and husband positive speech,
and between directives to couples and couple positive speech.
Therapist directives to the couple were also significantly
negatively related to couple negative speech, and positively
related to the ratio of positive to negative couple talk.
Therapist structuring to wives was significantly positively
related to wife positive speech. However, negative wife

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speech and the ratio of positive to negative wife talk turns
were not significantly related to any of the therapist
intervention variables. Therapist use of affect with
husbands was significantly negatively related to husband
negative talk and positively related to the ratio of positive
to negative husband speech.
Enactments were divided into two groups, one with
positive interaction and one with negative interaction over
time. MANOVA revealed significant overall differences
between the positive and negative groups. Structuring,
directives, and support were used more often with positive
couples.
Descriptive analysis indicated that enactments were
different lengths and were not regularly used by most
therapists. The frequency of therapist interventions varied
greatly, and therapists handled positive and negative couple
exchanges differently. Therapists also rarely directly
confronted negatives or encouraged positives. Couple talk
during enactments was generally positive. Couples usually
engaged in either positive or negative exchanges and couples
did not continue with one partner being positive and the
other negative for long.

Vll
LIST OF TABLES

3.1: Final sample 50


3.2: Demographic characteristics 51
3.3: List of couple variables and transformations used to
reduce skewness and kurtosis 60
3.4: Reliability of the original TISS codes 67
3.5: List of therapist intervention variables and
transformations used to reduce skewness and
kurtosis 70
3.6: TISS correlations by gender 72
4.1: Summary of therapist interventions 76
4.2: List of RCISS values by wife, husband, both, and
total 77
4.3: Mean differences on variables by therapist 78
4.4: TISS codes that differed significantly by client
characteristics 80
4.5: TISS and RCISS codes that differed significantly by
therapist characteristics and session number . . . . 83
4.6: Summary of stepwise regression results 87
4.7: Classifications and RCISS cumulative point graph
slopes for wife, husband, and combined by enactment
number 92
4.8: Univariate analysis of variance of difference between
regulated and unregulated enactments on therapist
interventions using the individual classification
system 94
4.9: Univariate analysis of variance of difference between
overall positive and non-positive RCISS speaker
slopes on therapist interventions 96

a • •

Vlll
LIST OF FIGURES

B.l: Cumulative RCISS Point Graph 1 136


B.2: Cumulative RCISS Point Graph 2 137
B.3: Cumulative RCISS Point Graph 3 138
B.4: Cumulative RCISS Point Graph 4 139
B.5: Cumulative RCISS Point Graph 5 140
B.6: Cumulative RCISS Point Graph 6 141
B.7: Cumulative RCISS Point Graph 7 142
B.8: Cumulative RCISS Point Graph 8 143
B.9: Cumulative RCISS Point Graph 9 144
B.IO: Cumulative RCISS Point Graph 10 145
B.ll: Cumulative RCISS Point Graph 11 146
B.12: Cumulative RCISS Point Graph 12 147
B.13: Cumulative RCISS Point Graph 13 148
B.14: Cumulative RCISS Point Graph 14 149
B.15: Cumulative RCISS Point Graph 15 150
B.16: Cumulative RCISS Point Graph 16 151
B.17: Cumulative RCISS Point Graph 17 152
B.18: Cumulative RCISS Point Graph 18 153
B.19: Cumulative RCISS Point Graph 19 154
B.20: Cumulative RCISS Point Graph 20 155
B.21: Cumulative RCISS Point Graph 21 156
B.22: Cumulative RCISS Point Graph 22 157
B.23: Cumulative RCISS Point Graph 23 158

IX
B.24: Cumulative RCISS Point Graph 24 159
B.25: Cumulative RCISS Point Graph 25 160
B.26: Cumulative RCISS Point Graph 26 161
B.27: Cumulative RCISS Point Graph 27 162
B.28: Cumulative RCISS Point Graph 28 163
B.29: Cumulative RCISS Point Graph 29 164
B.30: Cumulative RCISS Point Graph 30 165
B.31: Cumulative RCISS Point Graph 31 166
B.32: Cumulative RCISS Point Graph 32 167
B.33: Cumulative RCISS Point Graph 33 168
B.34: Cumulative RCISS Point Graph 34 169
B.35: Cumulative RCISS Point Graph 35 170
B.36: Cumulative RCISS Point Graph 36 171
CHAPTER I
INTRODUCTION

The majority of the research on therapy for couples has


been focused on determining if a theoretically derived
treatment approach works and whether it works better than a
competing approach. These studies have used experimental
designs and have tended to show that the particular type of
couple therapy tested does work with some percentage of the
research sample (Alexander, Holtzworth-Munroe, & Jameson,
1994; Gurman & Kniskern, 1991; Jacobson & Addis, 1993; Piercy
& Sprenkle, 1990). One of the problems with this approach is
that it yields little information on what it is about a
particular approach that may be making it effective and how
to enhance the approach. It also does not provide
information on why the treatment does not work with a
particular segment of the sample.
In order to determine why a treatment is effective or
not effective, scholars have called for different approaches
to research on couples, including process research
(Greenberg, 1991; Gurman & Kniskern, 1991; Gurman, Kniskern,
& Pinsof, 1986; Jacobson & Addis, 1993; Rice & Greenberg,
1984a). This study is a process study on how enactments, a
commonly used couple therapy intervention, are successfully
used. An enactment in couple therapy is a therapeutic
process where the couple talks directly to each other and the
therapist coaches the content and process of the couple's
interaction. To date, there has been no research that
specifically investigates enactments. The definition and
importance of process research is first discussed, followed
by a brief discussion of enactments and couple outcome
research. The purpose of the study is then presented.

Process Research
Therapy process research generally focuses on the
process between the clients and therapist in session as it
changes on a moment by moment basis. There are at least
three advantages to process research (Greenberg & Pinsof,
1986; Jacobson & Addis, 1993; Rice & Greenberg, 1984a).
First, process research has the potential of providing
specific information about how to effectively do therapy that
could be very useful to clinicians. Second, by studying the
micro-processes of therapy, researchers gain information on
what therapeutic behaviors actually make therapy effective
with specific clients. This can then be used to develop and
test theories of change. Third, models of change can be
generated with a few cases and, consequently, the research
can be done with small numbers. Because of these advantages
and the limitations of other forms of research, Jacobson and
Addis (1993), after a review of couple therapy research,
stated that couple process research must be a high priority.
One common approach to therapy process research is
outlined by Greenberg (1986, 1991) and Rice and Greenberg
(1984) and is based on task analysis. This form of process
research involves identifying and studying important sections
of therapy, generating a hypothesis about which processes are
relevant to change, developing a system to code those
processes, and then testing the hypothesized change processes
(Greenberg, 1986, 1991; Jacobson & Addis, 1993; Rice &
Greenberg, 1984b). The sections and aspects of therapy
identified for study are called events (Greenberg, 1984,
1986). The selection of an event to study helps sharpen the
focus and specify the context of how change occurs
(Greenberg, Ford, Alden, & Johnson, 1993). Events are often
chosen through directly observing the processes of therapy
(Greenberg, 1986, 1991; Rice & Greenberg, 1984b). This is
contrasted by the traditional approach of deriving from
theory the content of what is to be studied.
The event investigated in this study was obtained
through watching videotaped sessions of couple therapy and
through couple therapy clinical experience. The segments of
therapy identified through this method for research in this
study are segments of therapeutic enactments during couple
therapy sessions.
Enactments
The term enactment in the mental health field is used in
a number of ways both in and out of the field of marriage and
family therapy. In family therapy, enactment is used to
describe a therapy process in which the therapist allows or
instructs the family to interact with each other in a normal
way at first with little or no intervention from the
therapist (Aponte & VanDeusen, 1991). The therapist then
assesses the process of the interaction among the family
members and intervenes in and changes that interaction by
coaching it, increasing its intensity, prolonging transaction
times, indicating alternative transactions, and/or making the
processes conscious to family members (Minuchin & Fishman,
1981). Enactments are an important technique in structural
family therapy and form the basis for many structural therapy
interventions (Aponte & VanDeusen, 1991). Enactments are
used as a technique in other family therapy approaches as
well (Reid & Helmer, 1986). These approaches are discussed
in more detail in Chapter II.
The term is used similarly in emotionally focused couple
therapy. In this type of couple therapy, clients, once they
have clarified some aspect of their experience in the
relationship, are encouraged to either directly share these
with each other or specifically enact an interactional
position (Greenberg & Johnson, 1988). Greenberg and Johnson
(1988) describe at least three ways to enact interactional
patterns: vivifying enactments, position enactments and
impasse enactments. In vivifying enactments the therapist
helps the client speak for a part of the self that is not
normally spoken for in the relationship and then has the
client enact or speak for this part of the self to the
partner. In position enactments, the therapist clarifies a
relationship position that a client may be taking and has
that client enact the position with the partner. The
enactment can involve physical movement (such as turning away
at a specific point in the interaction) as well as verbal
exchange. Impasse enactments involve having the couple enact
a specific impasse, sometimes repeatedly to help them label
it and explore, understand, and accept the entrenched
positions.
The term "enactment" is explicitly used to describe a
major tool in emotionally focused therapy. However, other
couple therapy theories, such as behavioral marital therapy
(Jacobson & Margolin, 1979) and the Relationship Enhancement
approach (Guerney, Brock, & Coufal, 1986), also use
enactments. In both behavioral marital therapy and the
Relationship Enhancement approach, the term enactment is not
specifically used. However, an important component of both
of these approaches is communication training, and a primary
part of communication training is "behavioral rehearsal" and
"problem solving" (Guerney et al., 1986; Jacobson & Margolin,
1979). Both behavioral rehearsal and problem solving involve
having the couple talk directly to each other while the
therapist coaches the interaction, which is an enactment.
A number of couple enrichment programs use what are
often called role plays to help couples learn problem solving
and communication skills (L'Abate & Weinstein, 1987; Miller,
Nunnally, & Wackman, 1976). These usually consist of having
the couple face each other and talk though a problem while
trying to use the skills being taught. Often a facilitator
or others in the program coach the process of their
interaction. These role plays are essentially the same
intervention as an enactment in couple therapy.
Enactments in couple and family therapy can be used for
several purposes including to assess, change interaction
patterns, develop skills, solve problems, encourage affective
experiencing, emphasize strengths, produce insight, and
improve clients' ability to generalize new behaviors to
outside the therapy room. Often couple therapists use
enactments for all of these purposes at the same time. The
purposes of enactments are discussed in greater detail in
Chapter II.

Definition of Enactments
For the purpose of this study, an enactment was defined
as a therapeutic process in which the couple talked directly
to each other and the therapist coached the content and
process of the couple's interaction. Enactments that focus
only on assessment were not a part of this study.
Enactments that focus on helping couples resolve the
content of a problem reflect the philosophy that "more change
comes from dealing with problems than from talking about
them" (Colapinto, 1991, p. 438). Enactments that are
focused on changing the process of interaction also represent
the philosophy that change comes through dealing with
problems. However, there is also the assumption with process
oriented enactments that part of the problem is the process
of the interaction and not simply the content of the problem
presented by the couple. For example, if a couple comes into
therapy complaining of not being able to resolve financial
problems, a content enactment would focus only on how to
solve the financial problems, ignoring any communication
difficulties the couple may be having around the issue. In a
process enactment the therapist would intervene in the
communication processes the couple uses when talking about
finances in order to help the couple solve the problem. Both
of these forms of enactments are used to help couples solve
problems in the therapy room.

Research on Enactments
There has been no research done specifically on
enactments in therapy. However, the greatest amount of
outcome research done in the field of marriage and family
therapy has been done on structural family therapy,
behavioral marital therapy, and emotionally focused therapy.
These three theoretical approaches to therapy are also the
three primary theoretical orientations in couple and family
therapy that use enactments as an essential component of
treatment. Structural family therapy has been found to be
effective with different populations, including Hispanic boys
with behavioral and drug problems and minority inner-city
children with behavioral problems (Minuchin, Montalvo,
Guerney, Rosman, & Schumer, 1967; Szapocznik, Kurtines,
Foote, Perez-Vidal, & Hervis, 1983; Szapocznik et al., 1989;
Szapocznik et al., 1986).
Behavioral marital therapy is the most well researched
couple therapy to date (Jacobson & Addis, 1993). At least
twelve studies done in four countries demonstrate that
behavioral marital therapy is an effective treatment for
marital problems in moderately distressed couples. Component
analysis indicates that the communication component of
behavioral marital therapy can help prevent problems
(Jacobson, 1984) and is an important component for the long-
term effectiveness of behavioral marital therapy (Jacobson,
Schmaling, & Holtzworth-Munroe, 1987).
Other than behavioral marital therapy, the only couple
therapy approaches supported by replicated outcome research
are emotionally focused couple therapy and the Relationship
Enhancement approach. There are currently four outcome

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studies which demonstrate the effectiveness of emotionally
focused therapy (Goldman, 1987; James, 1991; Johnson &
Greenberg, 1985a; Johnson & Greenberg, 1985b). There are
also at least three studies that investigate the process of
change in emotionally focused therapy (Greenberg et al.,
1993; Greenberg, James, & Conry, 1988; Johnson & Greenberg,
1988).
The Relationship Enhancement approach is a couple
therapy approach that in an integration of couple therapy and
enrichment (Guerney et al., 1986). This approach is a
theoretical integration of the psychodynamic, humanistic,
behavioral, and interpersonal schools of thought. Behavioral
rehearsal (enactment) is at the core of clinical
interventions and is the primary tool for change. A number
of research studies have demonstrated that Relationship
Enhancement is an effective treatment for relationship
problems (Brock & Joanning, 1983; Jessee & Guerney, 1981;
Ridley, Jorgensen, Morgan, & Avery, 1982; Ross, Baker, &
Guerney, 1985; Wieman, 1973).
It is worth noting that structural family therapy,
behavioral marital therapy, emotionally focused therapy, and
the Relationship Enhancement approach are the most well
researched couple and family therapy approaches to date and
each of them use enactments as an essential part of
treatment. In addition to the research on these four therapy
approaches, an extensive body of research has developed on
the effectiveness of couple enrichment programs (Guerney &
Maxson, 1990; L'Abate & Weinstein, 1987). The majority of
these programs use a type of enactment: face-to-face
communication training in which the couple is coached on
communication processes and problem solving. Reviews of this
research indicate that the majority of couple enrichment
programs are effective in changing couple interaction and
satisfaction (Giblin, Sprenkle, & Sheehan, 1985; Guerney &
Maxson, 1990; Lipsey & Wilson, 1993; Wampler, 1982;
Zimpfer,1988).
The fact that the most well researched effective
therapeutic and enrichment intervention programs for
improving relationships use enactments indicates that
enactments may be an important intervention in the treatment
of couples. Consequently, enactments are a component of the
successful treatment of couples that needs to be studied.
Although researchers have called for the analysis of
components of successful treatment approaches and enactments
are used in the major approaches to couple treatment that
have been supported by replicated research, there has been no
research, process or otherwise, that specifically
investigates enactments.

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Purpose of Study
The purpose of this study was to investigate the use of
enactments in couple therapy. More specifically, the purpose
of the study was to investigate the association between
therapist interventions and positive and negative couple
interaction during enactments. A theory of enactments, along
with hypotheses, is presented in Chapter II.

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CHAPTER II
LITERATURE REVIEW

This chapter will consist of a discussion of the call


for process research and a review of the process and outcome
research literature that identifies in therapy factors linked
to outcome. Following this review, the literature on the use
of enactments is discussed. Finally, a theory of enactments,
along with hypotheses, is presented.

Process Research
A number of leading scholars in individual, couple, and
family therapy have called for more intensive research on
what makes therapy effective (Bergin & Garfield, 1994a;
Gurman et al., 1986; Jacobson & Addis, 1993; Rice &
Greenberg, 1984a). These researchers have also called for
investigation of specific interventions independent of the
theoretical orientations of clinicians. There are several
reasons for these requests, including the following:
(1) After years of research on therapy, it is still unclear
what makes therapy effective; (2) The overwhelming majority
of outcome research indicates that almost all treatment
approaches tested are effective; and (3) There seems to be a
lot of overlap in what clinicians using different theoretical
approaches actually do in therapy (Bergin & Garfield, 1994b;
Gurman & Kniskern, 1991; Gurman et al., 1986; Jacobson &

12
Addis, 1993; Jacobson & Gurman, 1986; Nichols, 1984; Orlinsky
& Howard, 1986; Piercy & Sprenkle, 1990; Stiles, Shapiro, &
Elliott, 1986; Smith, Glass, & Miller, 1980).
Although various theoretical approaches have been shown
to be effective with a variety of presenting problems, there
is little replicated research indicating that one approach is
better than another (Bergin & Garfield, 1994b; Gurman &
Kniskern, 1991; Jacobson & Addis; 1993; Orlinsky & Howard,
1986; Stiles et al., 1986). Lambert and Bergin (1994)
suggest three possible reasons for these findings. The first
is that different theoretical approaches can achieve similar
results through different processes. The second is that
different outcomes do occur but are not detected through
current research strategies. The third possible reason is
that many approaches to therapy, as applied in sessions,
contain common interventions and characteristics that are
responsible for the positive effects of therapy. Lambert and
Bergin (1994) point out that this third possibility has
received the most research to date, has some of the clearest
implications for practice, and is consistent with the
findings of the research on placebo effect (which demonstrate
that psychotherapy effectiveness is due to more than simple
placebo effects). They go on to state that, from their
review of the research, it "appears that what can be firmly
stated is that factors common across treatments are

13
accounting for a substantial amount of improvement found in
psychotherapy patients" (Lambert & Bergin, 1994, p. 163).
To date there has been very little research, process or
otherwise, that has focused on specific interventions in
family therapy, particularly interventions that are commonly
used in a variety of approaches to therapy. It is possible
that if researchers focus on specific interventions and
therapist behaviors, more information will be discovered
about what it is that therapists across theoretical
orientations in marriage and family therapy do to help their
clients change. Process research is specifically called for
because moment by moment information can be obtained on (a)
what therapists actually do in therapy while carrying out
specific interventions and (b) short-term outcomes of these
interventions. This is the reason scholars have called for
more process research (Gurman & Kniskern, 1991; Gurman et
al., 1986; Jacobson & Addis, 1993; Rice & Greenberg, 1984a).

Therapy Outcome Research


There have been a number of reviews of process and
outcome research in individual psychotherapy and marriage and
family therapy, all of which have demonstrated that the
approaches to therapy tested are at least partially effective
(Bergin & Garfield, 1994b; Gurman & Kniskern, 1991; Gurman et
al., 1986; Jacobson & Addis, 1993; Lipsey & Wilson, 1993;
Orlinsky & Howard, 1986; Piercy & Sprenkle, 1990; Shadish et

14
al., 1993; Stiles, Shapiro, & Elliott, 1986; Smith, Glass, &
Miller, 1980). Although the hundreds of studies reviewed do
not give definitive information on what makes therapy
effective, they do provide some clues. Clues from the
individual psychotherapy research and those from the marriage
and family therapy research are discussed here.

Clues from Individual Therapy Research


The extensive individual psychotherapy research has
yielded a number of clues on why therapy is effective. This
research is presented here in terms of general factors linked
to outcome, therapist factors associated with outcome, and
therapist interventions associated with outcome.
General factors. The most comprehensive review of this
literature to date was done by Lambert and Bergin (1994).
They organize factors associated with positive outcomes into
three area: support factors, learning factors, and action
factors. Support factors included factors such as catharsis,
positive relationship, reassurance, and therapist warmth,
respect, empathy and acceptance. Learning factors include
factors such as affective experiencing, cognitive learning,
corrective emotional experiences, feedback and insight.
Action factors includes factors such as behavioral
regulation, modeling, mastery efforts, practice and success
experiences. These factors are common across almost all
therapies. Each of these factors has been related to therapy

15
outcome by empirical research. Factors from each of these
areas—support, learning and action—can be present or worked
on within the context of enactments.
Therapist factors. A number of factors specific to the
therapist have been studied. Exhaustive reviews of both
process and outcome literature indicate that the most
important characteristics appear to be personal factors that
enhance the therapeutic relationship (Lambert & Bergin, 1994;
Orlinsky, Grawe, & Parks, 1994). These include factors such
as empathy, affirmation, collaboration, and self congruent
engagement with clients (Orlinsky et al., 1994). Three
examples are worth noting here.
The first comes from a study with a sample of 112
behavioral therapy clients who were surveyed regarding their
perception of helpful characteristics of the therapist.
Adjectives such as sensitive, gentle, and honest were most
commonly mentioned while technical factors were not
consistently mentioned (Lazarus, 1971).
Another research study on therapist factors, done by
Lafferty, Beutler, and Crago (1991), investigated differences
between therapists who were determined to be either less or
more effective by the amount of pre to post treatment change
in clients on the Revised Symptom Checklist-90. The
therapists who had clients who were more distressed after
therapy than before were labeled less effective and those
whose clients improved were labeled more effective. The less

16
effective therapists were rated by the clients as having less
empathic understanding than more effective therapists.
A third example comes from a study of two behaviorally
oriented approaches to treating problem drinkers (Miller,
Taylor, & West, 1980). The researchers were surprised to
find that, six to eight months post-treatment, therapist
empathy explained 67 percent of the variance in drinking
behavior.
Therapist interventions. Orlinsky et al. (1994), in
their extensive review of process-outcome literature,
investigated therapist interventions. They conclude that
therapists can contribute to successful outcomes through
skillfully applying three specific interventions that have
been found to be effective in numerous studies: experiential
confrontation, interpretation, and paradoxical intention.
Regarding these factors the researchers state that "these
consistent process-outcome relations, based on literally
hundreds of empirical findings, can be considered facts
established by 40-plus years of research on psychotherapy"
(p. 361).
It is important to note that experiential confrontation
in individual therapy is in many ways similar to enactments
in marriage and family therapy. One of the main differences
is that enactments involve having the person being confronted
in the room. In experiential confrontation, the person being
confronted is imagined to be in the room, such as in a

17
Gestalt "empty chair" confrontation, or role played by
another person, such as in psychodrama.
In summary, recent comprehensive reviews show that the
research from individual psychotherapy indicates a number of
common factors are linked to outcome (Lambert & Bergin, 1994;
Orlinsky et al., 1994). These include therapist personal
factors such as warmth, empathy, and communication ability,
as well as specific interventions such as experiential
confrontation, interpretation, and paradoxical intention. It
is also possible to state that common factors appear to have
much more of an impact on outcome than specific theoretical
approaches (Bergin & Garfield, 1994a). In the words of
Lambert and Bergin (1994), "Common factors loom large as
mediators of treatment outcome. The research base for this
conclusion is substantial and multidimensional, and we must
attend to its import" (p. 167). Most of the common factors
that are associated with positive outcomes in individual
therapy are also present in enactments in couples therapy.
It may be that some of these common factors are associated
with effective enactments in couples therapy just as they are
with effective individual therapy.

Clues from the Marriage and Family Research


While the outcome research is fairly extensive, the
marriage and family therapy literature on what makes therapy
effective (process research) is scarce. The majority of the

18
research comes from research on behavioral and emotionally
focused couple therapy.
Behavioral marital therapy research. Behavioral marital
therapy researchers have broken their treatment approach into
components they use with various groups of subjects in order
to determine which component of their overall treatment
approach is effective. Two reviews of this literature
concluded that, in general, there are no differences in
outcomes when various components or sequences of components
have been compared (Baucom & Hoffman, 1986; Gurman et al.,
1986). One study by Hahlweg and Markman (1988), done since
these reviews, found that communication and problem-solving
training (done with enactments or "behavioral rehearsal") had
a greater effect size than did behavior exchange techniques.
These differences, however, where not statistically
significant. Jacobson et al. (1987) found, after a two-year
follow-up, that couples who received both the behavioral
exchange component and the communication and problem solving
component were the least likely to be divorced or separated
and the most likely to be happily married, as compared with
couples who received only one of these components. This line
of research indicates that communication and problem-solving
is at least an active component of behavioral marital therapy
and very well may interact with the behavioral exchange
component to produce positive treatment outcomes.

19
A number of studies have been devoted to determining
whether behavioral marital therapy is enhanced by a cognitive
component (Margolin & Weiss, 1978; Baucom & Lester, 1986;
Baucom, Sayers, & Sher, 1990). The studies by Baucom and
colleagues (Baucom & Lester, 1986; Baucom et al., 1990),
which had greater controls than did the Margolin and Weiss
study, showed that behavioral marital therapy with the
cognitive component added does alter cognitions more than
behavioral marital therapy alone, but does not increase
marital satisfaction any more than behavioral marital therapy
alone. This indicates that changing cognitive processes may
not be necessary for enhancing marital satisfaction
(Jacobson, 1991). Coyne (1990) argues that cognitive marital
therapy will not be effective because it focuses exclusively
on changing cognitions through verbal discussion and
persuasion rather than through the action oriented
interventions in behavioral therapy. Coyne also asserts that
the action oriented behavioral interventions are the active
ingredient in the cognitive treatment of depression and
probably in couple therapy as well. It is worth noting that
enactments are, by their nature, action oriented.

Emotionally focused couple therapy research. In


emotionally focused therapy (EFT) research there have been
three studies that examine change factors. The first was a
study of couples treated with EFT in which the best therapy
sessions were coded (Johnson & Greenberg, 1988). These

20
sessions were identified by the therapists and the clients,
using the three couples in the study that had changed the
least and the most in couple satisfaction. The results of
the coding indicated that successful couples were more
accepting and affillative, attained a deeper level of
emotional experiencing and integration, and had more
softening experiences. Softening experiences were defined as
shifts from negative interaction cycles to interactions
characterized by increased accessibility and responsiveness.
The second study consisted of task analysis of
interviews with 21 couples four months after finishing
emotionally focused therapy (Greenberg et al., 1988). The
couples were asked to identify critical change incidents in
their therapy. Five categories of change were identified
from the 52 incidents cited by the subjects: expressing
underlying feelings leading to change in interpersonal
perception, expressing feelings and needs, acquiring
understanding, taking responsibility for experiences (rather
than blaming), and being validated by the therapist.
A third publication on in-session change in emotionally
focused therapy consisted of three separate studies
(Greenberg et al., 1988). These studies used a combination
of coded therapy segments and questionnaires. The results of
these studies indicated that spouses were more likely to make
affiliative statements after a therapist facilitates intimate
self-disclosure by their partners. The researchers also

21
found that in the best sessions, as rated by the couples,
there were significantly more affiliative statements than in
the worst sessions.
In a qualitative study based on the transcription,
coding, and analysis of sixteen videotaped sessions of couple
therapy. Burr (1994) identified five therapeutic
interventions that relate to achieving couple intimacy.
These interventions were (a) creating behavior change, (b)
empathy, (c) insight, (d) intouchness, and (e) giving
support. Burr found that all five of these processes had to
be present in order for couple intimacy to occur in session.
Enactments were also used in each of the sessions where
intimacy occurred and was sustained. However, Burr did not
investigate this potentially important variable. There has
not been a quantitative follow-up on this study to date.
No other published research was found on what makes
marriage and family therapy effective. Consequently, it is
safe to assume that there is a great deal of research that
needs to be done in order to determine how marriage and
family therapy works.

Enactments: A Common Factor


Enactments are used in a number of different types of
couple and family therapies and are listed as a common
general technique in family therapy by Reid and Helmer
(1986). Enactments are used in a variety of ways, and for

22
various purposes. For the purpose of this study, an
enactment was defined as a therapeutic process where the
members of the couple (or family) talk directly to each other
and the therapist coaches the content and process of the
couple's interaction.

Uses of Enactments
Enactments are used in a variety of ways in couple and
family therapy, including to make assessments, change
interaction patterns, develop skills, solve problems,
encourage affective experiencing, emphasize strengths,
produce insight, and better help clients generalize behaviors
to the outside world. Each of these is discussed along with
the specific approaches to therapy that use enactments for
these purposes.
Assessment. Enactments can be used for assessing the
interactions of the clients. Minuchin and Fishman (1981)
have said.
When the therapist gets the family members to
interact with each other . . . he [or she]
unleashes sequences beyond the family's control.
The accustomed rules take over, and transactional
components manifest themselves with an intensity
similar to that manifested in these transactions
outside of the therapy session. (pp. 78-79)

The theory is that dysfunctional patterns will arise from the


interactions that occur in sessions, and these are the same
patterns of transaction that occur outside the therapy room.

23
Actually seeing the clients interact can give different and
sometimes more accurate information than hearing clients'
reports of interactions.
Enactments are commonly used in the practice of couple
and family therapy for assessment purposes. They are
specifically discussed as an assessment tool in structural
family therapy, emotionally focused therapy, behavioral
marital therapy, and Ericksonian therapy (Greenberg &
Johnson, 1988; Jacobson & Margolin, 1979; Lankton, Lankton, &
Matthews, 1991; Minuchin & Fishman, 1981). However, because
ongoing assessment is a part of most couple and family
therapies, and enactments lend themselves so well to
assessment, it is likely that most therapists who use
enactments gain assessment information from using them.
Change interaction patterns. Enactments are often used
to change interaction patterns. This can be done through
coaching couples or families on the content or process of
their interaction. One of the advantages of enactments is
that interaction patterns can be changed immediately and the
therapist can observe and direct the changes in the patterns.
Most family therapists who use enactments would probably
report that a primary purpose for their use of enactments is
to help change interaction patterns. The only exception
might be in Ericksonian family therapy in which most
interventions are indirect (Lankton et al., 1991).
Theoretical approaches that specifically discuss using

24
enactment type interventions to change interaction patterns
include structural family therapy, emotionally focused
therapy, symbolic-experiential family therapy, and the
Relationship Enhancement approach to therapy (Greenberg &
Johnson, 1988; Guerney et al., 1986; Minuchin, 1974; Minuchin
& Fishman, 1981; Roberto, 1991).
Skill development. Enactments can be used to help
clients develop new skills. Skills that are often practiced
in the context of enactments commonly include such skills as
assertiveness and problem solving. The use of enactments or
behavioral rehearsal to build skills is particularly common
in couple enrichment and couple therapy approaches. Many
marriage and family enrichment programs use enactments (often
called role playing) for couples to practice with each other
the skills they are learning (L'Abate & Weinstein, 1987;
Miller et al., 1976). One of the most well researched
enrichment programs for couples, the Minnesota Couple
Communication Program, uses enactments for skill building
(Miller, Nunnally, & Wackman, 1976; Wampler, 1982).
Behavioral marital therapy and the Relationship Enhancement
approach are two couple therapy approaches that specifically
use enactments for the purpose of skill building (Jacobson
and Margolin, 1979; Guerney et al., 1986).

Problem solving. Enactments are commonly used as a way


to help couples solve problems. Helping couples solve
problems is at the core of many approaches to therapy. Those

25
approaches that specifically encourage the use of enactments
for problem solving include behavioral marital therapy and
the Relationship Enhancement approach as well as many couple
enrichment programs, such as the Minnesota Couple
Communication Program (Guerney et al., 1986; Jacobson &
Margolin, 1979; L'Abate & Weinstein, 1987; Miller et al.,
1976). Most approaches to couple and family therapy that use
enactments focus on solving problems and use enactments for
this purpose even though it is not specifically stated.
Affective experiencing. Enactments can be used to help
clients experience and communicate their emotions. The
experiential family therapists such as Satir and Whitaker
(Nichols, 1984; Roberto, 1991) often use enactments for these
purposes. Emotionally focused therapy, which is based on
experiential therapy, also uses enactments to help clients
experience and communicate their emotions (Greenberg &
Johnson, 1988). Emotional experiencing can be enhanced
through having partners directly express emotions to each
other during enactments.
Emphasizing strengths. By having clients face and solve
problems with each other, therapists can emphasize clients'
strengths and abilities to overcome difficulties. The use of
enactments for this purpose is explicitly discussed in
structural family therapy and Ericksonian family therapy
(Minuchin & Fishman, 1981; Lankton et al., 1991). In
Ericksonian family therapy, having family members talk to

26
each other is believed to create the implicit suggestion that
they are the experts and have the ability to solve their
problems. In other approaches to therapy which emphasize
client strengths and resources, enactments could be used to
help families identify their strengths. These approaches
might include brief therapies such as solution focused
therapy, problem solving therapy, and Mental Research
Institute (MRI) therapy.
Produce insight. Most family therapists do not talk
much about creating insight. This may be, in part, because
of a desire to emphasize here and now change and also to
emphasize the differences between marriage and family therapy
and traditional psychotherapies (Nichols, 1984). However,
process research on couple therapy sessions indicates that
therapists often use interventions for the purpose of
creating insight (Burr, 1994). For example, the technique of
reframing, which is commonly used in marriage and family
therapy, is a technique designed to produce or alter insight.
In structural family therapy, punctuating and reframing
interventions are used during enactments to help clients
"see" their behaviors differently (Colapinto, 1991).
Greenberg and Johnson (1986) discuss two types of
enactments in emotionally focused therapy that are, in part,
done for the purpose of creating insight: position enactments
and impasse enactments. In position enactments, the
therapist clarifies a relationship position that a client may

27
be taking and has that client enact the position with the
partner. The enactment can involve physical movement (such
as turning away at a specific point in the interaction) as
well as verbal exchange.
Impasse enactments involve having the couple enact a
specific impasse. Sometimes they enact it repeatedly. The
purpose of enacting an impasse is to help a couple label
impasses, and to help couples explore, understand, and change
or accept entrenched positions.
Generalize behavior. Enactments can be used to help
clients make changes in session which, it is hoped, will
generalize to interactions as home. In a number of
therapies, interventions are designed primarily to be
implemented outside of the therapy room. This is true of
brief strategic therapies such as solution focused therapy,
problem solving therapy, and the Mental Research Institute
(MRI) therapy, as well as therapies such as Bowen therapy,
Milan therapy, and Ericksonian therapy. However, other types
of therapy, such as structural therapy, experiential therapy,
intergenerational therapy, behavioral therapy, emotionally
focused therapy, the Relationship Enhancement approach,
structural therapy, and contextual therapy emphasize in-
session change. Enactments are either a formal part of these
theories or fit well within the theories and hence may be and
often are used by clinicians using these approaches.

28
In discussing the emphasis on in-session change that is
so common in marriage and family therapy, Nichols (1984)
said.

Just as live supervision is preferred because it


teaches therapists what to do while they do it, so
supervised change in the session seems more
effective than unsupervised change at home. (p.
540)
One of the reasons enactments are thought to be powerful is
that through them behaviors change in the session which will
hopefully then change outside of the therapy room, rather
than telling couples what to do out of the session and then
just hoping they do it.

A Theory of Successful Enactments


Through the process of reviewing the theoretical and
research literature, watching videotapes of therapy, and
doing therapy, a basic theory of successful enactments was
developed by the author. Although this is an exploratory
study, this theory of enactments was developed to identify
variables and hypothesized relationships. The definition of
a successful enactment will be presented, followed by a
discussion of interventions that are hypothesized to be
correlated with effective enactments.

Successful Enactments
John Gottman and colleagues have done a substantial
amount of research on couple interactional styles, problem

29
solving, and divorce (Gottman 1979, 1990, 1993, 1994;
Gottman, & Krokoff, 1989). Most of this research has been
done by coding brief segments of couple interaction. The
results indicate that couples who have satisfied marriages
give about five positive statements to each other for every
negative statement, regardless of interaction style (Gottman,
1993, 1994). Those couples who are not satisfied with their
marriages have a ratio of positives to negatives of less than
1.0 (Gottman, 1993, 1994). These ratios appear consistent Her e

regardless of the interaction style of the couple. Based on


this research, Gottman (1994) believes that interventions
that increase the ratio of positive to negative statements
will improve couple happiness. Consequently, changes in the
ratio of positive to negative statements to each other by the
couple is used as an indication of the success of an
enactment in this study.
There are several avenues of change in therapy that
could lead to a change in a couple's positive/negative ratio.
The first is successful problem resolution. When a couple is
able to successfully resolve a problem, this may increase
positive feelings toward each other, the marriage, and
themselves. It may also increase their own sense of
competence and their hope for a successful marital
experience. These overall positive feelings could then lead
to more positive communication and less negative
communication. On the other hand, unsuccessful problem

30
solving could lead to feelings of anger, frustration, and
pessimism about the marriage. All of these feelings could
lead to more negative and less positive communication.
Another possible avenue of change in therapy which could
lead to a change in the positive/negative ratio is changes in
the process of a couple's communication. One of the primary
functions of enactments is to change communication processes.
There are at least three avenues by which changing
communication processes may lead to changes in the
positive/negative ratio. First, therapists may directly
change the positive/negative ratio by encouraging positives
and discouraging negatives. Second, therapists may encourage
communication skills and techniques that make it more
difficult to communicate negatively. For example,
encouraging reflective listening, "I" statements, and
succinct asking could indirectly eliminate negative
communication by making it more difficult.
A third way that changing couple communication processes
could lead to changes in the positive/negative ratio is
through emotion. As previously discussed, enactments can be
used to help couples experience and express their emotions.
Directly expressing underlying emotions may help lead to the
development of greater empathy in partners (Greenberg &
Johnson, 1986). The empathy could in turn lead to less
negative communication and greater positive communication.
Additionally, expressing underlying emotion may also act as a

31
substitute for negative communication directed at the partner
and thus reduce negative emotion.

Therapist Interventions
There are a number of interventions within enactments
that may be correlated with successful enactments. These
have been identified through watching enactments on
videotape, through clinical experience, and through the
therapy literature, particularly that of the Relationship
Enhancement approach (Guerney et al., 1986). These
interventions include structuring, directives, producing
insight about process, dealing with affect, supporting,
teaching, confronting negatives, encouraging positives, and
maintaining a neutral therapeutic stance.
Structuring. Structuring is mentioned by Guerney et al.
(1986) as one of the primary therapeutic interventions that
Relationship Enhancement therapists make. It is also
mentioned as an important intervention in Behavioral Marital
Therapy (1979). Structuring involves explaining to and
reminding the couple of the guidelines and procedures for the
enactment, and directing the couple to engage in those
procedures. For example, the therapist might explain to the
couple that they are to pick a problem to solve and talk
directly to each other about it. The therapist may then
direct the couple to move their chairs so they are facing
each other. Both of these interventions would be structuring

32
interventions. If part way through the enactment the man
starts talking to the therapist rather than to the woman, the
therapist might remind him of the procedures of the enactment
and direct him to follow them by saying "talk to her."
Structuring may help contribute to a successful
enactment by helping the couple understand and follow the
basic format of enactments. It may also help the enactment
be successful through preventing the couple from breaking the
enactment up by diverting the conversation from each other to
the therapist.
Directives. Directives consist of telling a client to
communicate or behave differently. For example, if a client
raises his or her voice and the therapist says "Please use a
softer voice," the therapist is directing the client. "Try
leaning forward more in your chair" is an example of
directing client behavior. Directing client behavior may
help clients change their communication processes by giving
them concrete knowledge of what to do and by having them
actually do it.
Affect. An affectively oriented intervention is any
statement that involves discussing or referring to an
emotion. For example "How are you feeling," "So you are
feeling scared," and "Tell her about that emotion" are each
affectively oriented statements.
Discussing underlying emotion may contribute to a
successful enactment through at least two processes. One is

33
that when a couple talks about underlying emotions, it can
provide a common ground for empathy (Greenberg & Johnson,
1986). For example, a wife may not be able to empathize or
understand her husband's excessive spending, but she can
probably understand and empathize with his feelings of being
out of control. This empathy and understanding may lead to
less negative and greater positive interaction.
Another way the discussion of emotion may contribute to
a successful enactment is that when people talk about
emotions they may be less likely to act them out. For
example, if the man is angry at the women, he might be less
likely to verbally attack or jab her if he talks about his
anger and any other feelings he may be having.
Support. A supportive statement is any statement by the
therapist that offers support to at least one member of the
couple or their relationship. "You're doing great" or "I'm
with you" are examples of supportive statements.
Supportive statements may contribute to successful
enactments through helping to establish and maintain the
therapeutic relationship and perhaps through redoing or
preventing what is called flooding (Ekman, 1984; Gottman,
1994). Flooding is a state of psychological and
physiological arousal that makes it difficult for people to
process information (Gottman, 1994). When flooding occurs,
the person being flooded may withdraw from an interaction and
thus make problem solving and communication difficult. In

34
fact, withdrawal, particularly of the husband, is associated
with low marital satisfaction (Gottman & Krokoff, 1989).
Although the exact causes of flooding are not known, positive
interaction has been found to act as a buffer against
flooding (Gottman, 1994). It may be that supportive
behaviors (which by nature are positive) on the part of the
therapist could make therapy a psychologically safer place
and thus reduce the likelihood of flooding.
Insight process. Another intervention is for the
therapist to make a statement to produce insight about
process. Insight about process is a statement about a
communication process within the therapy room or within the
couple's relationship. In other words, an insight-process
statement is a statement about how the couple is
communicating. An example would be if the therapist said
"You both seem to jab each other a lot." This statement
emphasizes the negative interchanges the couple is having.
Insight about the process of communication might help a
couple change that process, resulting in more positive
interchanges between the couple.
Teaching. When a therapist teaches, the therapist
instructs the couple on how they are to do something or why
they are doing it. For example, a teaching statement
consists of a statement like, "It is important to use soft
voice tones while talking to each other because soft voice
tones are less likely to trigger anger in your partner."

35
Moderate teaching may help the client understand what types
of skills they need to develop and why they are doing
something. However, excessive teaching may result in
overpowering the client with details. It may also interrupt
the flow of the enactment and distract the couple from their
direct communication.

Encouraging positives. Encouraging positives involves


any therapist statement that directly encourages or suggests
that the client should say something in a positive or more
neutral manner. Examples include "Say that again in a more
positive way," and "I like how tenderly you are talking to
each other, keep going." Encouraging positive could
reinforce positive statements and help couples learn to use
more positive statements while talking to each other.
Confronting negatives. Confronting negatives involve
calling attention to any type of negative exchanges. This
may include pointing them out with a process statement or
directing them to not use them. For example, after a
negative statement, the therapist could confront it through
using a directive: "Say it again without the jab."
Confronting inappropriate behavior may help a couple learn
not to use those behaviors.
Alignment. Kerr and Bowen (1988) contend that
therapists should maintain a neutral stance in therapy. In
other words, the therapist should not align with any member
of the system against another member. When a therapist

36
consistently aligns with one person it could lead to
resentment on the part of the partner who is being aligned
against. This could in turn lead to greater negative
interchanges, and interfere with the enactment.

Hypotheses
A set of hypotheses regarding enactments was generated
through the process of reading the literature, viewing
marital therapy session videotapes, supervising marital
therapy, and doing marital therapy. Some of these hypotheses
have support in the literature outlined above. However, the
hypotheses were generated through directly observing,
supervising, and participating in marital therapy. This is
consistent with process research hypothesis generation
(Greenberg, 1991; Rice & Greenberg, 1984b).
Seven therapist behaviors have been identified:
structuring, affect, support, insight, alignment,
directive/teaching, encouraging positives, and confronting
negatives. Each of these variables is hypothesized to be
correlated with the positive and negative verbal exchanges of
a couple during an enactment. It was not known which of
these therapist behaviors would be most important.
There were three specific sets of hypotheses for this

study:
1. The use of the coded therapist interventions to the (a)
male, (b) female, and (c) couple during an enactment

37
will be positively related to rates of positive verbal
exchanges by the (a) male, (b) female, and (c) the
couple.
2. The use of the coded therapist interventions to the (a)
male, (b) female, and (c) couple during an enactment
will be negatively related to rates of negative verbal
exchanges by the (a) male, (b) female, and (c) the
couple.
3. The use of the coded therapist interventions to the (a)
male, (b) female, and (c) couple during an enactment
will be positively related to the ratio of the positive
to negative verbal exchanges by the (a) male, (b)
female, and (c) the couple.

38
CHAPTER III
METHODOLOGY

Methodology Steps
The methodology used in this study is a modification of
the process-analytic approach to research outlined by
Greenberg (1984, 1991) and Rice and Greenberg (1984a).
Greenberg's (1984) general method is based on task analysis.
Task analysis is a set of procedures for describing and
analyzing human behavior during complex problem solving tasks
(Greenberg, 1984). It originated in the area of industrial
psychology and was used to describe the analysis of
competencies that specific behavioral tasks required (Miller,
1955). Task analysis has also been used in the information-
processing field to develop theories of human problem solving
on a cognitive as well as behavioral level (Gagne, 1968;
Greenberg, 1984; Newell & Simon, 1972; Pascual-Leone, 1976;
Resnick, 1976). Greenberg (1984, 1991, 1994) has taken these
methods, refined them, and applied them to specific events
(tasks) in individual therapy.
Greenberg (1984) defines a therapeutic event as
an interactional sequence between client and
therapist. It is a performance sequence that has a
beginning, an end, and a particular structure that
gives it meaning as an island of behavior
distinguishable from the surrounding behaviors in
the ongoing psychotherapeutic process. . . It is
intrinsically complex and composed of
interconnected activities in a changing pattern,
but it occurs within a continuous period of time

39
and comes to some closure within the session. (p.
138)

Events are chosen through directly observing the processes of


therapy for situations that appear to bring about change
(Greenberg, 1986, 1991; Rice & Greenberg, 1984b).
Rice and Greenberg (1984a) discuss four different
specific approaches based on their general approach to
process research and give examples of each. The specific
approach used in this study is outlined shortly. However an
outline of Greenberg's (1991) task analysis steps, which were
used in a study of the empty chair technique is reviewed.
His first step was to make explicit the implicit map of an
expert clinician. Second, he selected the task and described
the talk and the task environment. Third, he verified the
importance of the task. Fourth, he analyzed the performance
and made a possible performance diagram. Fifth, he made an
empirical analysis by measuring the actual performance.
Sixth, he compared the actual performance with possible
performances and from this constructed a model. Seventh, he
validated the model through empirical research with more than
a single case, and eighth, he compared his model with the
outcomes of his research.
It is important to notice that most the steps (1-6) in
this method are focused on discovery, and relatively few are
focused on verification. This is true of Greenberg's
methodology in general. The steps of Greenberg's methodology

40
that are covered in this study of enactments are discussed
shortly. However, there are at least two important general
differences between this study and the work of Greenberg and
colleagues which deserve explanation.
First, there are differences in the focus of Greenberg
and colleagues' work and the focus of this study. The work
of Greenberg and colleagues is focused on client change and
assumes therapists deliver similar interventions during
change events (Greenberg, 1984, 1986, 1991). Consequently
the work of Greenberg and colleagues has focused only on the
client. The change event in this study is an enactment, a
therapist initiated event. This study coded the behaviors of
both clients and therapists. Within enactments therapists
engage in a variety of micro-interventions (discussed in
Chapter II) which potentially result in very different
overall enactments both between therapists and between
enactments performed by the same therapist. Consequently,
the focus of this study is on the relation between
therapist's micro-interventions and the client interaction
system.
Second, the process research done so far by Greenberg
and colleagues has focused on changes as they occur within
the individual client using both self-report and observation
measures. They have not included more than one client in the
room. In a recent review of research on couple therapy,
Jacobson and Addis (1993) recommend using Rice and

41
Greenberg's process-analytic research method with couple
therapy. This study does that. It examines the relation
between therapist behaviors and change in a couple's
interaction system. The difference between focusing on
individual change and change in an interaction (systemic
change) is important. Focusing on change in a couple's
interaction patterns adds a new dimension to the research and
requires a shift in thinking from intra- to inter-client
change.

Overview of Steps Used in this Study


The methodology used in this study consists of the
following seven steps.
Step 1. Study expert clinicians and successful therapy
to identify change process sections of therapy (referred to
as the task or event). In this study the event is an
enactment, defined as a therapeutic process in which the
couple talks directly to each other and the therapist coaches
the content and process of the couple's interaction.
This step covers the same ground as steps 1 and 2 in
Greenberg's (1991) outline. The author has done these steps
over the past four years in (a) watching and analyzing tapes,
(b) doing live and videotaped supervision, (c) doing therapy,
and (d) discussing his ideas with other therapists.
Step 2. Develop through observation a micro-theory of
change which includes hypotheses about which processes are

42
relevant to positive interaction during enactments. This has
already been done and is described in chapter II. This
provides a framework for the exploration of successful and
unsuccessful enactments. This step relates to steps 2 and 4
in Greenberg's (1991) outline.
Step 3. Develop a system to code the identified
processes (described below).
Step 4. Collect a sample of identified segments of
therapy.
Step 5. Code the sample.
Step 6. Through data analysis, test the hypothesized
relational processes.
Steps 3, 4, 5 and 6 used in this study correlate with
steps 5 and 6 outlined by Greenberg (1991).
Step 7. Refine the theory of change in preparation for
future research that will test hypothesized change processes.
This is essentially the same step as outlined by Greenberg
(1991) as step 6.
This methodology will result in a clearer understanding
of the processes that occur during enactments. The only step
of Greenberg's (1991) discovery oriented section that is not
being directly followed in this study is step 3: verify
significance of the task to be studied. Greenberg (1991)
states that a formal verification is optional. The
importance of enactments as a change segment has been
informally verified through the earlier phases of the project

43
(watching videotapes, supervising, and doing therapy). The
verification oriented steps of Greenberg's 1991) are beyond
the scope of this study and are suggested for future
research.
Another important aspect of Greenberg's method is that
there are usually several iterations of the discovery
oriented section of the methodology (Greenberg, 1986, 1991).
Each time the process is gone through, the theory is refined.
This study is the first phase or iteration of a process
analytic study on enactments.

Sample
Definition of an Enactment
The sample unit is an enactment in a couple therapy
session. The criteria used to identify the beginning and end
of enactments follow. There were two ways enactments could
begin (therapist initiated and couple initiated) and two ways
enactments could end (direction of talk and topic).
Therapist initiated beginnings. One way an enactment
may begin is with the first therapist talk turn in which the
therapist tries to get the couple to talk with each other.
One member of the couple must actually talk with the other
within 10 talk turns in order for this to be considered the
beginning of an enactment.
Couple initiated beginnings. The other way an enactment
begins is with (a) the first talk turn of a member of the

44
couple in which the direction of talk is from one member of
the couple to the other, and (b) the dialogue between the
couple continues for several talk turns. In order for an
enactment to be couple initiated, there must not be any
attempt by the therapist to start the enactment for at least
10 talk turns before the couple initiated beginning.
However, after the couple have started talking with each
other the therapist may take action to encourage them to
continue to stay in the enactment such as having them turn
their chairs toward each other.
Direction of talk endings. When the direction of talk
ceases to go between the couple for at least 25 talk turns,
the enactment has ended. The final talk turn in the
enactment is usually the therapist's talk turn following the
last time the couple talked to each other. An exception
would be if the therapist is interrupted and is unable to
complete a sentence about the couple's interchange. In this
case, the enactment ends in the therapist's previous talk
turn in which the therapist has finished his or her sentence.
Topic endings. Couples often change topics during and
enactment. However, if the couple stops talking to each
other for between 10 and 25 talk turns, a topic change during
this period signals an end to the enactment. This
distinction is important because it became apparent from
observing enactment that there is a qualitative difference
between the exchanges of a couple on one topic and those on

45
another topic when there has been a period of talk, usually
about 15 to 20 talk turns, in which the couple talks only to
the therapist. Because of the diverse nature and frequency
of talk turns, latitude of between 10 and 25 talk turns was
given to help coders identify these qualitatively different
enactments.

Enactment Identification
The enactment segments were taken from archived
videotapes of couple therapy at the Texas Tech University
Family Therapy Clinic. Since September of 1992, the Family
Therapy Clinic has videotaped every therapy session and
obtained written consent from clients to videotape and to
archive the tapes for future research. Because an extensive
library of videotapes has accumulated (over 600 couples
sessions), therapists who had done at least one couple
therapy session in the clinic from September 1992 to April
1994 were contacted by letter asking whether they used
enactments (see Appendix A). The letter also listed the case
number and dates of all of the couple cases they had seen
since September, 1992 and asked them to mark any case they
thought included enactments. Finally, the letter asked for
consent to use tapes of their work in this study. All
therapists agreed to allow tapes of their work to be used in
this study.

46
Out of the 18 therapists who had seen at least one
couple case, 10 indicated that they had done at least one
enactment. All of the tapes of each case in which the
therapists indicated they may have performed an enactment
(approximately 240 sessions) were reviewed by undergraduate
research assistants who had been instructed and trained on
how to recognize enactments in therapy. Out of the 240
sessions, a total of 117 enactments were identified. There
was a mean of 21.3 enactments per therapist with a range from
1 to 38 enactments (SD = 12.31). The 117 enactments came
from 41 cases with an average of 7.5 cases per therapist and
a range of 1 to 14 (SD = 4.13). There were approximately
twenty percent more enactments in the data base but the sound
on the videotapes was so poor that these enactments could not
be used.
Enactments varied in lengths. Of the 117 enactments
identified, the shortest enactment was two minutes long and
the longest enactment was 58 minutes. The average length was
19 minutes.

Criteria for Inclusion in Final Sample


There were several criteria used as guidelines to select
the final sample of 36 enactments from the list of 117
enactments. These included sound quality, length, session
number, experience level of therapist, gender of therapist,
and enactment per case.

47
Sound quality. The transcribers must have been able to
transcribe over ninety-five percent of the audio on the tape
in order for it to be included. This eliminated
approximately 10 enactments.
Length. Enactments were chosen based on how close they
were to 19 minutes in length (the average time of the
original 117 enactments). If more than one enactment was
equally close to 19 minutes, one was chosen randomly.
Originally the enactments had to be at least ten minutes
long. However, because final beginning and ending coding
reduced times, and because of the difficulty in obtaining
enactments that fulfilled all of the criteria, the shortest
enactment in the sample ended up being seven minutes.
Session. Because of the often unique nature of the
first session in therapy, enactments done in the first
session were not included in the final sample. Additionally,
if more than one enactment occurred in a session, the
enactment closest to 19 minutes in length was chosen, and the
other enactment was not included.
Experience of therapist. Enactments were chosen to
represent a balance of therapists who were both experienced
and inexperienced. To be counted as experienced, a therapist
must have had at least one full year of experience doing
therapy. One therapist had one case from her first year of
doing therapy and a second case from her second year of doing
therapy. The enactments from the first case were counted as

48
having had an inexperienced therapist, and the enactments
from the second case were counted as having had an
experienced therapist.
Gender of therapist. Enactments were chosen to
represent a balance of male and female therapists.
Additionally, it was attempted to balance gender of therapist
with experience level of therapist so there would equal
numbers of male and female experienced therapists.
Enactments per case. As much as possible, at least
three enactments per case and two cases per therapist where
chosen.
The above decision criteria guidelines produced data
from eight therapists, four female and four male. Four of
the enactments were done by inexperienced male therapists,
and six were done by inexperienced female therapists. Over
all, 18 were done by female and 18 were done by male
therapists for total of 36 enactments. A summary of the
final sample is contained in Table 3.1

Demographic Characteristics
After the sample of enactments was chosen, additional
information on the sample was obtained from client intake
forms. A summary of this information is contained in Table
3.2. Information included the session number of each
enactment, the age of the couple, number of years married or

49
Table 3 . 1 : F i n a l sample.

Therapist Gender Case Experienced Enactments


1 Female 1 Yes 3
1 Female 2 Yes 3
2 Female 1 No 3
2 Female 2 Yes 3
3 Female 1 Yes 3
4 Female 1 No 3
1 Male 1 Yes 3
1 Male 2 Yes 3
2 Male 1 Yes 3
2 Male 2 Yes 3
2 Male 3 Yes 2
3 Male 1 No 1
3 Male 2 No 1
4 Male 1 No 2

50
Table 3.2: Demographic characteristics.

Variable n Mean SD Range

Number of Sessions 36 7.56 5.06 18.00


Age
Woman 14 33.36 10.04 38.00
Man 14 35.86 9.38 38.00

Years Married 13 11.15 9.45 29.60

Number of Children 14 2.07 1.39 5.00

n Percent
Marital Status
Married 8 57
Remarried 5 36
Separated 1 7
Not Married 0 0

Education Level Woman


Some High School 5 39
High School/GED 4 31
Some College 3 23
College 1 8
Education Level Man
Grade School 1 8
Some High School 4 33
High School/GED 4 33
Some College 1 8
College 1 8
Masters 1 8

Ethnicity of Woman
African American 2 17
European American 11 79
Native American 1 7

Ethnicity of Man
African American 2 17
European American 12 86

Reason for Therapy


Marital Problems 12 86
Depression 1 7
Job Stress 1 7

51
together, religious affiliation, ethnicity, number of
children, and the reason the couple came in for therapy.

Measures
The Global Rapid Couples Interaction Scoring System
(RCISS) speaker codes were used to measure the dependent
variables (couple behaviors), and the Therapist Interaction
Scoring System (TISS) was used to measure independent
variables (therapist behaviors). Given the focus of the
analysis on strength of association, the designation of
independent and dependent variables was somewhat arbitrary
and was mainly based on the systemic assumption that
therapist behaviors influence couple interaction.

Coding Procedures
Each enactment segment was transcribed by research
assistants trained for this project. Talk turns were
identified on the transcript by starting a new paragraph.
Any verbal interruptions of a speaker marked the beginning of
a new talk turn. In order to assure talk turn accuracy, the
transcription was checked with the video tape by two
different research assistants sequentially. The changes of
the first checker were made to the transcript before the
second person began checking.
The coders used the transcript and the videotape
together for coding. The coders watched the enactment all

52
the way through on the videotape in order to become familiar
with the couple and therapist. They then started to code
from the first talk turn of the enactment and coded through
until the end of the enactment. The coders marked the codes
directly on the transcription next to each talk turn on a
line provided for the codes.
The transcription started approximately ten minutes
before the beginning of the enactment and ended approximately
ten minutes after the enactment ended. The beginnings and
endings of 35 of the 36 enactment were coded by a coder and a
checker (the author) independently. If the coded beginnings
and endings of the coder and the checker were within five
talk turns it counted as an agree. If the coder and the
checker were off more than five talk turns, it was counted as
a disagree. Out of 35 enactments that were independently
coded there was agreement on 31 beginnings and 31 endings.
This means that 89 percent of the beginnings and endings were
accurately coded. In cases where there was disagreement on
the beginnings and endings, only the segments of talk turns
independently agreed upon by both the coder and the checker
as actually being an enactment were used in the study.

Global Rapid Couples Interaction Scoring


System rRCISS)
The RCISS was developed in 1985 to speed up the process
of coding, to measure all aspects of both speaker and

53
listener behavior that have discriminated happy and unhappy
couples, and to reduce the economic costs of coding (Krokoff,
Gottman, & Hass, 1989). The RCISS is based on the Couples
Interaction Scoring System (CISS) (Gottman, 1979). The two
major changes between the CISS and the RCISS are that the
RCISS uses the talk turn instead of the thought unit as the
basic coding unit, and the RCISS uses a "detection system" of
coding (Gottman, 1985). In a detection system of coding all
codes that apply are checked, and the system of codes does
not need to be exhaustive or mutually exclusive (Gottman,
1985).
The eight RCISS negative codes are: complain, criticize,
negative relationship and issue problem talk, yes-but,
defensive (protect self), put down, escalate negative affect,
and other negative. The five positive RCISS codes are:
neutral or positive problem description, task-oriented
relationship information, assent (agreement), humor/laugh,
and other positive.
The RCISS codes have been found to be a valid correlates
of marital satisfaction across social classes (Krokoff et
al., 1989). They have been found to discriminate
dissatisfied from satisfied married couples and they
correlate well with the affect codes of the couple's
interaction at home (using the Couples Interaction Scoring
System [CISS]) and with positive and negative affect
reciprocity (Gottman, 1993, 1994; Krokoff et al., 1989).

54
The RCISS focuses on both verbal and nonverbal
communication. The listener codes require a clear view of
facial expressions. Because of the quality of the videotape
data, the listener codes were not used in this study. The
only codes that were used were the speaker codes. The RCISS
speaker codes alone have been used to classify couples into
what Gottman (1994) calls regulated and nonregulated groups.
These classifications were significantly related to the
likelihood of divorce, the consideration of divorce, physical
health, and marital satisfaction (Gottman, 1994).
Training. The coders were undergraduate and graduate
research assistants who were trained by the author. The
author and the coders together coded practice segments of
enactments that were not used in the study in order to train
the coders. It took approximately 6 months to train the
coders. Once there was agreement on the RCISS between the
coding of the trainer and a coder of .70 using Cohen's kappa
(1960), the coder was considered trained.
Reliability for the RCISS. Three coders coded the RCISS
(each coding different enactments). The author served as the
check coder. Reliability for the RCISS was determined by
randomly coding 4 consecutive pages from the transcript of
each enactment.
Cohen's kappa (1960) for all codes in the double coded
sections were then calculated. At the level of the 13
individual RCISS codes, after 5 months of training,

55
reliability was not established. To test the reliability of
the RCISS coding at the level of primary constructs of
positive and negative interaction, the codes were collapsed
using two different methods. The first was to collapse the
codes into one code that was either positive or negative.
Using this method, every talk turn that included one or more
negative codes was collapsed to being negative regardless of
the number of positive codes which may have been marked for
that talk turn. Talk turns which included only positive
codes were collapsed to be positive. Using this system of
collapsing the RCISS, the kappa for the sample was .67. Four
of the enactments with the lowest inter-rater agreement were
receded by the coder (but not the checker). With these four
recoded, the final sample kappa was .68.
The second method of collapsing the RCISS was used by
Gottman (1994). Each positive code received a value of 1 and
every negative code received a value of -1. These values
were summed to create a single number potentially ranging
from -8 if all negative codes and no positive codes were
checked, to 5 if all positive codes and no negative codes
were checked. Using this method Krokoff et al. (1989), in
the first publication on the RCISS, found a Pearson product-
moment correlation coefficient of .62 between raters. This
same test applied to the RCISS codes from this study resulted
in a Pearson product-moment correlation of .71.

56
Creation of couple variables from the RCISS. Each
variable consisted of a behavior or a set of behaviors that
occurred through time. As a general rule, each enactment was
a different length and contained a different number of talk
turns. Consequently, simply looking at the frequency of a
specific behavior as the sum of the occurrences of the code
for that behavior was inadequate. Instead, the frequency of
behaviors must be studied in relation to time or talk turn.
In this study, this was done in by dividing the code by a
relevant talk turn denominator. To create the variable
positive wife talk, positive wife scores to the husband or to
both (i.e., not including talk to therapist only) for each
case were divided by the number of talk turns in which the
wife talk to the husband and to both (but not to therapist
only) for each case. This system of division kept wife
positive from being distorted by length of enactment,
frequency of wife talk, and direction of wife talk. Negative
wife talk was created by taking the negative wife scores to
husband and to both (but not to therapist only) for each case
and dividing them by the number of wife talk to husband and
to both (but not to therapist only) talk turns for each case.
The variables positive husband talk and negative husband talk
were created in a similar manner. The variable positive
couple talk was created by taking the positive wife scores to
husband and both (but not to the therapist only), and adding
them to the positive husband scores to wife and to both (but

57
not to the therapist only), and dividing this couple positive
score by the total number of talk turns of both wife and
husband to each other and to both (but not to the therapist
only). The variable negative couple talk was created in a
similar manner.

The ratio of positive to negative speaker variables for


wife, husband, and total were created using a slightly
different process. These variables were created by dividing
the relevant positives scores (to the other partner and to
both) by the relevant negatives plus the relevant positive
score for each enactment. This strategy was employed in
order to avoid dividing by zero. Because the divisors in
these last three variables consisted of codes rather than
talk turns, these ratio variables are different than the
positive variables for wife, husband, and couples. In all
cases, the scores and talk turns did not involve talk which
went only to the therapist. This was done in order to gain a
more accurate view of the couple' s interaction with each
other.
Checking normality for couple variables. Normality was
examined by calculating the skewness and kurtosis for each of
the main variables. Skewness and kurtosis z scores were
calculated, and an alpha of .01 was used to determine
significance as recommended by Tabachnick and Fidell (1989).
Additionally, as recommended by Tabachnick and Fidell (1989)
variables that were negatively skewed were reflected

58
(recoded) so that all variables were skewed in a positive
direction. Logarithm, square root, and inverse
transformations were then performed on all variables, and the
transformation with the least amount of skewness and kurtosis
as compared to the original variable was chosen. After
transforming those variables for which transformation lowered
the skewness and kurtosis, there was only one variable.
Therapist Support to Wife, that was skewed significantly (z =
3.415, p < .001). No variable had significant kurtosis after
transformation. Table 3.3 lists each variable and the
transformation chosen to maximize the reduction in skewness
and kurtosis.

Therapist Interaction Scoring System (TISS)


The Therapist Interaction Scoring System (TISS) was
developed by the author for use in this project. The TISS is
similar to the RCISS in that it uses the talk turn as the
basic unit of coding and uses a detection system of coding.
The eight codes used in the TISS were developed through
approximately 40 hours of observing tapes of couple
therapysessions and refined during the process of training
coders. The eight codes include: structuring, affect,
support, insight process, directive, teaching, confronting
negatives, and encouraging positives. The final coding
definitions for each code are described below.

59
Table 3.3: List of couple variables and transformations used
to reduce skewness and kurtosis.

Variable Transformation

Wife Positive Inverse


Husband Positive Logarithm
Total Positive Logarithm

Wife Negative Square root


Husband Negative Square root
Total Negative Logarithm

Wife Positive/Negative Logarithm


Husband Positive/Negative Logarithm
Total Positive/Negative Logarithm

60
structuring fSTK A directive or instruction given by
the therapist on the rules or procedures of the enactment are
considered structuring interventions. For example "turn your
chairs toward each" is a structuring statement. Telling them
that during the enactment they are to talk with each other is
a structuring statement. The coding definition consisted of
the following:
Directing or instructing the couple on the rules and
procedures of the enactment. This includes instructing them
on the direction of talk and on reflective listening.
It includes any explicit attempt at controlling who has
the floor or at stopping couple talk.
Examples include interventions such as directing the
couple to move their chairs so that they face each other,
directing verbally or nonverbally the couple to talk with
each other rather than to the therapist, or hand motions that
direct the couple on the rules and procedures of the
enactment (pointing to the other partner when a client talks
to the therapist).
Structuring refers to interventions occurring in the here
and now and does not refer to anything outside the therapy
room.
If the therapist changes the direction of talk and makes a
topic suggestion than it was coded both structuring and
directive.

61
Directive fP). A directive is when the therapist
directs the couple to do anything except obey the basic rule
of the enactment (which is structuring). Directives include
such behaviors as telling a client to talk with a different
voice tone, to express something in a different way, and to
get back on the subject. The definition of directives used
by the coders was:

Directing the couple to do anything but obey the basic


rules of the enactment.
This could include directly instructing a client to talk
with a softer voice, a shorter amount of time, to not say a
certain word etc.
Directives also include prompts (not about the basic rules
of the enactment).
Directives include all topic suggestions. (However, when
the therapist asks a partner to repeat back what the other
partner just said, it should be coded structuring because it
is part of reflective listening; it is not a topic
suggestion.)
Only directives for change in the therapy room should
receive this code (i.e., giving homework is not a directive).
Affect (A). Any reference to emotion in general or
specific feelings is considered a statement about emotion.
The definition used by the coders was:
Asking clients how they feel
Encouraging clients to express feelings

62
• Discussing how emotion influences the couple's
relationship or communication
• Trying to get the clients more in touch with their
feelings

• The therapist must be asking about actual emotions


(regardless of how the clients respond). This code does not
include statements that substitute the word "feel" for
"think" or "sense" (i.e., "Do you feel like [or that]" should
not receive this code).

Support (S). Any statement that demonstrates support


for another person in the room is considered a support
statements. These include statements of praise, affection,
and encouragement. The definition of support used by the
coders was:
A statement that demonstrates support or encouragement for
another person in the room.
Because of the difficulty in being reliable, supportive
statements are generally only those which include blatant
content or affect that encourages, supports, or praises.
Insight Process (IP). Process is simply the way
something happens in session. When the therapist makes a
statement about the way something is being communicated, it
is a process statement. "You are using a harsh voice," "You
two are wondering off the subject," "You are talking in
paragraphs rather than sentences" are all examples of
statements about process.

63
A statement about process within the therapy room (the way
something is happening or is being done).
A statement about how a communication process in their
relationship or within the room influences an individual or
how an individual influences a process in their relationship
or in the room.
A statement about communication process within their
relationship (how they are communicating or interacting).
This does not have to be process occurring in the therapy
room (but may be in he present as well as the past).
Communication process includes any type of pattern, how
they talk, who talks when and in what sequence, and the
topics they use, or avoid, or switch to and from.
Does not include processes in the future.
Teaching (T). Teaching involves instructing or
lecturing the clients. Instructing the couple on what "I"
messages are and when they should be used would be coded as
teaching. Teaching does not include giving the clients
information on the rules and procedures of the enactment
(structuring). It also does not include simply directing the
couple to do something different (a directive), but includes
some type of rational or explanation. The definition of
teaching used by the coders was:

Giving the couple general information and instruction


about marriage and family life, mental health, or a topic
they may be discussing.

64
• Directives and structuring are not teaching.
Providing information other than about process.
• Teaching often falls into a lecture or mini-lecture format
and sometimes comes across "preachy."
Metaphor is not necessarily teaching.
Encouraging positives (EP), Encouraging positives is
any statement that directly encourages or suggests that the
client should say something in a positive or more neutral
manner. This code specifically has to do with how a couple
talks to each other. If the therapist were to say "tell each
other what you like about each other," this would not be
coded encouraging positives because there is no mention of
how it is to be said. If a therapist were to say "I would
like you to use a kind, gentle voice," it would be coded as
encouraging positives. Other examples include "Say that
again in a more positive way," and "I like how tenderly you
are talking to each other, keep going." The definition used
by the coders was:
A statement that directly encourages or suggests that the
client should say something in a positive or neutral manner.
(Note: the client does not have to follow through on the
suggestion in order to use this code.)
Confronting negatives (CN). Confronting negatives was
calling attention to negative exchanges. This may include
pointing them out with a process statement or directing them
to not use them. For example, after a negative statement,

65
the therapist could confront it by using the following
process statement "That was a jab." The therapist could also
confront it through using a directive: "Say it again without
the jab." The definition used by the coder was:
Calling attention to a negative client statement by
labeling it, questioning it, or in some other way confronting
it. There must be a negative referent somewhere in the
preceding client dialogue to use this code.
Reliability of the TISS. For the TISS, the entire
enactment was coded by the TISS coder and the checker. The
author served as the check coder. Reliability analysis was
done on each of the 8 codes in the TISS. The results are in
Table 3.4.
The first four codes listed in Table 3.4 (Structuring,
Directives, Affect, Support) had adequate levels of
reliability, using a Cohen's kappa of .70 as the cut-off.
These four types of therapist interventions were included in
the analyses. A fifth variable composed of all other
therapist talk turns was created. This variable, named Other
Interventions, was calculated by collapsing Insight Process,
Teaching, Confront Negatives, Encourage Positives, and all
therapist talk turns that did not receive a code. Therapist
talk turns that did not receive a code were ones in which the
therapist talked, but the intervention could not be coded as
one of the eight codes in the TISS. The kappa for the Other
Intervention code was .78.

66
Table 3.4: Reliability of the original TISS codes

Code Kappa n

Structuring .74 410


Directives .70 302
Affect .88 339
Support .80 91
Insight Process .55 170
Teaching .36 10
Encourage Positives .67 5
Confront Negatives .00 3

Total Therapist Talk Turns 1589

67
The main reason three of the codes did not reach
reliability was low base rate. Although encouraging
positives had a kappa of .67, it was not used in the analysis
because out of 1589 talk turns coded by both a coder and the
checker, the code was only used 6 times. A similar problem
occurred with confronting negatives and with teaching.
Insight process was not reliable for other reasons.
Defining and recognizing process was very difficult. Toward
the end of the coding process, as the coder and checker
refined the definition and developed better decision making
rules, the reliability of this code went up. Consequently,
it is believed that this code could be reliably coded in
future research.
Creation of therapist variables from the TISS. As is
true for the RCISS, each variable consisted of a behavior or
a set of behaviors that occur through time. Each enactment
was a different length and contained a different number of
talk turns. Consequently, simply looking at the frequency of
a specific behavior as the sum of the occurrences of the code
for that behavior was inadequate. Instead, the frequency of
behaviors must be studied in relation to time or talk turn.
For the TISS, to create the to wife intervention variables,
the total number of each TISS code directed to the wife
(only) in each enactment was divided by the total number of
wife talk turns to the husband and to both (but not to
therapist only) in each enactment. To create the to husband

68
intervention variables, the total number of each code to the
husband (only) in each enactment was divided by the total
number of husband talk turns to the wife and to both (but not
to the therapist only) in each enactment. To create the
couple intervention variables, the total number of each code
(which included to wife, to husband, and to both) in each
enactment was divided by the total number of husband and wife
talk turns that were made to each other and to both (but not
to the therapist only) in each enactment.
Checking normality of therapist intervention variables.
Normality was examined for the therapist intervention
variables in the same way it was done with the couple
variables. Skewness and kurtosis for each of the variables
was calculated and compared with skewness and kurtosis z.
scores. Logarithm, square root, and inverse transformations
were then performed on all variables and the transformation
with the least amount of skewness and kurtosis as compared to
the original variable was chosen. After transforming those
variables for which transformation lowered the skewness and
kurtosis, all variables were within limits for skewness and
kurtosis. Table 3.5 lists each therapist intervention
variable and the transformation chosen to minimize skewness
and kurtosis.
Checking for multicollinearity and singularity of
therapist intervention variables. Bivariate
multicollinearity and singularity were checked by examining

69
Table 3.5: List of therapist intervention variables and
transformations used to reduce skewness and kurtosis.

Therapist Variable Trans formation

Structuring
To wife Square root
To husband Square root
Total Square root
Directives
To wife Square root
To husband Square root
Total Square root
Support
To wife Square root
To husband Square root
Total Square root
Affect
To wife Square root
To husband None
Total Logarithm
Other
To wife Square root
To husband Square root
Total Square root
Alignment None

70
correlations among the variables. As recommended by
Tabachnick and Fidell (1989), those variables with
correlations .90 or higher were considered too highly
correlated for use together in analysis (Tabachnick & Fidell,
1989). All therapist intervention variables were correlated
at levels lower than .90.
Table 3.6 contains correlations of the therapist
intervention variables by client gender. The lower left part
of the table contains correlations among the therapist
interventions directed to wives. The upper right hand
section of the table contains correlations among the
therapist interventions directed to husbands. The
correlations between interventions of the same type made to
wives and husbands are on the diagonal. The correlation
matrix indicates that, although many of the variables are
significantly correlated, none are correlated highly enough
to be concerned with multicollinearity and singularity.

Direction of Talk
Four codes were developed to assess direction of talk.
The codes are discussed here.
Talking to both. When the therapist talks to both the
man and the women within a talk turn, this code is used.
Additionally, when the a member of the couple talks to both
the therapist and the other member of the couple, it also
receives this code.

71
Table 3.6: TISS correlations by gender.

Correlations by Gender

HTST HTD HTS HTA HTO ALIGN


WTST .21 .72' .59*** .53 *** .26 -.31 HTST
WTD 75^ .60*** .47** .75*** .18 -.13 HTD
WTS 15 .14 .45** .29 .08 -.15 HTS
WTA .43^ .55***-.10 .34* .30 -.05 HTA

WTO .48*** .48*** .23 .46** .44** -.28 HTO

ALIGN .55*** .44** .07 .40' .57*** 1.00 ALIGN

WTST WTD WTS WTA WTO ALIGN

Two-tailed significance: *p<0.05 **p<.0.01 ***p<.001

WTST = Wife total structuring


WTD = Wife total directives
WTS = Wife total support
WTA = Wife total affect
WTO = Wife total other

HTST = Husband total structuring


HTD = Husband total directives
HTS = Husband total support
HTA = Husband total affect
HTO = Husband total other

ALIGN = Alignment

72
Talking to woman. If the therapist or the man only
talks to the woman during a talk turn, this code is used.
Talking to man. If the therapist or woman only talks to
the man during a talk turn, this code is used.
Talking to Therapist. If either member of the couple
talks to the therapist only, this code is used.
Reliability of direction of talk. The reliability of
the direction of talk codes was also assessed using Cohen's
kappa. For the RCISS talk turns, the kappa for the direction
of talk was .85, and for the TISS talk turns the kappa for
the direction of talk was .83.
Creation of alignment from the direction of talk codes.
The variable alignment was created from the therapist
direction of talk codes. This variable was created by taking
the number of therapist talk turns to the woman and dividing
it by the number of therapist talk turns to the man plus the
number of therapist talk turns to the woman. Adding
therapist talk turns to the woman to the denominator was done
to avoid dividing by zero. There was no significant skewness
and kurtosis on the variable alignment.
The process of identifying the enactments, transcribing
the videotape segments for training and for the sample,
training the coders, and coding the sample took approximately
2400 hours. The work was primarily done by undergraduate
research assistants working under the direction of the
author. Research assistants received either class credit or

73
pay (approximately $1800 was paid out for transcription and
coding) for their work. Identification of the sample
required approximately 400 hours, transcription took
approximately 1000 hours, and training coders and coding the
sample took approximately 1000 hours.

74
CHAPTER IV
RESULTS

General Description of Codes


There were a total of 5591 talk turns in the sample,
each of which was coded. Out of those talk turns, 4002 talk
turns were made by members of the couple (1959 wives, 2043
husbands), and 1589 were made by therapists. Therapists
talked to the wife in 47 9 talk turns, to the husband in 617
talk turns and to both the wife and husband 493 talk turns.
See Table 4.1 for a more complete summary of therapist
interventions, and Table 4.2 for a summary of client positive
and negative interaction (RCISS) codes.
For descriptive purposes, the therapist interventions
made by each of the eight therapists are summarized in Table
4.3. It is noted that the range of differences between
therapists was small.

Preliminary Analyses
A series of analysis were done in order to check if
there were any unexpected relations between (a) any of the
independent and dependent variables and (b) client
characteristics, therapist characteristics, and session
characteristics.

75
Table 4.1: Summary of therapist interventions.

Variable
n=36 M SD Frequency

Structuring
To Wife 2.36 2. 23 85
To Husband 4.36 4. 60 157
To Both 4.67 3.,25 168
Total 11.39 7.,68 410

Directives
To Wife 2.53 3..23 91
To Husband 3.92 4..13 141
To Both 1.94 1..45 70
Total 8.39 6..86 302

Support
To Wife 0.39 0..84 14
To Husband 0.97 1..56 35
To Both 1.17 1..44 42
Total 2.53 3..08 91

Affect
To Wife 2.44 3,.24 88
To Husband 3.78 3 .67 136
To Both 3.19 2 .62 115
Total 9.42 7 .71 339

Other
To Wife 8.22 9 .36 296
To Husband 8.69 8 .30 313
To Both 6.36 6 .48 229
Total 23.28 21 .20 838

76
Table 4.2: List of RCISS values by wife, husband, both, and
total. ^ ' ' '

Variable Positives Negatives 1


Talk Turns
n=36 Freq. M SD Total M SD

Wife
To Husb 994 27.6 19.3 666 18.5 25.9 1281
To Both 513 14.3 14.8 216 6.0 10.7 521
To Ther 162 4.5 5.4 17 0.5 1.3 157
Total 1669 46.4 31.7 899 25 35.2 1959
Husband
To Wife 1023 28.4 17.8 544 15.4 22.4 1293
To Both 588 16.3 15.0 158 4.4 7.1 553
To Ther 167 4.6 7.8 73 2.0 4.7 197
Total 1778 49.4 28.5 785 21.8 30.3 2043
Total
To Spouse 2017 56.0 35.7 1220 33.9 46.7 2574
To Ther 329 9.1 1.9 90 2.5 5.6 1074
To Both 1101 30.6 26.6 374 10.4 16.1 354
Total 3447 95.8 56.5 1684 46.8 63.2 4002

77
Table 4.3: Mean differences on variables by therapist.

Therapist: 1 2 3 4 5 6 7 8
n = 6 6 8 3 3 2 6 2 Range

Wife Struct .03 .02 .02 .01 .06 .06 .03 .00 .06
Hus Struct .06 .03 .01 .07 .03 .13 .06 .04 .12
Total Struct .13 .09 .05 .09 .15 .29 .16 .23 .24
Wife Direct .04 .01 .02 .01 .11 .03 .04 .00 .11
Hus Direct .06 .03 .01 .05 .10 .10 .06 .03 .09
Total Direct .11 .05 .05 .07 .25 .16 .13 .08 .20
Wife Support .00 .00 .00 .00 .00 .00 .01 .00 .01
Hus Support .02 .01 .00 .01 .00 .01 .02 .01 .02
Total Support .02 .02 .01 .02 .01 .03 .06 .06 .05
Wife Affect .07 .01 .02 .01 .07 .01 .01 .00 .07
Hus Affect .05 .03 .01 .03 .08 .10 .04 .03 .09
Total Affect .16 .06 .05 .06 .18 .15 .09 .12 .13
wife Other .10 .02 .07 .06 .10 .11 .06 .04 .09
Hus Other .08 .04 .06 .14 .05 .10 .09 .10 .10
Total Other .23 .10 .19 .24 .27 .24 .20 .22 .17

78
Client Variables

Analyses were done with the client characteristics of age,


years married, marital status, ethnicity, and number of
children. For each of these analyses, the client
characteristic variable was recoded into a categorical
variable. Dependent on the number of categories, a one-way
analysis of variance or t-test was used to test for the
statistical significance of the mean differences.
As expected, the nine RCISS variables were not
significantly different on any of the client demographic
variables. There were some statistically significant
differences on the six TISS variables. Table 4.4 contains a
summary of these differences. There was no difference
between ethnicity on any of the TISS variables.
Additionally, there were no significant difference between
Age of wife and any of the TISS variables. Age of husband
was significantly different on two variables. Therapists
made more support and structuring interventions with older
husbands. Marital status was related to wife affect, total
affect, wife other and total other interventions. In
general, the more children a couple had, the more often
therapists used affect and other interventions.

These differences are interesting. However, since only


eight of the differences were statistically significant, it

79
Table 4.4: TISS codes that differed significantly by client
characteristics.

M SD M SD t

Age of Husband

Younger Older
(n=19) (n=17)

Hus Struct .19 .15 .32 .17 -2.47(34)

Hus Support .05 .09 .14 .13 -2.34(34)*

Marital status

M SD M SD M SD
Married Remarried Separated
(n=23) (n=ll) (n=2)

Hus Affect .06 .05 .13 .08 .08 .11 5.08*

Total Struct .30 .13 .40 .11 .54 .13 4.77*

Number of children

M SD M SD M SD F

No children 1 child 2-5 children


(n=3) (n=14) (n=19)

Wife Affect .00 .00 .10 .10 .25 .16 8.,38***


Total Affect .01 .01 .03 .02 .06 .03 7,.32**

Wife Other .29 .25 .26 .16 .44 .18 4..30*


Total Other .27 .24 .37 .13 .55 .16 7..65**

*p<.05 **p<.01 ***E<.001

80
was decided that these variables did not need to be
controlled for in the tests of the hypothesis.

Therapist Characteristics
There was only one significant relationship between the
RCISS variables and the therapist characteristics of
experience level and gender. The wives of inexperienced
therapists used more positives than did the wives of
experienced therapists.
Table 4.5 contains a summary of the nine statistically
significant relationships between the TISS variables and
therapist characteristics. Inexperienced therapists used
more affect interventions with couples than did experienced
therapist. There were no differences in interventions to
husbands between male and female therapists. To wives,
female therapists used more support and affect interventions.
These differences are interesting. However, since only
four of the r's were significant, it was decided that these
variables did not need to be controlled for in the tests of
the hypothesis.

Session Characteristics
The only session variable was the number of sessions
between the beginning of therapy and the session included in
this study. There was no relationship between the RCISS
variables and the session number. A summary of the

81
signification relations between sessions number and TISS
variables is contained in Table 4.5. Number of sessions was
related to the amount of directives therapists gave to
husbands and to the couple. Fewer directives were used in
enactments which were performed in sessions beyond the 10th
session of therapy. Therapists also used more affect
interventions with couples in enactments which occurred in
the first 10 sessions. Finally, other therapist
interventions were also used more often in enactments which
occurred in the first 10 sessions.
As with the difference in client and therapist
characteristics, the differences in session characteristics
are interesting. However, because only five differences were
statistically significant, it was decided that these
characteristics did not need to be controlled for in the
tests of the hypothesis.

Primary Analyses of Hypothesized Relationships


There were three different sets of primary analyses.
The first was a series of regression analyses designed to
test the hypothesized relationships between the therapist
interventions coded by the TISS and the couple interactions
coded by the RCISS. The second set was two MANOVA's designed
to determine differences in therapist interventions comparing
couples who were negative and positive over time. The third

82
Table 4.5: TISS and RCISS codes that differed significantly
by therapist characteristics and session number.

M SD M SD

Therapist Experience Level


Inexperienced Experienced
(n=13) (n=23)
Wife Positive* .77 .18 .64 .13 2.35(34)*
Total Affect** .06 .02 .03 .02 3.04(34)**

Gender of Therapist
Female Male
(n=18) (n=18)
Wife Support** .07 .09 .01 .04 2.75(34)**
Wife Affect*** .25 .15 .09 .13 3.59(34)***

Session Number
Less than 10 Over 10
(n=28) (n=8)

Hus Directive* .25 .19 .10 .10 2.04(34)*


Total Directives* .30 .15 .18 .03 2.05(34)*
Total Affect* .05 .03 .02 .01 2.25(34)*
Wife Other* .39 .19 .22 .16 2.57(34)*
Total Other* .48 .19 .32 .09 2.16(34)*

•^p<.05 **p<.01 ***p<.001

83
was a descriptive analysis of the annotated RCISS point
graphs of each of the 36 enactments.

Regression

In order to measure the strength of the hypothesized


association between the therapist behaviors and the couple
interaction codes, stepwise multiple regression was used.
The stepwise procedure was chosen so that variables that have
the strongest correlations in the presence of the other TISS
variables would be entered into the equation first, and those
that are not significantly correlated in the presence of the
entered variable(s) would left out. With 36 enactments or
cases and six independent variables, there were 6 cases per
variable.
Regression setup. Nine multiple regressions were
performed. For each of these, the independent variables were
the therapist intervention variables (structuring,
directives, support, affect, other, and alignment). Each of
the nine regressions had different dependent variables.
There were three sets of three parallel regressions. The
first set of three consisted of a regression with therapist
interventions to wife and wife positive speech, therapist
interventions to husband and husband positive speech, and
total therapist interventions and total positive couple
speech. The second set consisted of therapist interventions
to wife regressed with wife negative speech, therapist

84
interventions to husbands with negative husband speech, and
total therapist interventions being regressed with total
couple talk turns. The third set of regressions consisted of
a regression with the therapist interventions to wife and the
ratio of wife positive to wife negative speech (plus wife
positive speech to avoid dividing by zero), a regression with
therapist interventions to husband and husband positive
speech over husband negative speech (plus husband positive
speech), and a regression with total therapist interventions
with positive couple speech divided by negative couple speech
(plus positive couple speech).
It may be worthwhile to note that because coders could
check as many positive and negative codes as were relevant
within each talk turn, positive and negative codes are
theoretically and empirically independent of each other
(Gottman, 1994). It is also important to remember that each
of the therapist interventions was divided by the total
number of relevant client talk turns to the other partner
(e.g., for therapist interventions to wife, wife total talk
turns to husband were used). Additionally in the first six
regressions, each of the wife, husband, or couple RCISS
scores where divided by the relevant number of talk turns for
each speaker (e.g., wife positives were divided by the total
number of wife talk turns to the husband). In the last three
regressions, the positive RCISS scores were divided by
negative RCISS scores plus the positive RCISS scores (to

85
avoid dividing by zero). This resulted in the positive
scores being divided by the total scores (not talk turns) to
the other partner (or between both of them, when the couple
scores were used), in other words, all nine of the
regressions used different dependent variables (the RCISS
variables used in the first six variables were divided by
talk turns, the last three were divided by RCISS scores). In
all cases, the scores and talk turns did not involve talk
which went only to the therapist. This was done in order to
gain a more accurate view of the couple's interaction with
themselves.

Hypotheses regarding regressions. In each case, it was


hypothesized that the therapist interventions would be
related to the outcome of couple interaction. No specific
hypotheses were made as to which particular interventions
would predict which particular outcome. Results are
considered in terms of the hypotheses.
Regression results. Although the relations were not as
strong as expected, there were several statistically
significant results. Seven of the nine regressions had a
therapist intervention enter into the equation. However, no
regression had more than one variable entered. Table 4.6
contains a summary of the results.
Positive. Therapists' use of structuring was positively
related to wife speaker codes (adjR2=.13). Therapists' use of
directives to husband was positively associated with husband

86
Table 4.6 Summary of stepwise regression results.

n=36 B SE B MultR adjR2 F p<

Positive Wife
Wife Structuring 41 .16 .40 .13 6.33 .017
Positive Husband
Hus Directives 22 .07 .45 .18 8.73 .006
Positive Total
Total Directives 38 .09 .59 .33 18.37 .001

Negative Wife
No variables entered
Negative Husband
Affect -1.60 .78 .33 .08 4.22 .048

Negative Total
Directives -.29 .11 .40 .13 6.39 .016

Positive/Negative Wife
No variables entered
Positive/Negative Husband
.09 4.42 .043
Affect '43 .21 .34
Positive Total/Negative Total
Total Directives .26 .09 .45 .18 8.62 .006

The prediction variables in each equation were: structuring,


directives, affect, support, other, and alignment.
No more than one variable entered in each equation.

87
positive speech (adjR2=.i8), and therapist use of directive to
the couple was positively associated with couple positive
speech (adjR2=.33). No other interventions significantly
added to the predictive ability of the first variables
entered into the equations. Consequently, the hypotheses as
to therapist interventions increasing positive interactions
were only partially supported.
Negative. The two of the three regression analyses
between negative speaker codes and therapist interventions
showed significant relations. Use of affect interventions
with husbands was negatively related to husband negative
speech (adjR2=.08). In other words, during enactments in
which therapists use more affect interventions, husbands were
less likely to use negative speech. Additionally, therapist
use of directives with the couple was negatively related to
the couple's negative speech (adjR2=.13). No other variable
was significantly related to negative speech. Thus, the
hypotheses regarding the relationship between negative speech
and therapist interventions were only partially supported.
Positive-negative ratio. There were also significant
associations between two of the three ratio of positive to
negative RCISS speaker scores and therapist interventions.
Therapist use of affect interventions to husbands was
positively related to the ratio of husband RCISS speaker
scores (adjR2=.09). Consequently, the more often therapists
used affective interventions, the more likely the ratio of

88
husband positive-negative speaker scores was to be positive.
Additionally, total therapist directives were positively
related to the total ratio of RCISS speaker codes (adjR2=.18).
In other words, the more therapists used directive
interventions, the more positive the couple's ratio of
positive-negative RCISS scores. Thus, the hypothesized
relationships between therapist interventions and the ratio
of positive and negative RCISS scores were only partially
supported.
Summary of regression results. The stepwise regression
analyses revealed a significant positive association between
therapist directives to husbands and husband positive speech,
and between directives to couples and couple positive speech.
Therapist directives to couples were also significantly
negatively related to couple negative speech, and positively
related to the ratio of positive to negative couple talk.
Therapist structuring to wives was significantly positively
related to wife positive speech. However, negative wife
speech and the ratio of positive to negative wife talk turns
were not significantly related to any of the therapist
intervention variables. Therapist use of affect with
husbands was significantly negatively related to husband
negative talk and significantly positively related to the
ratio of positive to negative husband speech.

89
Multivariate Analysis of Variance

A second way of examining the data, that partially


addressed the issue of change over time, was to compare the
couple interaction patterns that become accumulatively
positive over time with couple interaction patterns that
become accumulatively negative over time. In other words, by
comparing these two groups of enactments, differences in the
use of therapist interventions may be discovered.
Gottman (1994) outlines a method of adding the RCISS
values from each talk turn to the sum of all previous talk
turns to create a cumulative RCISS score. These cumulative
scores, when graphed, form the point graphs found in appendix
A. The point graphs provide a visual and numerical
representation of the positive and negative trends of the
couple over time. A separate multivariate analysis of
variance (MANOVA) was performed for each of two different
enactment classification schemes: individual and couple.
Individual classification system. Gottman (1994) used
the slopes of the point graph lines to categorize couples
into two groups which he called regulated and unregulated
couples. Regulated couples were couples where the slopes of
the cumulative RCISS lines were significantly positive for
both the husband and the wife. If the slope of the
cumulative RCISS line was not positive for either member of
the couple, the couple was classified as unregulated.

90
Unregulated couples have been shown to be significantly more
likely to divorce, to consider divorce, to have poor physical
health, and to have low marital satisfaction (Gottman, 1994).
The slopes of the cumulative RCISS lines were determined
by using linear regression analysis both in Gottman's study
and in this study. Gottman classified couples based on one
15 minute observation. In this study, the classification was
done on the basis of interaction during the whole enactment.
The individual classification system was essentially the
same system used by Gottman (1994). Talk turns in which a
member of the couple talked only to the therapist were
excluded from the regressions that determined slope in order
to have the slope represent only the interaction between the
partners. Additionally, the slopes for the cumulative RCISS
point graph line for the wife and husband were calculated
separately. If there was a slope that was not significantly
positive for either member of the couple, the couple was
classified as unregulated or not positive. The results of
this classification system can be seen in Table 4.7. As can
be seen, slopes range from -1.46 to 1.42 for wife speech and
from -1.11 to 1.78 for the husband speech. The standard
error of B indicates the amount of variation around the
regression lines.
The first one-way MANOVA was done with the individual
classification system, which was most like that used by

91
Table 4.7: Classifications and RCISS cumulative point graph
slopes for wife, husband, and combined by enactment number.

Individual Method Couple Method


Enact.# Wife* Husband* Classified Combined Classified

1 -0.49 -0.33 Not Positive -0.39 Not Positive


2 0.96 0.83 Positive 0.95 Positive
3 1.18 0.77 Positive 0.98 Positive
4 0.99 1.08 Positive 1.04 Positive
5 1.09 1.11 Positive 1.09 Positive
6 0.46 0.75 Positive 0.61 Positive
7 0.25 0.97 Positive 0.65 Positive
8 0.00 0.05 Not Positive 0.00 Not Positive
9 0.77 -0.16 Not Positive 0.27 Positive
10 -1.01 -0.99 Not Positive -0.94 Not Positive
11 0.85 0.21 Positive 0.51 Positive
12 0.71 -0.10 Not Positive 0.44 Positive
13 1.10 0.88 Positive 0.98 Positive
14 0.87 0.70 Positive 0.82 Positive
15 0.24 1.05 Positive 0.73 Positive
16 1.22 1.18 Positive 1.19 Positive
17 -1.11 0.24 Not Positive -0.37 Not Positive
18 0.88 0.93 Positive 0.91 Positive
19 -0.21 0.10 Not Positive -0.04 Not Positive
20 -0.74 -0.61 Not Positive -0.68 Not Positive
21 1.40 1.26 Positive 1.30 Positive
22 1.21 1.32 Positive 1.24 Positive
23 1.42 1.27 Positive 1.34 Positive
24 1.30 1.07 Positive 1.20 Positive
25 1.22 1.33 Positive 1.16 Positive
26 0.65 0.61 Positive 0.70 Positive
27 -1.46 -1.11 Not Positive -0.74 Not Positive
28 0.95 0.90 Positive 0.93 Positive
29 -1.06 -0.29 Not Positive -0.58 Not Positive
30 1.14 1.07 Positive 1.10 Positive
31 -0.51 -0.88 Not Positive -0.66 Not Positive
32 1.01 1.04 Positive 1.01 Positive
33 0.80 0.65 Positive 0.72 Positive
34 -0.47 1.08 Not Positive 0.45 Positive
35 1.05 1.06 Positive 1.06 Positive
36 -1.18 1.78 Not Positive 0.21 Positive

Does not include talk to therapist only.

92
Gottman in defining regulated and unregulated couples. The
one-way MANOVA using this system did not find significant
differences on the latent canonical variable (F(6,29) = .97,
p = .464) nor any of the individual variables. Table 4.8
lists the univariate results.
Couple classification system. Because this study
involves a three person interaction, a second classification
system was also used. The second classification system was a
variation of that used by Gottman. Because therapists are
intervening in and responding to the interaction between the
couple, and also the interaction between each member of the
couple and the therapist (in other words the therapist was
working with the couple as a whole and not just two
individuals), it was decided to classify the enactments based
on the slope of the total RCISS line. The slope of the total
RCISS line involves both the husband and the wife together
(and their interaction with the therapist). Using linear
regression analysis, this system yielded 27 positive, or
regulated enactments, and 9 non-positive, or unregulated
enactments. The slopes for each of the 36 regressions are in
Table 4.7 . The slope of the couple line ranged from -2.98
to 6.07. As compared with the individual classification
system, the couple system classified 4 additional couples as
being positive (or regulated).
The MANOVA indicated that the latent variable underlying
the six therapist intervention variables was different for

93
Table 4.8: Univariate analysis of variance of difference
between regulated and unregulated enactments on therapist
interventions using the individual classification system.

Variable Regulated Unregulated


n = 36 M SD M SD F(6,28) B

Structuring .35 .13 .30 .14 2.39 .131

Directives .32 .14 .23 .17 3.28 .079

Support .12 .11 .13 .15 0.03 .861

Affect .05 .03 .03 .02 2.56 .119

Other .49 .20 .41 .15 1.69 .203

Alignment .44 .24 .38 .26 0.52 .478

94
regulated and unregulated couples (Wilks F(6,29) = 3.05, p =
.020). Cochran's test for homogeneity of variance showed
differences on directives C(17,2) = .82,p = .003, and affect
C((17,2) = .5., p = .001. Consequently, results should be
interpreted with caution.
The univariate F-tests indicated differences in the
means of structuring (F = 12.49, p < .001), directives (F
=13.60, p < .001), support (F =5.33, p < .027) (see Table
4.2). and affect (F = 4.11, p < .051). Other (F = 2.74, p <
.107) interventions approached significance. In each case,
means for the group with positive scores were higher than the
other group, indicating that therapists engaged in more of
each of these interventions with couples that have combined
positive cumulative RCISS speaker codes. The only variable
that did not approach significance was alignment (F = .65, p
< .425). Table 4.9 contains a summary of univariate
statistics.
Following these analysis, the differences between the
groups classified by the individual system and couple system
were examined. It was found that in the individual system
classification, there were four couples (enactment numbers 9,
12, 34, 36) classified as negative that were classified as
positive in the couple system. The reason for this was that
in the couple system, which used the total RCISS speaker
point graph slope, the overall slope was positive in these
four enactments. However, the calculation of the individual

95
Table 4.9: Univariate analysis of variance of difference
between overall positive and non-positive RCISS speaker
slopes on therapist interventions.

Variable Positive Non-positive


n = 36 M SD M SD F(6,29) E

Structuring .38 .12 .23 .09 12.49 .001


Directives .34 .15 .15 .07 13.60 .001
Support .15 .12 .05 .08 5.33 .027
Affect .05 .03 .03 .01 4.11 .051
Other .49 .19 .37 .13 2.74 .107

Alignment .43 .23 .36 .29 0.65 .425

96
point graph slopes for interaction between the couple
revealed that in each of the four reclassified enactments one
of the partners had a negatively sloped point graph line.
This negatively sloped point graph line resulted in the
enactment be classified as not positive.

Annotated Point Graphs


Point graphs were created using Gottman's (1994) method
of adding the RCISS values from each talk turn to the sum of
all previous talk turns to create a cumulative RCISS score.
These cumulative scores, when graphed, form a point graph,
which provided a visual and numerical representation of the
positive and negative trends of the couple over time. In
order to visually represent therapist interventions, the
point graphs were annotated with symbols representing the
TISS codes. The TISS codes were listed above the cumulative
RCISS line. Each of the 36 enactments can be found in
Appendix A.
These annotated point graphs were then visually analyzed
for any apparent changes, patterns, and relationships. There
were definite differences in the patterns of couple positive
and negative interchanges. Twenty-six of the enactments were
mostly positive, six appeared to have substantial changes in
the slope of the RCISS cumulative line, both from positive to
negative and from negative to positive. The other eight had
mostly negative lines.

97
Therapist interventions were quite varied. In a number
of enactments, therapists either did little to intervene in
the process when the couple was consistently negative (see
Figures B.l & B.27) or seemed to give up and allow the couple
negatively engage with each other (see Figures B.17 & B.20).
In others, therapists intervened at almost every talk turn
regardless of how positive or negative the clients were (see
Figures B.2 & B.34). In others, it appeared from the graphs
that the therapists would intervene when couples started to
be negative, but within a few talk turns of therapist
intervention, the couple became positive again (see Figures
B.3 & B.7).

There were also differences in how many interventions


were used at the same time. During some enactments,
therapists tended to do several different types of
interventions in the same talk turn (see Figures B.9 & B.36).
In other enactments therapists tended to only do one or two
coded interventions per talk turn (see Figures B.8 & B.IO).
In many enactments, the husband and wife were either
positive or negative during the same time periods, and when
one would shift from negative to positive or positive to
negative, the other would shift as well (see Figures B.2 &
B.20). However there were several enactments in which for
periods of time, one partner was positive and the other was
negative (the RCISS cumulative couple line goes up and down
at every point in these segments). When this occurred, it

98
usually only lasted for five to 20 talk turns before one
partner or the other also became either positive or negative
(see Figures B.8 & B.19). This finding seems to support the
general systems theory premise of circular causality or
influence (Nichols, 1984). Sequential analysis is needed in
order to further explore patterns of change, and possible
causal links between all three people involved in enactments

99
CHAPTER V
DISCUSSION

A number of leading scholars in individual, couple, and


family therapy have called for more intensive research on
what makes therapy effective (Bergin & Garfield, 1994a;
Gurman et al., 1986; Jacobson & Addis, 1993; Rice &
Greenberg, 1984a). These researchers have also called for
investigation of specific interventions independent of the
theoretical orientations of clinicians. To address these
needs, this study examined the use of enactments in couple
therapy. The purpose of the study was to investigate the
association between therapist interventions during enactments
and couples' positive and negative interaction within
enactments.
This study was unique in several ways. It was the first
to examine enactments in couples therapy, a potentially
important segment of change in couple therapy. The study
contains the first theoretical and empirical work on what may
make enactments effective in couple therapy. This study was
the first to evaluate the relations between therapist
interventions and the important dimension of positive and
negative couple exchanges. This is also the first study to
use Gottman's RCISS coding system and point graphs to both
visually and statistically examine couple therapy sessions.
This study resulted in the creation and reliable use of the

100
TISS coding system, which is the first coding system
specifically designed to measure therapist interventions
during enactments in couple sessions. This study was also
the first to graphically portray both couple positive and
negative interchanges with therapist interventions. The
study yielded a number of valuable findings.

Summary and Discussion of Results


Difference in the main variables by demographic
variables were examined first. Following these analyses,
there were three main types of analyses done in order to
examine the relations between therapist interventions and
couple positive and negative interchanges: regression,
MANOVA, and descriptive. The results of each of these are
summarized and discussed here.

Demographic Variables
There were several significant relationships between
demographic variables and main variables. However, none of
these were considered important enough to use as covariates.
A few of the more interesting findings are summarized and
discussed here.
Female therapists tended to use more support and affect
interventions to wives than male therapists. This supports
stereotypes about women being more affect oriented and
nurturant. It is curious that these differences were only

101
found for interventions to wives. It may be that female
therapists feel more comfortable using affect and support
interventions with other women.
Session number was related to use of directives to
husband, total use of directive, total use of affect, use of
other interventions to wives, and total use of other
interventions. It appears that therapists may have been more
active in enactments that occurred in the first ten session
of therapy. It seems reasonable that therapists would
intervene during enactments in different ways depending on
how long the couple has been in therapy. For example, later
in therapy the relationship may have improved and there may
therefor be less need for therapist intervention.

Stepwise Regression Analysis


The stepwise regression analyses revealed significant
associations, in the direction predicted, between therapist
directives, structuring, and use of affect, and various forms
of client positive and negative speech. The specific
relations were somewhat complex.
Directive interventions. Therapist directives to
husbands was the best predictor of husband positive speech,
and therapist directives to the couple as a whole were the
best predictors of the couple's positive speech. In both
cases, the more often therapists use directives, the more
likely the couple was to use positive speech. Therapist

102
directives to the couple were also significantly negatively
related to couple negative speech, and positively related to
the ratio of positive to negative couple talk.
There were no formal hypotheses about the how directives
would be associated with different forms of client speech,
however it was hypothesized that directives were positively
related to positive speech and negatively related to negative
speech. These hypotheses were, at least for the husband and
for the couples as a unit, supported. The direction of
causality has yet to be determined; however, the theory in
chapter two stated that directives improve couple
communication through giving clients concrete knowledge of
what to do and by having them actually do it.
Structuring interventions. Therapist structuring to
wives was significantly positively related to wife positive
speech. However, negative wife speech and the ratio of
positive to negative wife talk turns were not significantly
related to any of the therapist intervention variables. Wife
positive speech was the only client variable that was
significantly related to therapist structuring in the
presence of the other variables. Consequently, the
hypothesis regarding the positive association between
therapist structuring and wife positive speech was supported,
and all other hypotheses regarding the relationships between
structuring and client positive and negative interaction were
not supported.

103
structuring was theorized to improve couple
communication through helping the couple understand and
follow the basic format of enactments and through preventing
the couple from breaking the enactment up by diverting the
conversation from each other to the therapist. This
explanation seems somewhat inadequate. Structuring is one of
the primary interventions used in Relationship Enhancement
therapy (Guerney et al., 1986) and is an important
intervention in Behavioral Marital Therapy (1979). It
involves explaining to and reminding the couple of the
guidelines and procedures for the enactment, and directing
the couple to engage in those procedures. Another
explanation is that structuring may be related to wife
positive verbal speech because laying out and being directed
on the specific rules or the basic format for interacting
with her husband may reduce anxiety and emotionally free her
to be more positive.
Affect interventions. Therapist use of affect with
husbands was significantly negatively related to husband
negative talk and positively related to the ratio of positive
to negative husband speech. It is interesting that use of
affect was the best predictor of husband negativity and the
ratio of husband positive and negative speech, and no other
couple variables. Greenberg and Johnson (1986) hypothesized
that couples talking about emotion can provide a common
ground for empathy. It was also hypothesized that getting

104
couples to talk about emotion will help couples not act them
out on each other. The finding that use of affect with men
was associated with lower levels of negative husband speech
may lend support this second theory. Men have often been
portrayed as having difficulty with expressing emotion and
with empathy (Eisenberg & Lennon, 1983). It may be that use
of emotion with men is particularly helpful in reducing
negative emotional expression because men often have
difficulty expressing emotion on their own and consequently
respond more to coaching in this area. Women on the other
hand, may not respond to affect oriented coaching because
they may already have the ability, on average, to express
their emotions adequately with out help. These hypotheses
will require further research.
In one recent study involving a panel of 36 family
therapists, there was a great deal of disagreement over the
use of affect interventions with men in therapy (Dienhart &
Avis, 1994). The results of this study indicate that use of
affect interventions may be important in reducing negative
husband speech and increasing the ratio of positive to
negative husband talk.
Positive-negative differences. Because positive speech
and negative speech are empirically and theoretically
different (Gottman, 1994), it was expected that therapist
interventions could be related to positive and negative
interaction in different ways. However, there were no

105
specific hypothesized relations between different therapist
interventions and positive and negative speech because the
theoretical relations are unclear. However results of this
study have indicated differences which might be helpful in
developing a theory around what influences positive and
negative speech during enactments. It appears that
directives to the couple are associated clearly with
reductions of couple negative speech and increases in couple
positive speech. The fact that use of affect to husbands was
positively associated with less husband negative speech and
use of directives with husband was positively related to
positive husband speech is new information. It may be that
somehow the effects of use of affect are inherently limited
to reducing negative speech, and, at least in the presence of
directives, not related to increasing positive speech with
husbands. Use of directives with husbands, on the other
hand, may not be as effective in reducing negative husband
speech as affect is. At this early stage of research, the
data do not warrant firm conclusions regarding the reasons
for these differences.

Wife-Husband differences. The findings that positive


wife speech was the only specific wife speech variable to be
significantly related to therapist interventions is
interesting, particularly in light that all measures of
husband speech were related to therapist interventions.

106
There are at least three possible explanations for these
differences.

The first is that the differences may be related to the


action oriented nature of enactments themselves. Gender
stereotyping would lead to the suggestion that men may be
more likely to respond to interventions that are change
oriented in the here and now such as those used in
enactments. Women may, on the other hand, respond more to
insight oriented interventions. Although there has been
speculation and theory development about differences in
response to therapy interventions by gender, little research
has been done in this area (Dienhart & Avis, 1994).
The second possibility is based on the findings of
Gottman (1994). He hypothesized that based on his
observations of marital interactions that wives are more
likely than husbands to take responsibility for regulating
affect in the relationship. Gottman states that wives do
this by increasing positives (interjecting humor, caring, and
concern) which tends to dissipate negative affect. It may be
that for wives, positive speech is the element most
responsive to change interventions because wives are more
likely to use positives for couple emotional regulation.
Husbands, on the other hand, may not be used to regulating
the positive and negative emotional climate of the
relationship, and thus not have a pattern of negative or
positive speech that they prefer using to regulate couple

107
emotions. Consequently, when therapists intervene in husband
speech, husbands are likely to change both negative and
positive speech.
A third possibility is that wives are more attuned to
the state of the relationship and are less willing to change
behavior with their husbands during enactments. Chodorow
(1989) has suggested that women are more relationally
oriented than men, and Gottman (1994) found that in the
earliest stage of marital dissolution, wives emotionally
withdraw from the marriage and engage in more complaining and
criticizing. It may be that women are more likely to respond
during enactments with their standard form of emotional
regulation (use of positives), than to change their negative
speech, which may be a way of expression their current
feelings about the relationship.
Non-significant findings. None of the variables
significantly predicted negative wife speech and the ratio of
positive to negative wife speech. Consequently, the
hypothesized relationships between these wife variables and
therapist interventions were not supported. Additionally,
other interventions, and support interventions did not
significantly predict, in the presence of the other
variables, positive and negative client talk in any of the
regressions. The reasons for the lack of association are
unclear. It is possible that the theories were wrong, even
though, for example, therapist support has been shown to be

108
associated therapeutic outcome (Lambert & Bergin, 1994). It
is also possible that the way these variables were defined or
measured resulted in non-significance. Again, with support,
only direct verbal support or praise were coded. It may be
that non-verbal, or more subtle verbal forms of support make
the difference. It is also possible that different
combinations of interventions when used together are
important. For example, it may be that use of affect becomes
more important for wives when used in combination with
directives or support. Exploring these types of associations
were beyond the scope of this project.

Multivariate Analysis of Variance


In the MANOVA analyses, enactments were classified using
both an individual and a couple classification system. The
individual classification system was based on the slopes of
the RCISS lines for husband and wife separately. If the
slope for either the husband or the wife was not positive,
the couple was classified as non-positive. In the individual
system, only talk turns in which the couple talked to each
other or both the other partner and the therapist were
included in the regression analyses that determined the
slopes. In other words, talk turns in which the couple
talked to the therapist exclusively were not included. This
system was used to represent the verbal exchanges between the
couple (and not the therapist), which were the verbal

109
exchanges the therapist would theoretically be trying to
change in an enactment, it was also used because it is the
closest classification system to that used by Gottman (1994).
The results of the MANOVA that used the individual
classification system were not statistically significant. In
other words, there were no significant differences on the use
of any of the therapist interventions between the two groups
classified by the individual classification system.
The couple classification system was based on the slope
of the total RCISS point graph line. This line was formed by
the cumulative positive-negative codes over talk turns. This
line contained the husband and the wife speaker codes to each
other, to both the other partner and the therapist, and to
the therapist alone. This classification system was chosen
to represent the complete positive-negative couple verbal
picture experienced by the therapist. Using this system, the
MANOVA indicated significant differences between therapist
interventions in the two groups. The univariate statistics
indicated that structuring, directives, and support were used
more often in enactments in which the couple had total RCISS
point graph lines that had a positive slope over time, in
other word, use of structuring, directives, and support was
related to a cummulation of more positive than negative
scores over the course of the interaction. Although both
affect and other interventions were not significantly
different, there was a trend toward differences.

110
Consequently, it appears that in general therapists were more
active in sessions in which couple speech was more positive
over time.

Using the individual classification system, four couples


were classified as being non-positive that were classified as
positive using the couple system. They were classified
differently because in all four enactments one of the
partners had a negative point graph slope and the other
partner had a positive point graph slope. In other words,
one partner was generally positive and the other was
generally negative. The couple classification point graph
slopes for these four cases were positive because the slope
of one partner was positive enough to overcome the negative
slope of the other partner. These four mixed overall
positive enactments made the difference between there being
significant differences on the therapist intervention
variables in the couple classification system MANOVA and
there being no significant differences in the individual
classification system MANOVA.
Perhaps in the enactments in which one partner was very
positive and the other was negative, therapists were
particularly active as compared with the sessions in which
both partners were negative. If this is accurate, it may be
that when one partner is considerably positive and the other
partner is negative, the therapist works particularly hard to
try to influence the overall direction of the enactment.

Ill
This possibility should be tested in future research with a
larger sample.

Descriptive Analyses
Through the descriptive analyses, several interesting
findings were uncovered. The lengths of enactments were
quite different. Although enactments shorter than seven
minutes were not included in the study, the process of
reviewing tapes to find enactments resulted in a number of
enactments that were only two or three minutes long. The
longest enactment was 58 minutes.
There was also a large difference in the frequency of
use of enactments. Out of the 18 therapists who had done
couple therapy in the clinic, only ten of them indicated they
had done an enactment. Out of those ten, the range in usage
of enactments was from one enactment to the use of enactments
in almost all sessions by another therapist.
In this sample, which was a clinical sample made up
primarily of couples who came to therapy with marital
problems, the majority of the enactments had RCISS speaker
point graph slopes that were positive. In other words, the
majority of couples generally talked positively to each other
during enactments. This was not expected, both because most
of the couples were in therapy for marital problems, and
because Gottman (1994) successfully predicted marital

112
happiness and likelihood of divorce based on the slopes of
the point graphs.
There are at least two possible explanations for the
number of positive enactments found in this sample. One
explanation is that by the time in therapy when most of these
sessions were done, couples were less maritally distressed,
and consequently were more likely to be positive.
A second possible explanation for the positive couple
talk found in this sample is that couples may be more likely
to be negative and less likely to be positive with each other
when they do not have a third person coaching them as was the
case in Gottman's (1994) research. In other words, having a
therapist in the room intervening in the process (which is an
enactment) may influence couples to be more positive. This
theory is supported by Burr's (1994) study of marital therapy
attachment. In this study of clinical couples, it was found
that qualitative shifts to interaction characterized by more
closeness and positivity were more likely to occur when the
therapist was working with the couple in an enactment.
The idea that enactments themselves are associated with
positive couple communication raises an interesting question.
Is part of the positive speech observed in this sample of
clinical couples a result simply of having a trained
therapist in the room regardless of the type of intervention
used? Or is all of the positive speech the result of
therapist interventions? And if this true, and there is some

113
* • •

positive effect from having a trained therapist in the room,


is it possible that couples actually have the skills to
positively interact, but are simply not using them when they
are by themselves? These questions are beyond the scope of
this study, but may be valuable results of the work done
here.

Another interesting finding from the descriptive


analyses was the differences in the patterns of couple
positive and negative interchanges. Some were almost
completely positive, some almost completely negative, and
some had quadratic shapes. Therapist interventions were also
quite varied. In a number of enactments, therapists did
little to intervene in the process when the couple was
consistently negative. In other enactments, therapists
intervened at almost every talk turn regardless of how
positive or negative the clients were. In others, it
appeared from the graph that the therapists would intervene
when couples started to be negative, but within a few talk
turns of therapist intervention, the couple became positive
again. In other cases, when the therapist intervened in
negative talk, and the couple continued to talk negatively,
the therapist seemed to give up and allow the couple to
engage in negative exchanges with each other.
There were also differences in how many interventions
were used at the same time. During some enactments,
therapists tended to do several different types of

114
interventions in the same talk turn. This seemed to be
particularly prevalent at the beginnings and ends of
enactments. In other enactments therapists tended to only do
one or two coded interventions per talk turn.
In most enactments, the husband and wife were either
positive or negative during the same time periods, and when
one would shift from negative to positive or positive to
negative, the other would shift as well. However there were
several enactments where for periods of time, one was
positive and the other was negative. When this occurred, it
usually only lasted for five to 20 talk turns before one
partner or the other also became either positive or negative.
This finding seems to support the general systems theory
premise of circular causality or influence (Nichols, 1984).

Implications for Theory and the TISS


Some aspects of the theory appear to fit with the
findings of this study better than others. At least four of
the variables developed in the theory seem to be important
parts of enactments. Structuring, directives, affect, and,
to some degree, support appear to be associated with the
ratio of positive to negative couple talk turns as predicted
by the theory. This study provides more information
regarding the nature of these associations. In the presence
of the others, each was related to couple interaction in a
different way.

115
Directives seem particularly related to husband and
couple positive speech, couple negative speech, and the ratio
of couple positive to negative speech. Therapist use of
structuring appears to be particularly related to wife
positive speech. Therapist use of affect seems to be
particularly important in reducing husband negative speech
and increasing the ratio of positive to negative husband
talk.
The importance of therapists directly encourage
positives and confronting negatives was not supported in this
study. The coding for directly encouraging positives and
directly confronting negatives was unsuccessful because the
therapists rarely used these interventions. Consequently,
their effectiveness in enactments was not supported and is
still unknown. It is possible, however, that if they were
used more often in therapy, they could be important factors
in producing changes in couple positive and negative verbal
exchanges. Consequently, it is recommended that directly
encouraging positives and confronting negatives not be
eliminated from the TISS at this time.
One possible modification to the these two TISS codes
involves the makeup of positive and negative interaction as
defined by the RCISS. Both dimensions are defined both by
what type of affect, negative or non-negative, is used and by
the content of what is said. For example, any yes-but
statement is given a negative code, regardless of the

116

SiSi-l I ail II bn
affective nature of the statement. Brief verbal responses
that indicate agreement receive a positive code. Modifying
the confront negative and encourage positive codes to include
both the affective element of communication (as they do now)
as well as the content of speech that would receive a
negative or positive RCISS code, may increase the frequency
with which confronting negatives and encouraging positives
codes are used.
Teaching was another code that did not occur often
enough to be coded reliably. The teaching code only measured
explicit attempts to teach general facts. It appears that
the majority of teaching occurs more indirectly and that
direct teaching may not be a significant factor in couple
enactments. Additionally, teaching was not a major concept
in the theory of enactments. Consequently, eliminating the
code for teaching in the TISS may be warranted.
Insight process was also not reliably coded. However,
unlike the other unreliable codes, insight process did occur
often enough to code reliably and may still be a relevant
part of the theory of enactments. The problem, at least in
part, with coding insight process was in the practical coding
definition. As the TISS coder and checker struggled to code
insight process reliably, a decision was made to limit the
code to how interaction occurred or was presently occurring
in the therapy room, and the how the couple had interacted in
past. With these clarifications, and perhaps with more

117
extensive coder training, it is believed that insight process
could be reliably coded. Consequently, at this point it
should not be dropped from the theory.
Alignment as measured by who the therapist talked to
most often was not related in any way to positive or negative
couple verbal exchanges during enactments. Consequently,
alignment as measured by the ratio of talk turns to the woman
versus the man appears to not be relevant to the
effectiveness of enactments. However, through the process of
coding, it became apparent to the author that measuring
alignment simply by the balance of therapist talk turns may
not be the best measure of alignment. Sometimes the
therapist may talk more with one person because the therapist
is confronting that person, which would indicate possible
alignment with the other partner. Other times the therapist
may be talking more with one person because the therapist is
giving support or making small talk with that person,
indicating that an alignment is occurring with the person
being talked to the most. Because of this difficulty, it is
recommended that alignment be measured in a more
sophisticated manner. For example, alignment could be
measured through both direction of therapist talk and a code
evaluating content of therapist intervention. It could also
be measured through a session global observational
measurement or possibly a post session self-report instrument
for members of the couple and for the therapist.

118
Implications for Therapy
Because this is the first study to investigate
enactments in couple therapy, and because there are a number
of limitations to this study (discussed later in this
chapter), all suggestions for therapy are tentative and
should be taken with caution. In particular, it is unknown
from this study whether the direction of effects is for
therapist to couple (as assumed here) or from couple to
therapist, or both. With this in mind, there are some
potentially helpful implication of this study for therapy.
In general, it appears that the more active therapists
are during an enactment, the more positive couple verbal
exchanges are. More specifically, it appears that the
therapist skills of structuring, use of directives and
affect, and perhaps support all may be related to effective
enactments. Consequently, it may be important to train
therapists in the use of these basic skills.
One of the surprising results of this study is that the
therapists in our sample rarely directly encouraged positive
verbal exchanges or directly confronted negative verbal
exchanges. From the theory of enactments developed for this
study, these interventions were thought to be important. It
may be that therapists believe they are using these
interventions when in reality they are not. If this is the
case, it may require deliberate, conscious training and

119
practice to incorporate these interventions into the
repertoire of therapists.

The fact that therapists, at least in this sample,


rarely spoke of the dimensions of positive and negative
interaction may be an indication that therapists are not
attuned to these dimensions of couple interaction. Since
couple positive to negative interaction has been shown to be
significantly related to marital happiness and marital
stability (Gottman, 1994), as recommended by Gottman, it may
be important for therapists to pay more attention to and more
directly intervene in these basic dimensions of couple
interaction.

Implications for Future Research


There is a great deal of research yet to be done on
enactments in couple therapy. Suggestions for future work in
this area are summarized here.
This study revealed several important relationships
between therapist interventions and couple interaction.
However, the direction of causality of these relationships
needs to be established and will be an important area of work
in future research. Additionally, this study needs to be
replicated with a larger sample where the degree of marital
distress is known and can be accounted for, and factors such
as differences in couples and therapists can investigated.

120
Although qualitative analysis and theoretical work
indicates that enactments are an important change segment in
therapy (Burr, 1994; Greenberg & Johnson, 1986) experimental
research on couple therapy with and without enactments is
needed to firmly establish the impact of enactments on the
outcome of couple therapy. The therapist factors found to be
associated with couple exchanges in this study can be helpful
in establishing a protocol and training therapists for an
experimental study. Additionally, research on how enactment
segments differ from other segments of therapy within the
same session may be important.
The direction of causality between the therapist
interventions and client interaction will be an important
area for future research. One way of addressing the issue of
causality would be to use sequential analysis to investigate
the probability of various codes following each other.
Another question is whether the apparent differences
between the positive couple interaction of this sample and
the distressed couples in Gottman's (1994) sample are real.
If they are, why they are different may be important. For
example, is it therapist coaching alone that results in
increased positive couple exchanges, or is it possible that
part of any difference might be simply the result of having a
trained therapist in the room? If this is true, then it is
possible that couples have the skills involved in positive

121
communication and in avoiding negative communication, but for
some reason are not always using them with each other.
The results of this study indicate that enactments in
which one member of a couple is positive and the other is
negative may be associated with increased therapist activity.
This deserves further investigation.
A number of purposes for the uses of enactments were
discussed in Chapter II. Further investigation about how
therapists use enactments and how different intended uses of
enactments affect couple interaction may be a valuable avenue
of research.

This study indicated that therapists rarely directly


confront negatives or encourage couples to talk in a positive
or neutral fashion. Research on how the intentional uses of
these interventions may influence couples compared to what
appears to be the normative non-use of these interventions
may be valuable.
The differences in lengths of enactments may also be
fruitful area for further research. For example, is there an
optimal length for an enactment? What causes enactments to
be different lengths?
Any future research needs to take into account the
suggestions made for improving the TISS. For example,
modification in the way insight process was coded may be
important in coding this variable reliably. Expanding the
definitions of encouraging negative and confronting positives

122
to include both the affective as well as content definitions
of negative and positive may result in the codes being used
more often and consequently reliably. Alignment should also
be measured in a more sophisticated manner, such as examining
the content of therapist interventions to each member of the
couple and perhaps using self report measures on both the
couple and the therapist.
Finally, coding the RCISS reliably was fairly difficult
and took a great deal of training time (six months). The
RCISS is valuable because of the dimensions it measures and
because it was used in the innovative, important research of
Gottman (1994). However, researchers should be aware of the
difficulties (and consequently expense and time involved) in
reliably training coders in the use of the RCISS, and take
these difficulties into account when designing research
studies.

Limitations
There are a number of limitations to this study. These
include the size and characteristics of the sample, the lack
of information about causality, the lack of information about
the degree of marital distress of the couples, the fact that
the TISS was created for this study, and the number of
analyses done in the study.
The sample was collected from one clinic and consisted
of only 36 enactments. Consequently, it may be biased and

123
the findings may not apply to therapy done under other
circumstances with different populations. Although, there
were differing levels of therapist experience, all of the
therapists in this study were Ph.D. students from the same
program. This also could have biased the results. There
were only eight therapists and only five of them had more
than one case. Consequently accurately assessing the impact
of therapist and couple was not possible. Differences in
therapists and couples could be important.

The definition of an enactment in couple therapy


developed for use in this study is fairly specific.
Consequently, it may not be consistent with the way all
therapists define enactments in couple therapy.
Additionally, the enactments used in this study were at least
seven minutes long. It is possible that shorter enactments
are different in some way. For example, therapists may end
enactments sooner when the couple is negative.
Little is known about the degree of marital distress in
the couples in this sample beyond the reason they came to
therapy and their behavior during enactments. The degree of
marital distress could affect the results of this study. For
example, the amount of positive enactments in this study
could be the result of having few distressed couples rather
than enactments being associated with positive couple
interaction.

124
The TISS was developed for use in this project and has
not been validated. Therefor even though the codes used in
this study were reliable, they are not necessarily valid, and
the results must be taken with caution.
This study does not directly address causality.
Consequently any inferences regarding causality must be made
with extreme caution.
There were a lot of analysis done in this study, and
consequently the study-wise error type one error rate is
high. Additionally the homogeneity of variance assumption
was violated on the second MANOVA for directives and affect.
Consequently, the results of the MANOVA must be taken with
caution.

125
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133

mnBtwBiPK^ ij
APPENDIX A
LETTER SENT TO STUDENTS
Dear

I need your help-it should take less than 5 minutes. I am doing my dissertation on
enactments in marital therapy. For the purpose of my study, an enactment is defined as:

a therapeutic intervention where the couple talks to each other and the therapist
coaches the process and/or content of their discussion.

The study will be a process study where taped enactments will be coded and
examined. In order to write my prospectus (which I am hoping to write over the holidays)
I need some idea of how often you use enactments. Your assistance in filling out the
questions below would be extremely helpful to me. It would be particulariy helpful if you
will get this back to me before the end of this week (by Friday, Dec. 17th).
Below is a list of marital session case numbers seen by you since September 1,
1992, and the dates in which you saw that case. Please check those cases that you think
you might have used enactments.

Case# # Marital Sessions Dates Seen as Couple I Probably Used Enactments


(Yes/No)

Please answer the following two questions by circling your answer.


1) In general, I use enactment in marital therapy:
a) Almost every session
b) Quite a bit
c) Sometimes
d) Rarely
e) Never
2) Do you mind if I use tapes of your work with couples in my study (regardless of
whether or not you use enactments)?
a) I do not mind my tapes being used
b) I do mind
Please return this to my HDFS office box by December 17th (this Friday). Thank
you very much for your help!

Happy Holidays!

Scott R. Woolley

134

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