Acceptance in Couple and Family Therapy
KeywordsFamily Therapy Emotional Expressiveness Couple Therapy Natural Difference Emotional Distance
Acceptance in couple and family therapy refers to the process of individuals becoming more patient and sympathetic when problems arise because the individual recognizes that there are natural and understandable reasons for the way the individual, the partner, and the relationship are. Within an intervention context, acceptance helps individuals soften the impact of relationship aspects and dynamics that are likely unamendable to change, even if the partner makes attempts to change. Through acceptance, individuals relinquish the struggle to change others’ behavior, learn to see differences and problems as opportunities to increase relational closeness and emotional connection, and develop empathy around the seemingly intractable issues that drove the individuals apart (Christensen and Jacobson 2000). In contrast to more traditional behavioral change techniques, acceptance work encourages the complainant to change. The process of acceptance in couple and family therapy reduces relationship distress, facilitates emotional connection, and increases the likelihood that the parties involved are better able to handle future challenges and relationship issues.
Theoretical Context for Concept
While there has been some work within the family therapy literature on acceptance, the majority of research has focused on acceptance within couple therapy. Acceptance within couple therapy was first introduced as one of the major tenets of integrative behavioral couple therapy (IBCT; Jacobson et al. 2000) in response to limited long-term efficacy of change-oriented therapy approaches. Indeed, IBCT developed as an attempt to improve upon traditional couple therapy models such as traditional behavioral couple therapy (TBCT; Jacobson and Margolin 1979) which focused on couples making overt behavioral change in order to increase relationship satisfaction (e.g., increasing positive behaviors and decreasing negative behaviors). While change-oriented approaches such as TBCT are effective in helping some couples make changes and see increases in relationship satisfaction, a substantial number of couples do not benefit from therapy and show no clinically meaningful improvement by end of therapy (Jacobson et al. 2000).
A few explanations have been offered as to why overemphasizing behavioral change strategies is not always enough to result in meaningful changes for some individuals. One explanation is that approaches like TBCT fail to meet individual needs. Indeed, due to the nature of distress in treatment-seeking individuals, many partners and family members may be unwilling to make the changes requested of them or accommodate behavioral change. Moreover, by the time a family or couple is attending therapy, they have often reached a behavioral impasse due to entrenched problems in their relationships and the lack of a “collaborative set” or a mutual understanding that they are both responsible for the problems in the relationship and, therefore, both need to make change (Jacobson et al. 2000). Additionally, change-oriented treatment approaches often fail to take into account the historical context in which problems develop and the emotional hurt developed from repeated relationship problems that often lead to high relationship distress. All these problems, which are often present for treatment-seeking individuals, make it harder to change relationship dynamics. However, the most important reason that an exclusive focus on change is likely to be unsuccessful is that many domains of couple and family life are not modifiable by the couple/family. For example, it is not possible for an individual to will him/herself to feel (or not feel) a certain way. Similarly, personality or other stable traits are not amenable to change. Furthermore, external stresses such as a job loss or foreclosure are often out of the couple or family’s direct control. Thus, behavioral change techniques alone may be ineffective and insufficient without a simultaneous focus on acceptance of the problems at hand. Indeed, it is the combination of acceptance and change strategies that is likely to be most effective for most relational problems.
Treatments with a focus on acceptance such as IBCT build upon behavior-focused therapies by integrating acceptance strategies with change-oriented approaches. Indeed, IBCT has a stronger emphasis on creating relationship improvement by targeting the controlling variables that often impact relationships such as individuals’ thoughts, feelings, and desires rather than overt behavioral change alone. Through acceptance-based approaches, individuals come to a level of acceptance whereby they willingly let go of frustration, hurt feelings, and the struggle to change one another. IBCT and other acceptance-based approaches in couple and family therapy remove blame and help individuals see a new perspective on the relationship whereby the other party involved is no longer conceptualized as being deficient, inferior, or at fault.
Within all couples and families, there are countless natural differences between individuals. Some people tend to be more emotional, outgoing, or organized than others. Some people may be more career driven, and others may be more family or interpersonally oriented. Many, perhaps most, of these natural differences are experienced as just that – differences. The couple or family system is able to adapt to these differences without conflict. Indeed, some differences may be a source of strength for a couple. For example, an introvert may appreciate that his/her partner or family member helps maintain social connections, while the extravert appreciates not having to compete to be the center of attention in social settings. However, other differences create conflict and distress for the couple or family.
From an IBCT perspective, distress develops through a three-phase process. Acceptance is key in both avoiding and overcoming this process. In the first phase, when an individual experiences a difference that is unpleasant, that individual pushes the other person to change. For example, if two people differ in their standards for cleanliness, one person will often ask the other to pick up after him/herself, put dishes in the dishwasher rather than piling them in the sink, etc. If these requests for change can be accommodated, then no distress develops. However, if the messier person is unable or unwilling to change, then conflict around cleanliness develops.
In the second phase – called polarization – each attempt to change the other person results in the partner not only continuing the behavior but often acting more extreme than he or she otherwise would. For example, the more the individual “nags” his/her partner to be cleaner, the less likely the partner is to be responsive to those requests. Over time, the clean individual becomes more and more upset at even smaller instances of messiness. Polarization makes it hard for the couple to get out of the negative pattern. The repeated requests for change are often met with hard emotional expressions such as anger, yelling, and blame (or just simply walking away without responding), which often increase retaliation or unwillingness to compromise.
In the third phase – called the mutual trap – each partner views the other as the sole source of the conflict. Moreover, each partner feels that, if they give in to the other, the problem will only get worse. For example, the individual requesting more cleanliness worries his/her partner would never clean up if he/she didn’t “nag” the partner. In turn, the partner feels that if he/she “gives in” to the demands to clean, it’s only going to increase the “nagging.”
Models of acceptance within couple and family therapy posit that acceptance can reduce the initial unpleasantness of the differences, reduce the process of polarization, and offer an escape from the mutual trap by beginning to view the problem as a process that is jointly created. By better understanding and accepting one another’s actions or each other instead of pushing for change, individuals gain emotional distance from the problem. This emotional distance allows them to address the issue without engaging directly or pushing for behavioral change. Indeed, the response to problematic behavior moves from being extremely negative in valence (e.g., anger, vulnerability and pain, contempt) to neutral or positive (e.g., toleration, appreciation, and understanding), which subsequently generates a greater sense of emotional closeness and intimacy. For the individuals on the receiving end of the frequent pushes for change, increased acceptance helps them to be less reactive. As a result, they, too, learn to better accept why the other person is asking for change, become more understanding of how the negative pattern developed, and let go of the aspects of the relationship and other person that they cannot change. They may also learn to accept their contribution to the pattern. Through this process of acceptance, the desired change becomes more likely to occur. This process is consistent with the literature on individual therapy approaches (e.g., acceptance and commitment therapy) which suggests that when individuals are more accepting, do not judge or blame themselves, or try to stop unwanted problems, they move in a direction more consistent with their values, can better take action against the problem, and find more meaning in their lives.
Application of Concept in Couple and Family Therapy
As mentioned, acceptance within couple and family therapy has arisen largely within the framework of IBCT. IBCT assumes that problems in relationships do not just occur as a result of the negative behaviors of partners but also in the emotional disruption and reactivity caused by these actions. Thus, strategies are implemented in order for couples to not only gain a deeper understanding of how to communicate or interact more healthily (which would be a more skills-based and change-oriented approach) but to understand what factors in the relationship make relationship problems more likely to occur and what led to the problems initially. Through an acceptance approach, couples become less biased, are better able to reflect on their own behavior, and learn to stop undermining the relationship by using blaming, pushy, or hostile communication.
The first intervention used by the IBCT therapist to promote acceptance is unified detachment. Unified detachment helps couples talk about problems rather than engaging in the problematic dynamic. It creates a shift in perspective by labeling the problem as an “it” versus a “you,” teaching couples to no longer think of their partner as the cause of the problem. Instead, unified detachment helps couples develop an objective third party perspective on the major issues in their relationship by removing blame and promoting active communication.
Unified detachment begins with an initial feedback session that takes place within the first few weeks of therapy. During the session, the therapist promotes acceptance by beginning to introduce his/her formulation of the couple’s major problems and themes. Additionally, the therapist formulates a DEEP Understanding of the couple’s relationships problems, which is an acronym for the couple’s natural differences, emotional sensitivities, external stress, and patterns of interaction that often escalate conflict. The components of the DEEP Understanding help the couple see a more holistic picture of what is negatively impacting the relationship. Through discussion of the DEEP Understanding, the therapist models acceptance by validating both partners’ concerns as understandable and by using nonjudgmental language that removes blame from each member of the couple. Instead, the therapist focuses on the couple’s strength, begins the narrative that each partner is not at fault, and introduces the idea that the couple has developed a pattern of behavior and communication that has been getting them stuck. This approach is essential to the success of couples gaining acceptance and is modeled throughout therapy.
Unified detachment interventions continue throughout the course of treatment. In session, couples explore emotionally salient, negative interactions that have recently occurred in order to better understand the context in which the problem developed instead of focusing on who is to blame. Rather than allowing partners to jump into old habits of telling each other why they think the other is at fault, therapists encourage couples to focus on each of their contributions to the recent interaction. By gaining more emotional distance from the issue, couples begin to think of the interaction from an outside perspective and gain insight into the sequence of events. For example, they think through how the components of the DEEP Understanding such as differences, emotional triggers, the impact of stress, and the way they interacted with one another prevented them from better addressing the problem. Through unified detachment, partners formulate a new, more accepting, and less biased narrative of the negative relationship interactions wherein the partner is no longer to blame.
In the second acceptance strategy in IBCT – empathic joining – the therapist encourages couples to be more open and provides opportunities for couples to discuss emotional sensitivities and support one another through those emotional disclosures. Problematic relationship dynamics often arise because, as partners feel more hurt or distant from each other over time, they often blame, accuse, or negatively judge their partners. These negative behaviors and cognitions often result in greater separation and defensiveness, which only lead to more relationship distress.
For example, take an individual who feels emotionally unsupported by his/her partner. Throughout the relationship, this person has likely learned that being vulnerable with emotions only leads to disappointment as his/her partner may not be the best at validating those emotions or expressing his/her own. Over time, the partner who feels unsupported is less likely to share emotional sensitivities and more likely to display harder emotions such as anger or contempt. Additionally, instead of being vulnerable, he/she is more likely to say a hurtful statement such as, “You are totally unfeeling and don’t know how to connect with anyone!” This in turn may hurt the partner’s feelings, which could result in him/her displaying his/her own hard emotional expressions such as yelling or withdrawing.
During empathic joining, the therapist instead encourages both partners to share their hidden emotions – the softer, more vulnerable emotions that underlie the reaction that the partner sees (e.g., anger, contempt). After one individual discloses a vulnerable emotion, the therapist works with the partner to appropriately support that disclosure. If the partner has difficulty doing so, the therapist supports the disclosure him/herself (providing a model to the partner) and then explores why it was difficult for the partner to support that disclosure. Through these empathic joining exercises, the partners become less blaming, more empathetic, and more accepting of each other and the pattern in which they have gotten stuck. Empathic joining promotes compassion and emotional intimacy. Through the subsequent increase in emotional connectedness, partners become more open to any subsequent changes that are under their control.
In the final IBCT strategy to promote acceptance, therapists help couples with tolerance building. Through tolerance building, couples begin to see the differences that first created the conflict as natural and as part of portions of their partner that they do like. For example, differences that create conflict can be related to traits that they initially found attractive (e.g., a partner that is now viewed as “irresponsible” could have been initially viewed as “spontaneous”). Alternatively, aspects of the partner that an individual currently enjoys (e.g., initiating a spontaneous evening out) could be related to aspects of the partner that create conflict (e.g., lack of follow-through on household tasks). Additionally, partners work to better tolerate situations that are out of their control. By letting these biased perspectives go and learning to tolerate what cannot be changed, couples increase acceptance which in turn removes emotional distance and blame. Throughout this technique, therapists also model empathy so that both partners feel heard and understood. Modeling this air of acceptance is central to partners feeling emotionally safe to be vulnerable, which in turn helps them to let go of hurt and stop blaming their partners.
Following IBCT’s model, a few secondary interventions have been developed which also focus on acceptance promotion. One intervention is the marriage checkup, which offers early detection and preventative care for relationship functioning. While the intervention is brief and only consists of two, 8-hour sessions (one assessment and one feedback session), it helps couples create more intimacy and closeness in their relationship. Indeed, the program promotes greater understanding of common relationship issues and differences between partners, which helps build acceptance. Couples who participated in the marriage checkup, compared to those in a control group, were significantly more relationally satisfied 2 years following the intervention (Córdova et al. 2014).
Another secondary intervention with a focus on acceptance is the OurRelationship.com program (Doss et al. 2016). As an online adaptation of IBCT, the program’s goals are consistent with those of IBCT. Indeed, through online activities, the program helps couples select the biggest problem in their relationship, develop a DEEP Understanding of the problem, and problem solve solutions tailored to the issue. Throughout the program and through several contacts with study coaches that promote empathic joining and unified detachment, couples gain acceptance and a better understanding of what occurs during emotionally salient, negative interactions. By the end of the 8-hour program, the couples reported significantly increased relationship satisfaction, relationship confidence, and positive relationship qualities as well as reduced negative relationship qualities (Doss et al. 2016).
Furthermore, acceptance is a central component of other primary interventions such as the Compassionate and Accepting Relationships through Empathy (CARE) program. CARE encourages couples to use prosocial, empathy-based skills and teaches the importance of acceptance in relationships. Many couples who received CARE reported increased relationship satisfaction, greater affection, and less hostile communications over 3-year follow-up (Rogge et al. 2013).
Overall, the literature on acceptance within secondary and tertiary interventions shows that acceptance is a key element in enacting positive change for couples. Indeed, IBCT has been shown to be effective at increasing relationship satisfaction and communication and reducing negative relationship behaviors both short and long term (Christensen et al. 2004, 2006). Moreover, acceptance has been shown to be a mechanism of change of treatment gains across acceptance-focused interventions such as IBCT and the marriage checkup (Doss et al. 2005; Hawrilenko et al. 2016).
While most of the research on acceptance has occurred within the couple intervention literature, acceptance has also shown to be important within family therapy in promoting positive changes in negative family dynamics. Specifically, when acceptance is included in a family therapy approach, parents and children learn how to be more value-centered, better accept difficult emotions, and stop repeated measures to prevent unwanted problems. Acceptance within family therapy results in the reduction of parent-adolescent conflict and improvements in psychological flexibility and individual functioning (e.g., Coyne et al. 2011; Greco and Eifert 2004).
The case of Steve and Carmen can be used to illustrate the use of acceptance in an IBCT framework. After 20 years of marriage, Steve and Carmen sought couple therapy because of their lack of emotional intimacy. Between their responsibilities to their two teenage daughters and their two careers, Steve and Carmen’s relationship had taken a backseat. Steve described that the intimacy in their relationship had degraded to the point where he felt that they were “just roommates.” Although he identified that both he and Carmen were great parents and led fulfilling individual lives, he felt that the romantic spark they once had was gone. Carmen, likewise, reported they were not as close as they used to be and wished they could get back to “being in love.”
While both Steve and Carmen agreed that intimacy was lacking in their relationship, each partner had different ideas of what led to the lack of intimacy as well as how it should have been fixed. Steve believed they both became busy with life, jobs, and family and that they failed to prioritize the relationship. He thought that if they spent more time together, the intimacy issue would abate. Carmen, on the other hand, saw the lack of intimacy as resulting from the fact that they rarely talked outside of surface-level conversations or discussing their children. She felt the relationship could not improve without first making the effort to dive deeper into more emotional conversations, such as through sharing their passions, interests, and goals as individuals and as a couple. Her attempts to engage Steve in these conversations were frequently, if not always, a letdown. Both partners’ attempts to solve the intimacy issue – Carmen pushing for deep conversation and Steve wanting to spend more fun time together – ultimately created more discord in the relationship.
After a thorough assessment process including standardized measures, an introductory session with the couple, and individual sessions with each person, the therapist initiated the first acceptance intervention – unified detachment – in the feedback session. In this session, the therapist presented the formulation of Steve and Carmen’s relationship problems to the couple. The therapist emphasized that there was a natural difference between Steve and Carmen around emotional expressiveness. For example, more in touch with her emotions and able to describe how she is feeling at any given moment, Carmen became frustrated when Steve could not reciprocate. Additionally, the therapist hypothesized that Carmen was sensitive to Steve’s inability to share his feelings partially due to past experiences. Indeed, Carmen’s previous partner had cheated on her and hid his infidelity for over a year by being vague about his whereabouts and feelings. As a result, Carmen frequently tried to initiate meaningful conversations with Steve in order to calm her anxieties that he might also be cheating on her. When he refused to engage because he felt put on the spot and unable to connect to his emotions, Steve often raised his voice and would ultimately storm out of the room.
To help Carmen and Steve better understand this negative pattern, the therapist hypothesized that, as a response to Steve’s withdrawal, Carmen felt rejected, hurt, and lonely – much like she did in her previous relationship. After receiving confirmation that Carmen felt this way, the therapist then emphasized that, later, when Steve tried to placate the situation by offering to watch TV or go on a walk with Carmen – a good solution to the intimacy issue in his mind – Carmen felt he was ignoring their earlier fight. Additionally, the therapist helped Steve identify that he often withdrew from Carmen’s attempts to initiate meaningful conversations both because communicating emotions was challenging for him and because he felt like it interfered with his attempts to get them to spend enjoyable, light-hearted times together.
During the course of therapy, the therapist created unified detachment by encouraging Carmen to reframe Steve’s inability to share his emotions as a natural difference rather than a malicious attempt to keep her in the dark. Additionally, the therapist helped reframe Steve’s attributions of Carmen’s desire for deeper communication as being related to her past experiences and not ceaseless nagging. By helping the couple to see their problem as “differences in need for intimacy and emotional expressiveness” and as an “it” rather than a “you,” the therapist promoted acceptance in Steve and Carmen’s relationship.
Over the course of treatment, the therapist also utilized empathic joining and encouraged Steve and Carmen to share vulnerable emotions with each other, as this was an area in which they both struggled. Indeed, Carmen had not been as open with Steve about her past relationship and had not shared those feelings of fear and loneliness. During session, she began to share her feelings of fear and hurt stemming from her past relationship. Once Carmen opened up, it not only gave Steve a fuller picture, but it allowed him the opportunity to respond to those emotions in a soft, kind, and accepting manner. Additionally, because Steve was not naturally skilled at expressing his emotions, the structure and therapist’s support during empathic joining helped him open up to Carmen in ways that he had not done previously. By increasing acceptance around their emotional sensitivities and the natural differences between them, Steve and Carmen were more effective at healing the relationship. These supportive interactions, repeated over the course of therapy, helped the couple interrupt their previous unproductive pattern of communication, reestablish trust, and build emotional intimacy.
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