ACTING ON WHAT WE KNOW:
THE HOPE OF PREVENTION

Scott M. Stanley
Howard J. Markman
University of Denver
Center for Marital and Family Studies
PREP, Inc.
Web: http://members.aol.com/prepinc

Based on a paper presented by the first author to the
Family Impact Seminar, June 1997, Washington D.C.

Author Note: Preparation of this brief was supported in part by National Institute of Mental Health, Prevention Research Grant, Grant 5-RO1-MH35525-12 Long Term Effects Of Premarital Intervention. Requests for information on the research underlying this chapter can be sent to the authors at the Center for Marital and Family Studies, Psychology Department, University of Denver, Denver, Colorado 80208.

Competing Needs: To Know More and To Do More

When it comes to the great problems facing our society as a result of marital distress and divorce, there is a legitimate tension between the desire to know more and the desire to act now. Do we wait until more research better informs our efforts, or move forward with the best of what we now know? Of course, these choices are not mutually exclusive. We should conduct more research and we should act on the knowledge that currently exists. What follows is an overview of the issues facing us in the task of preventing marital distress and divorce. Here, we hope to speak to the issues of what we know, what we are encouraged by, and where we need to go from here. There are many issues not considered here that are nonetheless very important.
The Problem

While all know the basic facts, some of the highlights bear repeating:
  • Young couples marrying for the first time face roughly a 40-50% chance of divorce (U.S. Census Bureau, Current Population Reports, P23-180, 1992, p. 5).
  • Many other couples are in stable but chronically distressed marriages.
  • Adults and children are at increased risk for mental and physical problems due to marital distress (e.g., Cherlin & Furstenberg, 1994; Coie et al. 1993; Coyne, Kahn, & Gotlib, 1987; Cowan & Cowan, 1992; Fincham, Grych, & Osborne, 1993).
  • Mismanaged conflict predicts both marital distress and negative effects for children (e.g., Gottman, 1994; Markman & Hahlweg, 1993; Clements, Stanley, & Markman, 1997; Cowan & Cowan, 1992; Grych & Fincham, 1990).
  • Conflicts at home lead to decreased work productivity, especially for men (e.g., Forthofer, Markman, Cox, Stanley, & Kessler, 1996).
  • The "triple threat" of marital conflict, divorce, and out-of-wedlock births has led to a generation of U.S. children at great risk for poverty, alienation, and antisocial behavior.

These problems have gained the increased attention of researchers, ministers, policy makers, and the government. The after shocks of marital distress and divorce affect us all. These kind of facts press us to do something. This press has led to a singular opportunity: it has united liberals and conservatives in a rare consensus that our society is deeply threatened by the deterioration of both marriage as an institution and individual marriages in particular.

The Hope of Prevention

With the range of problems traceable to marital distress and divorce, increasing focus is being paid to attempts to help couples prevent such outcomes (Silliman, Stanley, Coffin, Markman, & Jordan, in press). Preventive efforts stand in contrast to efforts to ameliorate marital distress after it has set in. The decisions our society must face in this battle reflect the classic tension between short and long-term costs. As the Fram oil filter commercial so succinctly put it a couple of decades ago: "you can pay me now or pay me later." The message to car owners was simple: you can pay for regular maintenance that prevents your engine from suffering undue wear and tear, or you can pay later to overhaul the entire engine. We believe that America routinely tends toward the more short-sighted view. We are a culture that finds prevention hard to do--at least in terms of any collective will. The government budget deficit is one notable example of such short-sightedness. When it comes to the state of marriage in America, there has historically been little attention to prevention in the form of premarital preparation, though that may well be changing in our time (e.g., McManus, 1993). To the degree that prevention is coming to be fashionable, it is because people are getting increasingly clarity on the magnitude and implications of our societal marital problems.

The question more and more people are putting forth is "do we have the collective will to try to do something to turn the tide on this problem?" And if the answer is "yes," do we know what kinds of things we should be doing to make a difference? No one could easily summarize the field in so short a space as this, but our desire is to lay out reasons for hope that prevention can make a difference in marital outcomes. While we need to know much more--and we believe we will know more over time--what we already know is encouraging about the task of prevention. We will not attempt to cover the many different models for preventing marital failure. We do plan to highlight key thoughts and strategies regarding prevention, and discuss in some detail some of the basis for optimism.

Understanding the Targets of Prevention

Prevention or health promotion programs developed for couples fit the public health classification (Commission on Chronic Illness, 1957) of:

1) primary prevention , or proactive efforts to reduce emotional and behavioral deficits or disorders or maintain healthy functioning; and

2) secondary prevention , or early identification, diagnosis, and treatment of deficits to avert more serious breakdown or establish healthy functioning. Primary and secondary interventions can be used with non- or mildly-symptomatic couples to facilitate: 1) developmental transitions (e.g., first or remarriage, empty nest), 2) resolution of conflict over differences (e.g., financial decisions, parenting styles), 3) relationship deterioration due to life crises (e.g., strains related to child hospitalization), and 4) social support (e.g., esteem and practical aid). As discussed below, primary and secondary programs for couples have typically focused on assessment and self/other awareness, enhancing knowledge for decision-making, and interpersonal skill development.
(from Silliman, Stanley, Coffin, Markman, & Jordan, in press)

This distinction between primary and secondary prevention has become classic in all fields of prevention. For either kind of preventive effort, the targets can be further classified into one of two key strategies: raising protective factors and lowering risk factors (e.g., Coie, et al., 1993). Protective factors are those that add to the chances of a couple doing well over time, and are therefore targets in preventive efforts. These factors could include enhancing such things as friendship in the marital relationship (e.g., Stanley, Blumberg, & Markman, in press), interpersonal support (e.g., Pasch & Bradbury, in press), and mutual dedication (e.g., Stanley & Markman, 1992). Risk factors are those negative factors clearly associated with greater risk of marital failure, and lowering such risks is crucial in preventive interventions. Risk factors would include such things as negative interaction patterns (e.g., Clements, Stanley, & Markman, 1997; Gottman, 1994; Karney & Bradbury, 1997; Markman, Stanley, & Blumberg, 1994; Stanley, Blumberg, & Markman, in press) and dysfunctional relationship beliefs (e.g., Baucom & Epstein, 1990; Eidelson & Epstein, 1981; Fincham & Bradbury, 1989).

Research That Informs Our Choices for Prevention

In addition to a foundation of "basic" research on marriage and family relationships, three broad streams of research are particularly useful for framing preventive strategies designed to help couples have stronger, happier, and lasting marriages: Prediction Research , Survey Research , and Outcome Research . These three streams of research focus our efforts on the most fruitful protective and risk factors--or targets--for prevention.

Prediction Research and Studies of Long Term Risk

A variety of longitudinal studies look at the factors that help explain why some marriages make it and some do not. While many factors are associated with increased risk for marital failure, many of the risk factors are relatively uninteresting for the work of prevention because they are not amenable to change. In contrast, much research is pointing toward the most feasible targets for effective preventive efforts with couples.

Being realistic also means focusing on dimensions that couples are actually able to do something about--e.g., dynamic factors as opposed to static factors. Many factors affect a couple's chances (Karney & Bradbury, 1995; Kurdek, 1993), but many of these are static factors that are not very amenable to change (e.g., family of origin issues, divorce history, or personality tendencies). Cognitive-behavioral programs tend to focus on the dimensions that are both predictive and changeable. (from Stanley, in press)

Numerous factors have been shown to increase the risk of marital dissolution. Factors shown to increase risk include, but are not limited to, wives' employment and income (Greenstein, 1990), neuroticism (Kelly & Conley, 1987), premarital cohabitation (Bumpass, Martin, & Sweet, 1991; Thomson & Colella, 1992), difficulties in the areas of leisure activities and sexual relations (Fowers et al., 1996), physiological arousal prior to problem-solving discussions (Levenson & Gottman, 1985), parental divorce (Glenn & Kramer, 1987), previous divorce of husbands (Aguirre & Parr, 1982; Bumpass et al., 1991), communication positivity/negativity (Markman, 1981), communication withdrawal and invalidation (Markman & Hahlweg, 1993), defensiveness and withdrawal (Gottman & Krokoff, 1989), higher ratios of hostility to warmth (Matthews et al., 1996), dissatisfaction with partners' personality and habits (Fowers et al., 1996), difficulties in communication and problem solving (Fowers et al., 1996) religious dissimilarity (Maneker & Rankin, 1993), maintaining separate finances (Kurdek, 1993), knowing the partner a short time before marriage (Kurdek, 1993), marrying young (Booth & Edwards, 1985; Bumpass et al., 1991; Martin & Bumpass, 1989), being less conscientious (Kurdek, 1993), problems relating to friends and family (Kurdek, 1991; Fowers et al., 1996), low or differing levels of education (Bumpass et al., 1991) and having dissimilar attitudes (Kurdek, 1993; Larsen & Olson, 1989).
(from Clements, Stanley, & Markman, 1997)

The variables of greatest interest are those that are both dynamic in nature and causal in the development of marital distress and divorce. Related to this, many prospective studies of the prediction of marital distress or divorce have pointed to the quality of the interaction between the partners as highly predictive of future outcomes (e.g., Gottman & Krokoff, 1989; Gottman & Levenson, 1992; Markman & Hahlweg, 1993; Matthews et al., 1996). Studies such as these and their cross-sectional counterparts (e.g., Birchler, Clopton, & Adams, 1984; Margolin & Wampold, 1981) included procedures in which couples' interactions were observed and coded by trained observers to discriminate among couples on current or future level of distress or divorce. To be quite simplistic, many studies such as those mentioned above showed that couples who were either currently doing more poorly or likely to do more poorly in the future interacted more negatively and less positively than other couples. The hallmarks of couples headed for trouble included negative reciprocity, poor affect management, and withdrawal during problem conversations. As Matthews and colleagues (1996) summarized, "The weight of the evidence, then, suggests that the quality of marital interactions, whether warm and supportive or hostile and negative, relates to risk for marital distress and even dissolution of the relationship" (p. 643). In this way, the interaction between two partners appears to be dynamic, changeable, and causal in the development of marital distress and divorce. Prediction studies are so valuable precisely for the hope of illuminating such targets for prevention (or intervention).
(from Clements, Stanley, & Markman, 1997)

In contrast, many of the dynamic variables were important in the prediction of both marital stability and marital satisfaction. In each of the comparisons, groups of couples could be reliably discriminated by dynamic relationship variables. Such findings are consistent with findings using growth curve analyses. Most notably, the work of Karney and Bradbury (1997) demonstrates that behavioral data (from objective coding) are more associated with the slope of these curves than such static dimensions as neuroticism (which are more associated with intercept). Hence, the dynamic factors are particularly telling of the course of marital quality over time. Many other studies are pointing the way to the importance of key dynamic processes and risk over time in marriage (e.g., Gottman, 1993; Levenson & Gottman, 1985; Markman & Hahlweg, 1993; Matthews et al., 1996).
(from Clements, Stanley, & Markman, 1997)

There are many studies providing ever greater illumination of the causes or precursors of marital failure. Effective preventive interventions will, no doubt, address factors that are associated with increased risk in ways designed to lower those risks.

Survey Research

Some key studies tell us what couples think are the most important dimensions for helping them to build stronger marriages from the outset.

In an important, large sample survey recently conducted in the Catholic Church, couples were asked many questions about their premarital preparation experiences. When asked what content areas were most helpful, the top three rankings went to the three "C's" of communicatio n (73.5% rated as helpful), commitment (70.4% rated as helpful), and conflict resolution (67.2% rated as helpful; Center for Marriage and Family, 1995). Rated significantly lower were topics such as personality issues, finances, background compatibility, and career issues (see Silliman & Schumm, 1989, for similar findings). While it is doubtful that most of the premarital programs experienced by these couples were skills-based, it is very clear that these couples who were now well into their marriages recognized the central need for these foci in premarital training. (from Stanley, in press)

The research from the Center for Marriage and Family at Creighton University also found that couples rated high for usefulness such topics as the role of religion and values, children, and the sacraments (Center for Marriage and Family, 1995). Many other topics were rated as useful, but the top six reflected the central role of the topics of communication, conflict, and a number of dimensions that one could say reflect the "bigger meanings" of things (religion, values, commitment, and sacraments).
Outcome Research

Outcome studies attempt to assess the comparable effects of various approaches to preventing or reducing marital distress and divorce. Here is a brief review of findings on three of the most widely used programs for couples--programs that are used both maritally and premaritally (from Silliman, et al., in press). These three programs are among the most commonly researched, used, and recognized in the couples' psycho-education field:

Relationship Enhancement . RE (Guerney, 1977), an empathy-building social learning program of 16-24 hours, is one of the most extensively tested skills building programs in existence. This program based on a Rogerian communication model shows impressive results for a wide variety of types of couples (DeLong, 1993). While the program has been used for treating a wide array of problems, it is use with premarital and marital couples the is in focus here. Related to this use, several treatment groups of college-age, dating couples gained significantly in empathy skills (e.g., Ridley, et al., 1982) and problem solving skills (Ridley, et al., 1981) from pre to post-test and relative to control groups.

One six-month follow-up found disclosure and empathy gains for RE participants relative to a lecture-discussion control group (Avery, et al., 1980), while another found communication, but not problem solving skills retention for experiential vs. discussion group couples (Ridley, et al., 1981). Sustained gains in self-disclosure were not evident at follow-up in comparisons of participants and non-participants in another study (Ridley & Bain, 1983). Heitland (1986) observed significant pre to post-test differences on listening, expression, and problem solving for college and high-school participants in an eight-hour RE workshop, relative to control group couples. Meta-analytic research on many major marital programs (RE, CC, Engaged Encounter; Giblin, Sprenkle, & Sheehan, 1985) found RE to have the strongest effect sizes of those tested.

Couple Communication . Like RE, CC is one of the older and best researched skills-based programs for couples. While the program can be used in a variety of formats and settings, most of the outcome research on CC has studied the effects of the 12 hour, structured skills training program, with most samples being married couples from middle-class backgrounds (Wampler, 1990). There is evidence suggesting the relevance of the material for couples at various stages and with various backgrounds (Wampler, 1990). Miller, et al. (1976) originally developed CC (earlier called the Minnesota Couple Communication Program) to improve communication quality for couples. Miller, et al. (1983) report that small-group participants valued self and other-awareness exercises and the climate of support emerging from the exercises. Studies also show clear gains in communication behavior post training (e.g., Russell, et al., 1984).

Wampler (1990) reviewed studies on CC, noting strong gains in communication quality following training, but also noting that these effects diminish over time. Gains in individual functioning and relationship quality are more durable, although the longest term follow up assessments are well less than a year in duration (Wampler, 1990). CC is used by clergy, lay leaders, therapists, business personnel, and chaplains in all branches of the U.S. armed forces. Presenters of CC can use the approach individually with couples or in group settings. The program was redesigned and updated in 1991.

Prevention and Relationship Enhancement Program . PREP targets changes in attitudes and behavior that are specifically related to risk and protective factors in a wide array of marital research (Markman, Stanley, & Blumberg, 1994; Stanley, Blumberg, & Markman, in press). Stanley suggests that the rationale for PREP (and programs like it) are specifically supported by 1) studies that predict marital success and failure, 2) outcome research on program effects, and 3) survey research on what couples say are the most relevant topics of prevention (Stanley, in press). With regard risks, PREP primarily targets those dimensions that are both highly predictive of marital success or failure, and that are amenable to change (dynamic vs. static factors; Clements, Stanley, & Markman, 1997; Stanley et al., 1995; Stanley, in press).

PREP offers a 12-hour sequence of mini-lectures, discussion, and interpersonal skill practice in week night, weekend, or one-day formats (Markman et al., 1986; Stanley, et al., 1995). Topics of focus include communication, conflict management, forgiveness, religious beliefs and practices, expectations, fun, and friendship (Markman, Stanley, & Blumberg, 1994). Also, strategies for enhancing and maintaining commitment have come to play an increasingly larger role in the kinds of cognitive changes attempted in PREP (e.g., Stanley, Lobitz, & Dickson, in press). Both secular (or non-sectarian) and Christian versions of PREP are available (Stanley & Trathen, 1994). As is true of other programs, PREP is not exclusively focused on skills training. PREP also includes an extensive assessment focus in the form of in depth exercises about expectations and beliefs that will affect marriages.

PREP has been more extensively researched regarding long-term effects than other programs--with most of the research using premarital couples. In the long term study in Denver, program effects have been tracked using both self-report and observational coding of couple interaction (Markman et al., 1988; Markman et al., 1993). The following are a sampling of findings from this research project. Three years following intervention, the PREP couples maintained higher levels of relationship satisfaction, sexual satisfaction, and lower problem intensity than matched control couples (Markman et al., 1988) . PREP participants demonstrated significantly more positive interaction up to four years post-intervention, including greater communication skill, support/validation, positive affect, positive escalation, and overall positive communication relative to a matched control group. PREP couples also showed greater communication skill, positive affect, and overall positive communication than couples who had declined the intervention years earlier (Markman, et al., 1993). More significantly, clear group differences were obtained up to four years following intervention on negative communication patterns (e.g., withdrawal, denial, dominance, negative affect, etc.), with PREP couples communicating less negatively than both matched control couples and decliner couples. These kinds of differences are very important because such patterns are strongly correlated with marital distress, violence, and breakup (Holtzworth-Munroe, et al., 1995; Markman, Floyd, Stanley, & Storaasli, 1988; Gottman & Krokoff, 1989). The follow ups with the Denver sample also revealed a statistically greater chance of premarital breakup among control group and decliner couples than PREP couples, with similar, though non statistically significant, trends for divorce and separation four to five years after training (Markman, et al., 1993).

In a pre-post design using random assignment, Blumberg found PREP more effective than Engaged Encounter in building positive communication, problem solving, and support/validation behaviors at post-intervention (reported in Renick, Blumberg, & Markman, 1992). Similar research programs in Germany (Hahlweg & Markman, 1993; Hahlweg et al., 1997) and Australia (Behrens & Halford, 1994) have demonstrated significant gains in communication, conflict management, and satisfaction at post-test, with the former sample showing a maintenance of communication and satisfaction gains at one and three year follow-ups. Furthermore, the most recent data from the Germany project show that, at the five year follow up, PREP couples have a divorce rate of 4% vs 24% for the control couples (Hahlweg, personal communication, February, 1997). VanWidenfeldt et al., (1996) did not obtain the same kinds of positive findings. However, interpretations of these results are problematic because the PREP couples had been together significantly longer than controls, the PREP couples had been together an average of nine years prior to intervention (making generalizations to prevention difficult), and a differential dropout rate led to the control couples being increasingly select for couples doing well over time.

A large scale, NIMH supported research project is under way in Denver. It is designed to test the effectiveness of PREP as compared to other prevention programs, including conditions for testing PREP when given by clergy or lay leaders of religious organizations compared to university staff compared to natural occurring premarital interventions in religious organizations. In order to address key methodological weaknesses in many outcome studies, this new research utilizes a large sample, random assignment, and plans long term follow up.
(from Silliman, et al., in press)

On a further encouraging note, Giblin, et al., (1985) conducted a meta-analysis of marital enrichment outcome research. In general, they found strong evidence for a positive effect across a number of programs, with those taking such programs being generally better off than about 70% of those not taking such programs. Further, they found that the measures that tended to demonstrate the strongest effects (those perhaps most sensitive to capturing the effects of such programs) were behavioral (e.g., objective coding of interaction). Lastly, they concluded that the programs showing the most promising effects were those utilizing behavioral rehearsal (e.g., skills training). These findings are very important in that they speak in a broad way to issues common in the psycho-educational and prevention literatures. Their results suggest a wide variety of couples and families can benefit from such programs, and in fact, they found some of the strongest effects for those in greater need. The latter finding is encouraging for those focused on prevention since getting those who need help the most to get it is one of the major difficulties of prevention work.




Special Methodological Challenges In Outcome Studies: Selection Effects

Outcome studies are particularly complicated to conduct and interpret. A variety of methodological issues affect these studies. Historically, outcome studies are plagued by such problems as short or non-existent follow-ups, poor measurement, lack of objective measurement, and key selection effects. Selection effects are particularly important to understand in interpreting results in outcome studies.

Selection effects may be the most difficult of all the complications to deal with because so much of what affects them are out of the hands of the researcher. In essence, the key question with regard to selection effects is this: do positive results in outcome studies reflect more about the positive effects of the programs studied or the nature of the couples who "self-select" to choose, remain in, or complete those programs--or the studies assessing effects of the programs--over time? For example, in the long-term study on PREP in Denver, about half of the couples initially offered the program declined to take part in it (Markman, et al., 1988; Stanley, Markman, St. Peters, & Leber, 1995). While the decliners were not different than the acceptors on key variables at time one, it nevertheless is possible that unmeasured effects having to do with accepting or declining such a program account for some of the differences between the PREP couples and control couples (who were not offered the program) over time. While no one really knows, such selection effects could work in favor of positive findings for the program being tested (of course, they could also work somehow against demonstrating positive effects).

Another selection effect common to outcome studies is reflected in differential attrition. For example, in many if not all of the PREP studies, the control couples are both somewhat more likely to break up and/or more likely to drop out the research. This latter occurrence is particularly problematic as researchers may not be able to collect information that is, in fact, directly related to program outcome effects. In other words, if more control couples drop out and do not provide data, and for many of those, the dropping out is actually related to negative marital outcomes, these negative results are unmeasured in the control group to a greater degree than in the PREP groups. Indeed, evidence does suggests that those couples who drop out of these ongoing studies are more likely to be couples who are not doing well (e.g., Markman et al., 1993; VanWidenfeldt, et al., 1996). The combination of either differential drop out and/or break up rates leaves control groups in these long-term studies that are increasingly select for couples doing well--thereby biasing results against significance in favor of the intervention. Hence, this selection effect works against discovering positive effects of an intervention.

Perhaps even more important are selection effects around who considers or takes part in such a program to help their marriage in the first place. A common concern in prevention is that those who most need help may be less inclined to accept it in the first place. Sullivan and Bradbury (1997) found that couples participating in premarital counseling were not those at relatively high risk, while many couples who did participate were at low risk. They note that, in part, higher risk couples may simply be uninformed about the availability of programs that may help them lower their risks. Clearly, to the degree that we have effective programs to offer couples, we must also be able to reach the couples who have the greatest need. On a practical point, this last issue may be more a marketing challenge than anything else. Given that many studies do not assess higher risk couples, and that higher risk couples are far harder to study (e.g., because of differential attrition), assessing these effects is also a very strong methodological challenge for researchers conducting outcome research.




TheCore Message From Prediction Research,

Survey Research, and Outcome Research

While much more research can and will be done, the overwhelming weight of these streams of research points towards the importance of targeting such dimensions as communication (interaction patterns), conflict management, attitudes and beliefs (e.g., cognitions), and the big meanings of things--e.g., core beliefs pertaining to faith and commitment This is seen in prediction studies that demonstrate the crucial role of interaction patterns and processes, outcome studies showing encouraging effects from a number of programs that focus on communication and conflict management, and the survey studies wherein the couples are plainly telling us what matters most to them.

This is what we would be the very most encouraged about in the field of prevention this convergence from very different research paradigms and very different researchers on the targets for preventive work most likely to yield positive effects. Based on the current state of marital research, efforts designed to lower risks for couples should be addressing these kinds of dimensions. A good number do and many do not, but we do believe more practitioners than ever are paying attention to the research and shifting what they do based on what they hear. In fact, we note an increasing focus on dimensions such as those above in the types of premarital prevention being done in communities, and we believe that this is in response to greater awareness of the kinds of research that do exist.

To summarize, the good news here is that we really do know more than ever about where to target the efforts of interventions likely to be the most effective in helping couples stay married and stay happy. This is information that is usable now to those working to educate couples for better marriages. Further, the field can continue to be responsive to research findings as they become available and further inform our understanding of risks in marriage and ways we might attempt to lower those risks.

What Do Couples Report About Their Satisfaction With Premarital Training?

Separate from data on effectiveness from outcome studies, most couples report high satisfaction with their experience in preventive/premarital programs.
  • In a nationwide random phone survey, 35% of couples marrying in the past five years had premarital counseling in a religious context, and 75% of these couples reported that this preparation was helpful to them (Stanley and Markman, 1997).

  • The Creighton University report on premarital preparation in the Catholic church found that, within the first four years of marriage, 80% of the individuals surveyed reported the training as valuable (Center for Marriage and Family, 1995).

  • Sullivan and Bradbury (1997) found that approximately 90% of couples who taken premarital training would choose to do so again--though there were no differences between those who did and did not have some premarital training on marital outcomes.

Couple satisfaction with preventive interventions is an important measure of outcome. While the studies on program effectiveness are complicated and open to various interpretations, there can be no doubt that couples who take part in preventive experiences come away valuing these experiences.

PREP: an Example of an Empirically Based Program Designed to

Reduce or Prevent Marital Distress and Divorce

I believe that there are many sound programs in existence that can be used in the service of helping couples prevent marital distress and divorce. Having been involved with the research and development of PREP (The Prevention and Relationship Enhancement Program) for 20 years, it is easiest for me to describe it as an example of a program based on empirical research and geared toward preventing marital failure. To do this, we will excerpt from recent writings on PREP. A discussion of research findings from different studies on this approach was provided earlier.

Theoretical Underpinning

PREP is based on the cognitive/behavioral tradition of change, with significant influence coming from the field of behavioral marital therapy. Therefore, the focus is on ways of thinking (attitudes and expectations) and behaving (communication and conflict management) that are associated with marital success and failure. The skills oriented approach rests on the assumption that couples can learn new behaviors that can help them prevent the deterioration in relationship quality commonly seen in marriage. In addition to the cognitive/behavioral roots, PREP is largely based on a broad range of marital research.

By taking into account a broad range of empirical findings on marriage, one can develop a rich model of marital success and failure. The current version of PREP is based on the seminal research on communication begun in the 1970s (e.g., Gottman, Notarius, Gonso, & Markman, 1976; Guerney, 1977; Markman, 1981; Miller, 1971; Wampler & Sprenkle, 1980) with the addition of concepts and techniques from more recent research bearing on such dimensions as conflict management, gender differences, commitment, religion, cognitions, fun and friendship (Stanley et al., 1995).
(from Stanley, Blumberg, & Markman, in press)




Intervention Model

While it is not always possible to help couples before distress develops, prevention is strongly preferred to interventions that come after much damage has already occurred. A framework now gaining popularity in prevention efforts draws attention to the key goals of reducing riskfactors and raising protective factors (e.g., Coie et al., 1993). Consistent with the theoretical model of marital distress just covered, and this framework for prevention, PREP has four major goals. The two key goals under the rubric of reducing risk are to teach couples better communication and conflict management strategies, and to aid couples in clarifying and evaluating expectations. The two key goals under the rubric of raising protection are to boost understanding of and choices reflecting commitment, and to enhance the positive bonding that comes from fun, friendship, and sensuality. These aims (described in more detail below) are accomplished using cognitive-behavioral strategies, seeking to directly modify cognitions and behaviors associated with marital success and failure.

As discussed earlier, many couples experience the erosion of their relationship as they encounter the problems of life together, but have not the skills for coping with those problems. Even without encountering problems per se, many couples have styles of interaction that are inherently irritating to the partners. That is why PREP focuses so much on communication, conflict management, expectations, and commitment. Whatever the background, problems, and differences two people face, it is how they handle these issues that will be the key determining factor as to whether they grow more deeply together or further apart as they go through life. Importantly, PREP focuses on key factors that are both strongly related to the ongoing health of relationships, and that are also changeable through education and skills training.
(from Stanley, Blumberg, & Markman, in press)

Cognitive-behavioral programs focus very actively on directly influencing interaction (and thinking). The core belief reflected in this is that it is the immediacy of the interchange between two people that most directly affects the story of a marriage over time.
(from Stanley, in press)

When couples are not handling their differences and disagreements with some level of respect and teamwork, these negative experiences grow to destroy all the more positive elements that drew the two partners together in the first place. Negative interaction and negative interpretations of the motives of one another are acids that actively eat away at the positive bond between spouses over time.

Prior to the wedding day, most first time married couples have had few tests of their ability to handle conflict. They simply have not encountered many significant issues or disagreements during courtship. That is partly why satisfaction tends to be very high at this stage (Stanley & Markman, 1992). Yet, there's clear evidence that how couples communicate and handle conflict foretells an important story about their future--more important than their premarital level of satisfaction (Markman, 1981; Markman & Hahlweg, 1993). Over time, this committed couple must increasingly deal with the problems of life, together . This explains why so many couples can start out so committed and so happy only to find their attachment being eroded by the constant dripping of unresolved and upsetting conflicts.

What they argue about and how they argue is a function of both expectations and their abilities to communicate and negotiate effectively--most of which is based on previous experiences in life with family of origin, past relationships, and the cultural context. Certain patterns of mismanaged conflict that are destructive for relationships will be repeatedly expressed in many couples (Gottman, 1993; Gottman & Krokoff, 1989; Markman, Stanley, & Blumberg, 1994; Notarius & Markman, 1993). Out of this mix, a very important change occurs over time in the relationship: the presence of the partner becomes increasingly associated with pain and frustration, not pleasure or support . For most couples, this violates a basic assumption about what being together is about--having a most intimate and supportive friend for life.
(from Stanley, Blumberg, & Markman, in press)

In part, PREP and other cognitive-behavioral approaches teach couples positive communication and conflict management skills for counteracting and limiting specific negative patterns (in thought and deed) so that the more positive bond in marriage can continue to bloom.
(from Stanley, in press)




Negotiating Everything and Dealing with Gender


Probably one key reason for the increases in the rates of marital failure is growing affluence of out society (Whitehead, 1997). This affluence brings increased opportunities of all kinds, which in turn means better alternatives for people when and if their marriages become dissatisfying. Alternatives and the quality of them is a key concept in the literature on commitment (e.g., Johnson, 1982; Rusbult, 1983; Stanley & Markman, 1992; Stanley, Lobitz, & Dickson, in press). Along with increasing options for people, women in particular have seen a great increase in financial options that exist independently of men. This has probably changed the dynamics between men and women such that women have more power than they used to have in their marriages, on average, and therefore less incentives against leaving if their marriages are chronically painful.

In this sea of upheaval, part of what has changed so much is that couples are less likely than ever before to enter marriage with a given, mutually understood set of roles and expectations. While those marrying from similar backgrounds may still have a relatively more "given" set of expectations going into marriages, more and more couples marrying today have a great deal of work to do in figuring out "what are the rules here?" This means that couples have to negotiate so much more than they used to, just to get along. When you combine this fact with the research suggesting how crucial it is for couples to handle differences and conflict well, it is easy to make the case that attempts to help couples lower the odds of marital failure should include great attention to strategies for handling differences and disagreements well, and also for exploring and sharing key expectations.

PREP has a particularly strong focus on helping couples understand some of the ways in which gender differences can commonly be displayed in how conflict is handled. For example, a commonly reported pattern in the marital literature is that of females pursuing talking about issues and men withdrawing from or avoiding such talking. While this pattern can be seen in either direction, it is more common to find the stereotypical pattern. While some might interpret this as having to do with deficits in handling intimacy among males, there is more evidence that these patterns reflect the likelihood that males, in general, do not handle conflict as well in marriage as women (see Markman & Kraft, 1989 for a fuller discussion; see also Christensen & Heavey, 1990; Levenson, Carstensen, & Gottman, 1994; Markman, Stanley, & Blumberg, 1994). It is not that women like conflict more, they just seem better able to manage it than men--at least in marriage. (There are, however, complicated and somewhat contradictory findings about the health implications for men and women of distressed marriages that are beyond the scope of this discussion).

Therefore, we believe that approaches are wise to address key gender differences. It has been our experience in many settings with a wide range of groups that the kinds of techniques taught in PREP are widely acceptable to couples of diverse views on roles--both traditional and egalitarian. Regardless of the beliefs a couple espouses about roles and gender, men and women generally seem very appreciative of an approach that helps them to communicate with respect, work together on problem solving, and keep conflicts under some control. No matter how individual couples understand gender and roles, when a marriage is going well for both, the process usually looks like teamwork. PREP and approaches like it can help couples preserve and enhance this sense of going through life as a team.

A key point to realize in all of this is that patterns that are commonly assumed to be more associated with males vs. females when it comes to conflict in marriage are really patterns mostly associated with degrees of marital distress. Common negative patterns such as pursuit and withdrawal are simply not good for marriage. In PREP, we reassure couples that these kinds of patterns are common, but we also link them integrally to the concept of Danger Signs (Markman, Stanley, & Blumberg, 1994). Various studies attest to the negative impact of such patterns (Christensen & Heavey, 1990; Levenson, Carstensen, & Gottman, 1994; Stanley & Markman, 1997). So, what might be normal is not necessarily good for two people trying to stay married and stay happy. Preventive approaches can often avoid the "gender war" by focusing on helping two people who love one another to work together in ways that both can appreciate.

Simple wisdom suggests that effective approaches to prevention will pay some attention to the issue of gender: what men and women expect, and how they handle the process of the marriage.

"Big" Meanings: Are We "Getting It"

The field of marital research is increasingly turning attention to what we would call the "big meanings" of things. While the earliest research focused on marital satisfaction, the next great wave (which continues strongly) focused on interaction. Now, the field is increasingly turning to such topics as commitment, friendship, support, forgiveness, and faith and values. This trend reflects where couples have been all along. After all, couples do not marry to have someone to have conflicts with, they marry to have a life long best friend--a real mate. Programs designed to help couples have great marriages are and will be turning increased attention to how couples can nurture and grow in these more wonderful aspects of marriage. However, the role of good communication and conflict management is unlikely to diminish because when issues are not routinely handled well, the experience of repeated negative patterns can do great damage over time to the positive bond between mates. Hence, a balanced approach to prevention and marital education will include attention to both lowering key risk factors and raising key protective factors for couples (Stanley et al., 1995). We expect an increasing focus in the field of prevention on teaching couples strategies for preserving and protecting the positive experiences of marriage.




Three Key Educational Strategies for Prevention

Those working to prevent marital distress and divorce have a variety of educational strategies to call upon. The following are common strategies that find sound basis in the understanding of risk and protective factors in the existing marital literature. Sound preventive efforts will focus on these strategies in varying degrees. In each of these strategies, the focus can be on risk factors that have been identified in empirical research. Therefore, the prevention strategies chosen can at least be based on a plausible model of risk factors for couples (as opposed to being focused on factors that no research or even sound theory would indicate are all that important in the real risks that couples face).

Raising Awareness . One kind of change that prevention programs can attempt is in the area of people's awareness about key findings from research. As mentioned above, we know far more than ever before (and need to know even more) about risk factors. We believe that couples can make use of this kind of information. For example, in PREP, we highlight key Danger Signs from empirical research, in part, to make the participants more aware of the kinds of patterns that will harm their relationship if not kept in some check. We believe raising awareness about such matters is an intervention in itself.

Fostering Change in Attitudes and Belief . Another kind of intervention that can be attempted in prevention programs are changes in how people think. The targets here can be of many forms. For example, ways of thinking and acting that are associated with greater levels of commitment (especially dedication to one another) can be emphasized based on empirical research (Stanley, Lobitz, & Dickson, in press). Or, kinds of dysfunctional thinking (e.g., chronically making negative interpretations about the motives of one's mate) can be identified with strategies given for helping overcome such biases in perception (e.g., see Markman, Stanley, & Blumberg, 1994). Lastly, an important target for such cognitive interventions would be unrealistic expectations that can lead to higher levels of frustration and lower levels of satisfaction (Eidelson & Epstein, 1981).

Skills Training and the use of Structure. Many programs, including PREP, go directly at changes in the behavioral exchange between partners. To us, one of the most promising foci here lies in attempting to teach couples positive skills for directly countering key negative patterns. The positive skills training components in a program like PREP are therefore primarily focused on reducing the negative patterns that are so corrosive of the marriage bond over time. The idea of structure embodies a belief that couples can benefit from having agreed upon ground rules for handling issues a certain way. For example, agreeing to use Time Out or to shift into more constructive modes when damaging interactions are likely to occur (see Stanley, Blumberg, & Markman, in press for more theoretical detail).

Key Opportunities for Prevention

Opportunities to impact couples are somewhat limited. It is hard to get a couple's attention when they are happy, and it is often too late to get their attention when they are already seriously distressed. This means that we should focus on key access points where windows of opportunities exist. In fact, preventionists have long recognized the value of focusing on key transition times in life (e.g., Markman et al., 1986). Two key transition times that offer clear opportunities for working with couples are the transition to marriage and the transition to parenthood (e.g., Jordan, 1995; Stanley et al., 1995). It is at such times of transition that couples are most likely to seek the services of institutions that are mindful of prevention. For example, 74% of couples marrying for the first time do so in a religious context (National Center for Health Statistics, 19xx). While some may argue that couples could get more out of prevention a little further into marriage, the opportunities for prevention come when the couples come to the preventionist. Hence, premarital preventive efforts are likely to be particularly possible in the context of religious organizations at the transition to marriage point (Stanley et al., 1995; Sullivan & Bradbury, 1997). At times such as transition to parenthood, religious organizations as well as health care organizations have natural access to couples.


Why Religious Institutions?
We recognize that to fully realize the goal of preventing marital distress, we must not only develop sound, tested interventions, but these interventions must also be used by practitioners who are motivated and capable of delivering them. With this in mind, we have started to examine how programs like PREP may be used within religious organizations (e.g., churches and synagogues).

Religious organizations comprise the single largest array of institutions in our culture that have both a great interest in preventing marital breakdown and the capability to deliver premarital (and marital) interventions such as PREP. We see four key reasons why these organizations can play such a great role in the work of preventing marital distress and divorce. First, most couples get married under the auspices of a religious organization. Second, religious organizations do not need to be persuaded that the goals of preventive interventions are important (Spilka, Hood, & Gorsuch, 1985). Third, religious organizations commonly have traditions and structures for delivering educational programs which are consistent with the values emphasized (Trathen, 1992). Finally, because religious organizations are more deeply embedded in their respective cultures than other organizations (such as mental health agencies), cultural resistances and barriers which other institutions may encounter (e.g., the mental heath system) are likely to be greatly lessened (Bloom, 1985). (from Stanley, Markman, St. Peters, & Leber, 1995)




The Necessity of a Long Term Approach to Prevention


Working with couples at key transition points is a good opportunity for prevention. However, ongoing effective prevention will really require much more. While data from outcome studies are encouraging for the effectiveness of PREP and other programs, there is no evidence or particular reason to believe that the effects are of a nature that should last a lifetime. Both for reasons having to do with the effects of attrition in these studies and a probable weakening of effects over time, studies that we are aware of do not show clear group difference beyond five years or so. This suggests that, even for effective interventions, it will be wise for couples and those who work with couples to consider ongoing interventions to maintain preventive effects. In essence, this kind of prevention should be thought of as the kind of inoculation that we give our children early in life that require occasional boosters shots to maintain effectiveness. Such booster effects would probably be most effectively given and maintained within community environments such as churches and synagogues.

Perhaps just as importantly, couples need ongoing supports for their marriages. In a society where people are increasingly mobile, and therefore disconnected from families and other long term supports, this fact becomes all the more crucial. Long term, effective prevention will include some attention to the matter of long term supports for marriage.

  • Summary

 

Many exciting advances are taking place in the fields of marital research. There is much we need to know and much we already know. A substantial body of knowledge exists that can inform (and does inform) current efforts at prevention around the world. There are many highly motivated and dedicated people across disciplines who are interested in the work of prevention. Further, we think key leaders in these disciplines have been responsive to the knowledge gained in the ever growing research base. Twenty years from now we will probably be doing things somewhat differently based on new research. However, if one is to act now, the existing body of research provides substantial guidance regarding the key risk factors associated with marital failure and the probable best strategies to attempt to modify those risks. We are encouraged by how far we have come, but do not want to diminish how far we need to go.

Not only do we need to continue to refine our understanding of marital failure--it's causes and the best hopes for prevention--we need to do a far better job of getting the existing knowledge out to people who have the most direct contact with couples (Stanley, et al., 1995). Therefore, we close by emphasizing these two crucial tasks for the field to continue to pursue:

1) It is important to continue funding for basic marriage research that can better inform the tasks of prevention.

2) It is crucial to continue increasing efforts to disseminate knowledge gained in the laboratory to practitioners in the field.

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