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Article 20

Brief Couples Relationship Enhancement Therapy/Enrichmentand Prevention

Barry G. Ginsberg

Relationship enhancement therapy (RE),developed by Bernard G. Guerney in the 1960s(Guerney, 1977), combines psychodynamic, behavioral,communication, experiential, and relationship (family)systems perspectives into an integrative whole. Thisapproach was one of the earliest to recognize thebenefits of an educational skill training model over thetraditional diagnosis and treatment model that has beenpopular for decades. Central to the development of REis the belief that one’s personality is shaped by his orher relationships, which in turn shape relationships overthe life span. The individual is seen as developinginterpersonal reflexes, which trigger the same kind ofresponse in others. These reflexes or habits are seen asautomatic and nonconscious and operate reciprocally(Leary, 1957, Shannon & Guerney, 1973, Sullivan,1947). From this perspective, Guerney conceived ofthe idea of training people in constructive relationshipskills, which became the foundation of RE therapy (Ely,Guerney, & Stover, 1973; Guerney, 1964).

From an RE framework, the key issue in a couple’srelationship is their ability to maintain a context ofintimacy and engagement that allows them toexperience a sense of trust and security in which theycan be “safely vulnerable.” Couples can do this if theyfeel attached, which in turn depends on their ability toemotionally engage with one another, a quality thatenables people to develop in healthy ways and to trustthemselves.

Interpersonal reflexes, or the ways in which aperson habitually relates to others, almost certainlyinfluence how two people come together to form asignificant and intimate relationship. Once therelationship becomes significant, these reflexes (habits)become the signposts around which emotionalengagement can deepen. In the process, each partner’sreflexes are modified to accommodate the other’s. Newhabits then evolve that help secure the relationship.Stress and conflict arise from this process and provideopportunities for change. It is important for therelationship to be flexible enough to cope with theseforces; at the same time, the couple has to remain

sufficiently emotionally engaged to maintain the trustand security of the relationship (Ginsberg, 2000).

Stress and conflict, then, are the vehicles that bothchallenge the degree of emotional engagement betweentwo people, and often provide the opportunity to deepenthis engagement. The key in couples therapy is not todirectly help couples solve problems, but to have themskillfully maintain emotional engagement under stress.In fact, it is likely that a couple’s difficulty in resolvingconflict has more to do with emotional disengagementthan with an inability to solve problems. RE attemptsto help couples return to closer, more intimate levels ofemotional engagement and to help them learn the skillsnecessary to maintain the security of their relationship.In particular, couples are asked to not make judgmentsor accusations, and to not ask questions while listeningto one another. Instead, they are asked to acknowledgethe underlying feelings that motivate their spouse’sexpressions and actions. They are asked to avoidjudgment and acknowledge (own) their feelings whenspeaking. This helps to keep the relationship on a moreequivalent basis.

By agreeing to follow these rules, couples createa relationship context that reduces the frequency ofcriticism and prevents stonewalling. Specifically, whencouples stop judging each other, they become lessdefensive – defensiveness is a hallmark of all troubledrelationships – and embark together on a process of“softening,” which refers to a change in the hardnessof the quality of confrontation. Acceptance is animportant variable in this softening process. Accordingto the precepts of RE, nonjudgment and acceptance aretaught together, because these two skills are integrallyrelated. When a member of a couple acknowledges thefeelings of the other person while inhibiting his or herown feelings and judgments, that person is practicingnonjudgment and acceptance.

In RE, couples learn to access their internalexperience by exploring the emotions that motivatebehavior. When people perceive that an interpersonalcontext is safe enough, they are freer to reveal thesemotivating feelings to themselves as well as their

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partners. RE rests on three core skills that, takentogether, allow couples to become emotionally engaged.

The first is the expressive (owning) skill. Bypracticing ownership, each member of a couple learnsto recognize his or her own feelings, to takeresponsibility for them without projecting them ontoothers, and to assert them. Empathic responder(receptive), the second skill, enables each partner towait longer before expressing his or her own feelingsand perspective, to understand the underlyingmotivations (feelings) of his or her partner, and toincorporate this understanding into his or her ownexpression.

In RE, each member of a couple practicesexpressing his or her feelings and owning these feelings;this then enables each person to accept the other. Byreciprocally practicing the skill of acknowledging theinternal experience of the other—through receptivelistening—a context of acceptance is created.Ultimately, through supervised and then unsupervisedhome (audiotape) practice, couples learn to create anongoing relationship context of acceptance that operatesin their day-to-day lives. Establishing this context is acritical outcome of RE therapy.

The third core skill of RE—the relationship orconversive (discussion-negotiation/engagement) skill—solidifies emotional engagement. This critical skilldepends on the ability of each person, afterunderstanding the other person’s feelings, to givemeaning to the importance of the relationship, that is,to make a connection to their shared internal experience.To practice the conversive (emotional engagement)skill, one partner is designated as the expresser or“speaker,” and is instructed to say “switch” when he orshe wishes to stop talking and begin listening (empathicresponder). In other words, couples are asked tomaintain distinct positions of either listener or speaker,and agree that the speaker is responsible for switchingthese positions. This acknowledges the fact that thespeaker is in the more vulnerable position. At the switch,the new speaker (the former listener) must then indicatehow he or she feels to know his or her partner’s feelingsabout what was just expressed (e.g., “I feel bad thatyou were hurt by…”). Then he or she can express theadditional thoughts and feelings that he or she wantshim or her to know and acknowledge.

The conversive skill encompasses two componentskills: the ability to interact and to engage. Theinteractive component (discussion-negotiation) helpscouples learn to differentiate from one another (whento speak and when to listen); the engagement componentfosters emotional engagement (your feelings meansomething to me and elicit feelings in me as a result).In those cases in which the conversation takes place in

a climate of openness and acceptance, couples are ableto both interact independently and to emotionallyengage with each other.

Two additional RE skills are generalization andmaintenance. These two skills are included with owningexpression, receptive listening, and conversive(discussion-negotiation/engagement) skills as the coreRE skills. The success of the therapy/enrichment liesin clients’ abilities to extend to these skills to theireveryday lives. The development of a client’sgeneralization and maintenance skills begins with thevery first session of RE.

As couples learn and apply these skills, they createan ongoing context of acceptance and engagement.Once couples begin to grasp the core skills and perhapsbegin to practice them at home, other skills can beincorporated into the learning process. Secondary skillsinclude problem/conflict resolution, facilitative, self-change, and helping others. It is the author’s belief thatmost couples learn these related skills as an outgrowthof practicing the core skills and are specifically taughtonly when pertinent to a particular couple’s needs.Booster and refresher sessions are scheduled to supportgeneralization and maintenance and enhance theoutcome (Ginsberg, 2004).

Relationship enhancement is a powerful andeffective approach when working with couples. Becauseof its emphasis on skill training, it reduces defensivenessand elicits the positive motivations that make theoutcome successful. The structured, systematic, andtime-designated nature of RE (Ginsberg, 2000) helpscouples learn to create a safe, secure, and intimatecontext in their own lives.

Probably the most difficult aspect of couple’stherapy is engaging couples under the conditions ofconflict and high arousal levels. In fact, it is likely thatthese factors and how the therapist responds to themare critical to the success of the therapy. The REtherapist integrates dynamic, didactic, and structuringmethods to help couples use RE skills (empathicresponding, owning of one’s own motivation[expressive skill], and the conversive skill) to connectwith the underlying positives, love and the importanceof the other person. In other words, the therapist engagesthe couple in a constructive way to elicit the positivefeelings and resources underlying the relationshipeasing the emotional arousal that leads to conflict anddisengagement.

Helping couples learn and apply the core RE skillsin their everyday lives is the key to sustaining emotionalengagement and improving their coping skills. It isessential that the RE therapist act as a model for clientsas this enhances learning and fosters trust. In particular,the therapist employs good interpersonal skills such as

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genuineness, empathy, and acceptance. Furthermore,the RE therapist uses his or her skills to emotionallyengage clients without being triangulated into thedynamics of their relationships.

Effective RE therapists draw upon the principlesand skills of RE. Two essential attitudes that affecttherapist effectiveness are having humility regardingone’s ability to understand and directly influence theclients’ problems, and having trust in the clients’ abilityto resolve their own difficulties. The very idea of helpingthem learn skills is based on these attitudes. REtherapists have developed good teaching skills that helpclients see that learning RE skills could have a positiveimpact on the quality of their relationship and theirproblems. RE therapists also believe that clients canlearn the skills and change, and can be motivated topractice and maintain the skills over time.

Therapists must create a climate that is safe andtake responsibility to maintain this safety during theprocess of therapy. The principles and structure of RE(including the rules of conversation) provide aframework to accomplish this. Therapists also need tomaintain fairness and impartiality while being free toform coalitions to balance power.

The RE therapist draws upon these skills andattitudes, and applies them in a structured, systematic,and time-designated way to foster softening andemotional engagement in couples’ relationships. Withincreased softening and emotional engagement, couplesare able to reduce the frequency of conflict; recovermore quickly; and collaborate in more mutual andsatisfying ways. With continued home practice,supervision with the therapist of audiotaped homepractice and periodic booster sessions, couples continueto improve and are less likely to regress to former habitsof conflict and disengagement.

The shift to an educational skill training andprocess-focused approach from a diagnosis-treatment-cure and problem-solving approach can be difficult.After all, couples come to us with the hope that we canhelp them solve their problems. In the educational skill-training approach, therapists accept and recognize thatproblem solving is dependent on the couple’s ability tocollaborate. Once they are more skillful in mutualunderstanding and acceptance, problem solutionbecomes easier. This eases their dependence on thetherapist for problem solution and gain mastery. As thetherapy (skill practice) becomes more home centered,a relationship context emerges that is collaborative,constructive, and emotionally engaged. This is theoutcome we most want in all our relationships.

It is important to note that when therapistsembrace an educational model, they do not make adistinction between amelioration and prevention

(therapy or enrichment). These methods can be offeredto all couples whether in crisis or just interested inimproving their relationships.

References

Ely, A. L., Guerney, B. G., Jr., & Stover, L. (1973).Efficacy of the training phase of conjugal therapy.Psychotherapy: Theory, Research, and Practice,10(3), 201-207.

Ginsberg, B. G. (2000). Relationship enhancementcouples therapy. In F. M. Dattilio & L. Bevilacqua(Eds.), Comparative treatments of relationshipdysfunction. New York: Springer.

Ginsberg, B. G. (2004). Relationship enhancementfamily therapy. Doylestown, PA: RelationshipEnhancement Press.

Guerney, B. G., Jr. (1964). Filial therapy: Descriptionand rationale. Journal of Consulting Psychology,28(4), 303-310.

Guerney, B. G., Jr. (1977). Relationship enhancement:Skill training programs for therapy, problem,prevention, and enrichment. San Francisco: Jossey-Bass.

Leary, T. (1957). Interpersonal diagnosis of personality:New York: Ronald.

Shannon, J., & Guerney, B. G., Jr. (1973). Interpersonaleffects of interpersonal behavior. Journal ofPersonality and Social Psychology, 26, 142-150.

Sullivan, H. S. (1947). Concepts of modern psychiatry.Washington, DC: William Alanson White PsychiatricFoundation.