Assessment

BMT has a fairly distinct tradition of beginning the couple evaluation process by employing three or four different methods of gathering information to understand the problems and strengths of a given relationship and to plan various interventions to accomplish the therapeutic goals. First, there are a series of semi-structured clinical interviews, typically 2 to 3 sessions, which often include separate meetings with each partner as well as meeting the couple in a conjoint format. In general, the objectives of these so-called assessment interviews are to (1) screen clients for the appropriateness of couple therapy, (2) determine the nature and course of events related to partners' presenting complaints, (3) determine the goals and objectives of the partners for couple therapy, (4) establish an effective therapeutic relationship, and (5) orient the couple to the therapist's orientation and approach to treatment.

Each partner has one or more reasons for initiating couple therapy. Typically, in the first meeting, the therapist will help the partners to develop a problem list, which indicates each person's perception of the various problems in the relationship. Problems can be categorized into matters of content and process. Problematic content areas often include finances, sex, dealing with in-laws, raising children, struggling with partners' annoying personality traits or mental illnesses, or coping with specific stresses that adversely impact the marriage, such as unemployment, major physical illnesses, or other traumatic events external to the couple relationship. Process concerns have to do with how the couple interacts. Typical complaints include ineffective ways of communicating with one another and discord regarding how they attempt to solve problems and manage marital conflicts.

It is also important during the evaluation stage to ascertain the partners' respective goals and expectations for couple therapy. For example, are they both committed to the relationship or is one partner planning separation or divorce? Are the identified problems negotiable for both partners? Are their goals and expectations realistic given partners' levels of competence and motivation? Before making a viable treatment plan, all these interpersonal competence and motivational issues must be considered. Finally, the initial interviews allow for the therapist to establish a therapeutic relationship with the couple. The therapist must gain sufficient credibility and trust and offer hope that the partners' pain, suffering, dissatisfaction, and distress can be addressed effectively. If this step is not accomplished, likely the couple will not continue with therapy. One way to aid in the accomplishment of this preliminary bonding is to explain in advance the purpose and value of the various evaluation and intervention procedures. What is expected from the clients? What are the role and responsibilities of the therapist? How will information be gathered and what is the prognosis for resolving their problems? An open discussion about what will be done and why is another hallmark of the BMT approach.

A second fairly unique assessment procedure used in BMT to gather diagnostic information about the couple is the administration of various questionnaires and inventories to learn about specific strengths and problem areas. The discussion of specific measures is beyond the scope of this article. Suffice it to say that there exist several standardized measures that are designed to assess one or more of the following variables: global relationship satisfaction; communication skills and deficits; areas of change requested by the partners; types of conflict; intensity levels of conflict and styles of conflict resolution; partners' cognitions, expectations, and beliefs about the relationship that may be causing problems; sexual function and dissatisfaction; participation in pleasurable events and rewarding social activities; and steps toward divorce. BMT practitioners typically ask the couple to complete a selected set of these instruments either before or at the very beginning of the evaluation process. Often feedback and interpretation of the results are given to the couple regarding their responses.

The third assessment procedure that is routinely associated with the practice of BMT is observation and analysis of a sample of in vivo marital conflict interaction. That is, couples are helped to identify an existing issue about which they have disagreement; they are asked to spend 10 to 15 minutes in the session talking together in a demonstration of just how they go about attempting to resolve an existing marital conflict. The therapist may or may not leave the room to less obtrusively observe and/or to videotape the communication sample for later review and analysis. The conflict resolution communication sample provides unique and important information regarding the level of problem-solving skill the couple possesses to resolve relationship conflicts and the extent to which improvement in these processes will become treatment goals.

In many programs associated with BMT, a fourth assessment procedure involves asking partners to collect data about events and interactions that occur in their home environments. In an attempt to obtain reliable information about the baseline (i.e., before treatment) frequency of certain events (e.g., arguments per week in which either partner loses one's temper), partners may be asked to observe and count the frequency of these events. Accordingly, later when treatment interventions are introduced, partners may again be asked to count these events to determine if improvement has occurred. Some BMT programs gather these data as part of the assessment stage; others may postpone this so-called spouse observation procedure until the formal intervention stage of treatment.

In conclusion, the multimethod assessment procedures employed by BMT practitioners provide both converging and diverging types of information that are used in a systematic manner to conceptualize relationship dysfunction (and relationship strengths) and to formulate a treatment plan (i.e., interventions).

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