How CBT Can Be Used To Improve Relationships

8.1 Introduction

Relationship problems affect many couples and families and these issues manifest in a number of ways. In this module, you will learn about the root cause of problems within most common problems, how they are conceptualised within the CBT paradigm and how CBT practitioners work with clients to improve their relationships. CBT can reduce the risk of divorce and, if a couple makes the decision to end their relationship, it will improve their chances of finding a healthier relationship in the future.

CBT can be used to help couples and families resolve their differences and relate in a healthier manner and it can also be used with single people to equip them with the tools they will use in future relationships. The end of a relationship can be traumatic and CBT practitioners can play a role in helping someone move forward with their life. This module focuses primarily on romanticrelationships, but the basic principles can be applied to family relationships.

Fact

There are over 100,000 divorces in the UK each year.

Source: www.ons.gov.uk

8.2 Where Do Relationship Problems Stem From?

In the same way that cognitive distortions, negative emotions and maladaptive behaviours can cause an individual to develop psychological problems, they can also trigger problems in relationships. Conflicts between two or more individuals usually arise because neither party fully appreciates the other's point of view or possesses the skills required to resolve problems within the relationship.

When two people arrive in a relationship with different expectations around communication styles, the stage is set for misunderstandings and conflict unless they both make a conscious effort to relate positively to one another and to appreciate that their perspectives will be different. Unfortunately, good communication in relationships is a daunting task, particularly for people who were not encouraged to express their emotions or work out disagreements in a constructive manner when they were growing up.

Activity: What Problems Bring Couples to Therapy?

Estimated time: 5+ minutes

Why do you think a couple might decide to attend therapy? Try to identify at least three common causes.

Do you think CBT may be more effective for some problems than others? Why?

8.3 How CBT Can Be Used to Improve Relationships

Clients seek help due to the fact that when relationships suffer, the people involved suffer too. CBT interventions can improve relationships in different ways.

For example

A teenaged boy could be hurting because his socially anxious parents don't allow him to mingle with his friends. A young girl may rebel against her father whose authoritarian behaviour has alienated her from the family. Another client may be suffering because he or she feels that the parents treated their siblings much better than themselves.CBT interventions for couples and families are usually targeted at all the individuals involved.

Some major benefits include:

1.It trains people to be actively engaged and present in the relationship

2. Reduced anxiety helps relieve the relationship of additional strain motivates clients to be more enthusiastic by encouraging behavioural activation and communication

3.Therapy helps with sleep management; couples or families who feel well-rested and relaxed are more likely to relate better

4. It helps children and parents adjust to fears and anxieties and leads to happier families

As therapy progresses, the couple or family develop healthier and more positive thought patterns which in turn drive empowering behaviour

8.4 Why Might a Couple Seek Out CBT?

Couples seeking help usually fall into three groups. Couples may attend CBT following a traumatic or difficult outside event that has placed their usual methods of communication and relating under strain.

For example

A couple may report that they have enjoyed a good relationship for several years, but have started to fight more often and feel distant from one another since their child was born. In the same way that an individual may become psychologically distressed following an adverse life

event, a previously healthy relationship may require assistance during life's more trying times. In these cases, the couple typically report feeling basically happy with one another and wish to collaborate in working out their issues. Other couples attend therapy because one or both parties acted in a manner that places the relationship or another person under threat.

Examples

Infidelity - If one person commits infidelity, the relationship will be changed forever.

Addiction - Partners of addicts often report feeling depressed, helpless and conflicted - they want to stay with the person they love, but they suspect that their quality of life will improve if they leave the relationship.

If one person no longer trusts the other, their motivation to engage in the therapy process will be significantly impaired. If the couple have been having disagreements or have been engaging in dysfunctional patterns for many years, there may be a shortage of goodwill on both sides.

Finally, a couple may decide to seek help because one or both members feel dissatisfied in a general sense. They might have no specific problems, yet are entertaining the idea that the relationship may have run its course. Upon closer inspection, these couples have usually adopted negative patterns that have endured for months, years, or even decades.

For example

One member of the couple might always have preferred to go out several times each week and entertain friends at home at the weekend, whereas their partner always favoured a quiet life. If they never established how to compromise in key areas, their relationship would soon begin to decline.

Fact

In the UK, 42% of all marriages end in divorce.

Source: www.diemlegal.co.uk

8.5 Assumptions

It is healthy and normal to have personal standards and there are specific standards that all couples need to reach if they are to have a good relationship. 'Partners should not abuse one another and 'Partners should not cheat on one another' are two such examples. When two members of a couple hold a set of different (or even conflicting) assumptions about what an intimate relationship 'should be like', it is inevitable that one or both will feel disappointed some or even all of the time. When both parties hold realistic assumptions and respect one another's views, they will have a more harmonious relationship.

Some of the unrealistic assumptions that often give rise to personal problems include “We shouldn't argue”, “Once you're married, you'll never find anyone else attractive” and “My partner should be able to intuitively understand what I'm thinking and feeling”. These standards, which might not even be available to someone's conscious awareness, cause a great deal of distress in relationships. Even when both members of a couple share the same standards, they will still encounter problems if these standards are unrealistic.

Activity: Unrealistic Expectations

Estimated time: 5+ minutes

Drawing on your personal knowledge of relationships (whether romantic or non-romantic), make a

list of the assumptions people tend to bring to relationships.

Are these assumptions healthy?

8.6 Attributions

When we make an attribution, we are assigning meaning and motive to a behaviour or remark. Sometimes we may be correct, but on other occasions we might be wrong. It is human nature to assume that our initial analysis of a situation is accurate and we all jump to conclusions from time to time. Attribution styles can erode a relationship.

For example

Negative attributions based on feelings (an example of emotional reasoning) rather than evidence can soon damage trust and goodwill.Sometimes, people attribute their partner's behaviour to a specific situation. If perhaps their partner has recently been under a lot of pressure at work and they appear stressed, they could draw a link between the two. However, someone who thinks that their partner is stressed solely because it is their nature to be this way is making a global attribution. Negative global attributions get in the way of positive relationships.

8.7 Working With Assumptions and Attributions

Couples therapy is effective when it allows both people the chance to step back from their relationship and see how their assumptions and behaviours fuel maladaptive patterns. Without therapy, it might never occur to the couple that it is their style of relating, as opposed to

external events that are maintaining their problems. In some instances, a couple's troubles can be pinned down to an identifiable source, but problems often develop because the couple have no healthy, reliable images of what good relationships and healthy communication look like.

Example

Suppose that a couple, Julie and Arnie, go to a therapist because they fight on a regular basis. Sometimes, their fights don't seem to be rooted in any meaningful issue - small misunderstandings are soon blown out of all proportion. Julie finds most of their fights baffling. One minute it seems as though they are getting on well, then he overreacts to an innocent remark. To make matters worse, Arnie will end arguments, not with an explanation or apology, but by leaving the house and returning a few hours later, or by retreating to the spare room and passing the evening online.

During a therapy session, the therapist asks Arnie what, in his opinion, starts these arguments. He says that Julie often makes comments that “wind him up”. Julie is surprised to hear this, because she does not intend to aggravate Arnie. She also says that she is upset that Arnie does not always tell her exactly why he is upset. The therapist works with Arnie and Julie to uncover the assumptions and attributions behind their behaviour.

Having discussed the situation, it is clear that Arnie is working under the assumption that his partner should know what he is thinking and how he is feeling without her having to ask. He is also attributing malicious intent to Julie, assuming that she is trying to upset him. Meanwhile, Julie is working under the assumption that partners should always take time to explain their feelings to one another.

8.8 Techniques Used in CBT for Couples

Challenging 'rules' such as 'shoulds' and 'oughts'.Therapists challenge these assumptions using the same techniques that apply in individual therapy. They help couples identify their 'shoulds/musts/oughts', weighing up the advantages and disadvantages of living their lives by these rules and experimenting with new ways of approaching their relationship and the world in general. The therapist will challenge them to experiment with more realistic thoughts and expectations between therapy sessions.

Overcoming selective perception

Unhappy couples tend to focus on the negative aspects of their interactions and to overlook the positive events and feelings that occur within their relationship. To break this pattern, the therapist may ask them to note down what has gone well in their relationship over the past week and to continue this exercise for the foreseeable future.

Working on forming alternative attributions

Someone who is in the habit of assuming that their partner's behaviour is motivated by a desire to upset or anger them is not in a position to forge a constructive relationship. A therapist can teach both partners to try alternative attributions and to avoid sweeping global attributions such as “She's a bitter person”. This is because once an individual has made global attributions, their perception becomes biased and they are increasingly likely to focus on the negative aspects of a partner's behaviour and to feel dissatisfied in their relationship.

Identifying negative patterns and cycles

Every couple has their own dynamics and patterns that characterise their relationship. Some are healthy, whereas others lay the foundation for serious problems.

For example

If Partner A always tries to help Partner B whenever the latter is upset, or if Partner B automatically gives Partner A some space to cool down whenever they argue, they are creating a positive and balanced relationship environment. Unfortunately, relationship patterns are not always positive.

For instance, if Partner B distances themselves whenever Partner A seeks their affection, this will gradually create a rift and imbalance. To make matters worse, these destructive responses become easier and even automatic over time. The couple may reach a crisis point whereby they are both unhappy, but cannot pinpoint why. Once they have gained sufficient insight into the couple's relationship, a therapist can draw up diagrams showing how these dynamics interact with one another in maintaining the relationship.

Behavioural contracts

If an individual is engaging in one or more behaviours that are adversely affecting their partner, the therapist may encourage them to draw up a behavioural contract in which they agree to modify their behaviour. Behavioural contracts might go both ways, i.e. each member of the couple agrees to modify their actions in order to better meet the needs of their partner. Contracts may also include rewards. Terms and conditions should be clearly set out and agreed upon in advance. Depending on the couple's needs and preferences, they can be highly structured or loose and informal.

Problem-solving skill

If a couple does not have the ability to solve problems as they arise, their relationships is likely to come under strain when they come up against the inevitable problems of day to day life. When two people can work together as a unit, they will feel strong and united in the face of adversity, lowering conflict and promoting positive mood in both individuals. Both members of the couple need to be taught how to identify a problem, devise solutions, weigh up the advantages and disadvantages of each, implement the solution, then evaluate it afterwards.

Role playing exercises

With the supervision of their therapist, both people within a couple can try re-enacting various scenarios, taking on the role of the other person and talking about the thoughts and feelings they are experiencing in their new role. This gives each individual the chance to correct their partner's misunderstandings. Role play lets people experiment with new ways of communicating with one another in a controlled environment.The therapist may step in at any time and suggest that the couple try alternatives to their current behaviours.

Listening skills

When both members of a couple can appreciate what the other is thinking and feeling, they are in a better position to honour the other's emotions and communicate in a constructive fashion. Unfortunately, many people do not have good listening skills. Training in empathetic listening promotes honesty and intimacy. An empathetic listener knows how to give the other person their undivided attention to refrain from interrupting and use techniques such as paraphrasing and echoing to ensure that the other party feels understood.

Teaching assertive communication skills

If one or both parties feel as though they cannot express their feelings, they are liable to start resenting one another. Communication might shut down entirely. At the other end of the spectrum, couples who resort to aggressive communication in a bid to make themselves “heard” will have a relationship characterised by angry outbursts or even threats. Assertiveness skills training teaches couples that there is a middle ground.

They can find ways to let their partner know what they think and feel without resorting to either sulky silence or bursts of hostility. If both individuals understand how to use assertive communication, they will no longer have to waste time searching for potential hidden meanings behind their partner's words. The overall level of trust and goodwill will increase. Communication skills can be taught using role play within sessions. Supplementary materials, such as books and leaflets, can also be helpful.

Anxiety and anger management

Someone who is anxious or experiences pathological anger is likely to encounter problems in their relationships. In order to make progress, they need to learn how to express their emotions in a more constructive manner so that they can avoid causing needless conflict within their relationship. Relaxation skills training and self-soothing techniques can help in these cases.

Interventions that target pathological jealousy

Irrational jealousy leads to resentment on both sides. The jealous person may not realise that their jealousy is irrational and feel as though their partner is constantly on the verge of cheating. An absence of trust in the relationship quickly results in friction and arguments. The person who is suspected of misbehaving can inadvertently feed the cycle by attempting to reassure their jealous partner.

For example

If Partner A constantly asks Partner B to explain their schedule in minute detail, Partner B may try to provide reassurance by going into extensive detail regarding their personal activities. However, this will eventually cause them to feel suffocated and annoyed. When they withdraw from Partner A and express their annoyance, the latter will take it as evidence that Partner B is 'hiding something' or 'being defensive', thus the cycle begins anew.

A CBT practitioner can help the couple overcome this pattern by helping the jealous person evaluate their thoughts in a more rational manner and by helping the other person respond in ways that do not reward the jealousy.

Interventions that help individuals overcome mental illness

Living with depression, anxiety, or other chronic mental illness can lead to challenges in arelationship.

For example

If one partner has had depression for a few months and the other has started to believe that there is no hope of recovery, this could start and maintain a negative cycle consisting of frustration, withdrawal, further depression and so on. A couple's therapist may recommend that the person suffering mental illness seeks out therapy tailored to their condition.

Mindfulness exercises

If one partner believes that the other isn't 'there for them', they can start feeling resentful and taken for granted. Mindfulness exercises that encourage the absent partner to engage in the present can help overcome this gap and help both parties regain a sense of closeness.

8.9 Why Might a Single Person Seek Help to Improve Their Relationship Skills?

Although relationship skills training and therapy are primarily aimed at couples and family units, it can also be used to good effect with individuals.

For example

Someone who is looking to find a partner, but cannot seem to maintain a relationship, might benefit from interventions that improve their self-image and communication skills. Some people report conflicting feelings around intimacy and partnerships in general, which are supported by unhelpful beliefs and assumptions that need to be challenged.

For instance

If someone grew up in a home where romantic relationships seemed unreliable or even fleeting, they may have internalised the assumption that 'all relationships fail' and 'everyone will leave'. Individual therapy can also be used to help someone come to terms with the termination of a relationship. The end of a relationship can signal a major life change for an individual, both in terms of their day to day arrangements and their identity. CBT interventions can be used to help someone adopt a realistic yet optimistic view of the future in which they feel able to enter into another, healthier, relationship.

Module Summary

Relationships are a major part of life for most people, but they can also be a significant source of distress. CBT can help repair and improve relationships in several ways. First, it can uncover and challenge destructive assumptions, attributions and patterns of response that occur between members of a couple or family.Most relationship conflicts occur because two people lack insight into how their thoughts, feelings and behaviours contribute to misunderstandings. Maladaptive patterns can persist over time and give rise to significant resentment. Interventions include communication skills training, role play, listening skills training and exercises that challenge destructive assumptions and attributions.

Generally, there are three reasons why a couple begins therapy. Their relationship might recently have come under strain as a result of external forces, one party might have conducted themselves in such a manner that the relationship has been damaged, or there may be an underlying feeling of dissatisfaction with the relationship and life in general. Relationship therapy can also be beneficial for single people. They might be struggling to form healthy relationships and need help in identifying negative patterns that have prevented themforming bonds in the past, or they might need help in moving past a relationship that held a great deal of meaning for them.