#76843: Maintaining a Healthy Marriage: Implications for Counselors

To achieve a mutually satisfying relationship, it is advantageous to have established a solid foundation from which future relationships are built. This foundation is established via interactions in the family of origin. Parental attachment has been identified as an indicator of early emotional adjustment and later functioning in relationships [10,11,12,13,14,15]. Attachment theory emphasizes the influence parents have over their child's personality development [16]. Consequently, a secure bond results in a secure child who feels comfortable exploring his or her environment. The secure bond further allows the child to become accustomed to, and later involved in, interpersonal relationships. Overall, the literature is consistent in demonstrating that meeting a child's early emotional needs has long-lasting, positive social implications [11,17,18]. Some experts believe the bonds that people form as children become a representation of how future relationships will be approached [19]. If children are secure in their attachments, they have been found to be more open to having attachments later in their lives. Conversely, if children are either attachment anxious or avoidant, they later come to believe that others are also emotionally unavailable.

Erikson's stages of psychosocial development have also been used to identify factors that contribute to healthy adult relationships [20]. Each stage includes a relationship component; however, the emphasis shifts from the biological family in infancy and childhood to establishing a family with a non-biological partner. According to Erikson, a healthy relationship in adulthood is heavily dependent upon the relational health within the family of origin [20].

The conflict associated with the earliest developmental stage is trust versus mistrust [20]. At this stage, infants rely on their mother (or other caregiver) to provide comfort. If this is provided, infants develop a sense of trust, which is considered the first relationship milestone, providing a physiologic understanding of the importance of relationships and interdependence. This stage of psychosocial development has been replicated in research and referred to as primary attachment [11]. Primary attachment begins with an infant's initial connection to her or his parent, and its success helps the child adjust to future relationships. If mistrust develops, this can have negative consequences that can impact an individual's future relationships [20].

Erikson's second stage of psychosocial development occurs in early childhood (1 to 3 years). During this period, the major conflict is autonomy versus shame. The child begins to physically separate from the parent via gross motor skill development. At the same time, the parent seeks to balance between age-appropriate independence and restricting physical exploration for safety reasons [20]. The proper balance of exploration and caution further solidifies the relational bond if the child feels supported in the quest for independence [11]. The successful resolution of this stage of psychosocial development results in pride and acceptance of the cycle of life. However, shame and doubt can result and be demonstrated by a lack of self-confidence [20].

The resolution of the second stage naturally progresses to the establishment of more independence and relationships outside of the home. Specifically, the child begins formal schooling in the third stage, which is characterized by the conflict of initiative versus guilt [20]. By definition, initiative involves the child feeling comfortable enough to begin establishing goals. Because school is the primary setting for goal establishment and attainment, there are both intellectual and social components. As such, if all previous conflicts have been successfully resolved, further confidence should occur.

School relationships become of further importance as the child enters school age in the fourth developmental stage. The successful resolution of the main conflict of this stage (industry versus inferiority) is heavily dependent on the parental role in the previous stages. In other words, the ability for the now elementary school-age child to socially succeed is achieved via modeling and encouragement of the parent(s) [20].

Stage five, which encompasses adolescence (12 to 18 years of age), places strong emphasis on social relationships [20]. The major conflict during this period is identity versus role confusion. Adolescents are tasked with developing a sense of self and personal identity and staying true to their own selves.

From a healthy relationship perspective, successful resolution of the main conflict of the next stage (young adulthood), intimacy versus isolation, is the culmination of all previous stages. According to Erikson, the ability to establish and maintain close, intimate, and committed relationships during this stage is central [20]. One's ability to be intimate with others is heavily dependent on early bonding, established confidence, and goal achievement, all of which are established in earlier stages. If the conflicts of previous stages are not successfully resolved, healthy relationships become difficult.

As noted, adequate relationship role models are beneficial in every stage [11,20]. Research has examined the impact of marital conflict on child attachment through specific parent and child behaviors [15]. Parental behaviors that have been found to affect child attachment include how marital problems are communicated and resolved and the degree of responsibility one assumes during conflict [3,15]. Researchers also evaluated sensitive behaviors such as promptness and appropriateness of parental responses to the child.

Several other correlations between attachment behaviors and marital conflict have been identified [15]. Specifically, current marital conflict is negatively correlated with perceived sensitive interactions and positively correlated with perceived parenting attitude with mothers. Also, the degree of attachment between mother and child is correlated with positive interactions. Father-child attachment has been found to be influenced by the degree of marital conflict, which is negatively correlated with both positive parenting attitudes and marital discord. The unfortunate outcome of insecurely attached children is potential lifelong difficulties with interpersonal relationships [15,20,21].

Other theories have focused less on the foundation of attachment and relationship role models and more on present intimate relationships. Despite marriages and long-term relationships having existed for thousands of years, it was not until Sternberg wrote about the three components of love that essential components of healthy relationships were delineated [2]. According to Sternberg and his Triarchic Theory of Relationships, a healthy long-term relationship is comprised of adequate levels of intimacy, passion, and commitment [2]. The level of each of these components fluctuates depending on the type and duration of the relationship. That being said, certain types of relationships are more likely to be healthy and span time. Companionate love is a relationship that is high in both intimacy and commitment but low in passion. Although physical attraction, or passion, may have decreased, the couple will likely stay together in the long term. The other types of relationships are liking (only intimacy), empty love (only commitment), infatuation (only passion), fatuous love (passion and commitment), and romantic love (intimacy and passion); these types are less likely to be lasting unless they evolve. According to Sternberg, the healthiest relationship is one of consummate love, in which intimacy, passion, and commitment are equally strong [2]. However, consummate love is not the end of the journey. Indeed, to have a relationship of consummate love is one of attainment and maintenance. A relationship of consummate love acknowledges commitment while maintaining positive emotions and being mindful of how one communicates during conflict [2,22].

If an individual does not perceive the healthiest of attachments from his or her family of origin, companionate or consummate types of relationships are still achievable [2]. To this end, attachment-based family therapy and attachment-focused group therapy may be helpful [19]. The latter is a curriculum-based intervention for men and women considered to be insecurely attached. In the group process, participants address maladaptive beliefs about relationships and relationship role models; it is important to discuss role models as they are believed to establish the basis for future romantic partners [20,21]. The group may work toward an understanding of relationship insecurity, and after this is achieved, concrete skills training and interventions may be introduced. In some studies, the group format was seen as more beneficial than individual sessions as it doubled as a source of support and a method to have understood how others have functioned in relationships. Throughout the group process, trust and communication with others is also established [19,23].

Another intervention for developing successful relationships despite being insecurely attached is attachment-based family therapy. Although this treatment was originally designed for families and individuals who experienced adolescent depression and suicide, it has also been suggested for fostering healthy relationships [19,24]. Attachment-based family therapy assists group participants in processing past and present relationship conflicts that reinforce mistrust and insecurity. Therapy can then move into individual competency and independence. The goal of this type of therapy is to decrease isolation, increase self-esteem, and instill relationship hopefulness [19].

Fostering a healthy marriage or long-term relationship can be akin to flying a plane. In order for a plane to reach the necessary altitude, effort and work are necessary. It requires maintenance before and after each flight and a crew to support the pilot in order for the plane to take off. When the plane is in the air and has reached its altitude, the work does not stop; it takes constant monitoring to make sure a plane flies smoothly and stays in the air. The start of any relationship also requires work and effort, and when a relationship is stabilized, the work does not stop. There is no "autopilot" in relationships; monitoring for checks and balances is required. Even seemingly stable relationships are at risk to dissolve without the presence of support and positive emotions within the couple [22].

Historically, the majority of research on couples has focused on conflict as the primary, and sometimes sole, predictor of relationship outcomes [7]. However, research has also shown that approaching a relationship from a positive affective state is important, even during conflict. Neurologic studies indicate that approaches to tasks or events are influenced by a positive affective state [25]. For example, a frustrated or sad member of a couple may interpret seemingly neutral communication and conflict as his or her own shortcoming. Positive affect is instrumental in minimizing the magnitude and duration of conflict. This has been illustrated in studies of couples engaged in a positive, approach-oriented interaction task [7,43].

A study involving 119 newlywed heterosexual couples assessed their approach to conflict six months and again one year after their weddings [7]. For the initial meeting, couples individually completed measures focused on their overall perception of the relationship. Then, the couples were asked to briefly discuss an issue as if they were at home. Participants completed measures of how each felt after the discussion. Finally, the couples were separated and asked to focus on their positive feelings toward their partner and then reunited to discuss these feelings. After the first session, researchers categorized the couples as either approaching conflict from a positive place of affection or from a negative place of contempt and predicted that those with a positive approach would perceive more marital satisfaction and be less likely to divorce. After one year, approaching conflict from a positive place had a positive correlation with marital satisfaction and a negative correlation with divorce [7]. However, there was a subjective threshold in that the magnitude of the conflict was a consideration. In other words, approaching an abusive relationship from a place of forgiveness, optimistic expectations, positive thoughts, and kindness was more harmful than helpful [26].

In some cases, approaching communication from a positive place can be difficult in couple interactions. For instance, a dynamic may develop whereby one partner assumes a place of psychologic shelter when interpreting how responsive the other is to his or her needs [6]. In order to avoid the anticipated risk of rejection, one partner appears emotionally closed off from the other. This results in a dilemma: emotional closeness is a necessity for a healthy relationship, but this is difficult or impossible when one partner is afraid of being rejected and/or being emotionally discounted [6,27].

To avoid developing this dynamic, couples are encouraged to foster a foundation of emotional wellness in their relationship. In one study, couples participated in an online intervention designed to increase relationship excitement [28]. Preintervention measures assessed subjective levels of relationship excitement, relationship satisfaction, affective states experienced in the previous week, and the amount of time spent on exciting activities. A correlation was noted between excitement in the relationship and the experience of positive emotions. As a proactive method to maintain relationship health, researchers suggested that couples be encouraged to routinely find ways to increase levels of excitement within their relationship [28]. Mental health counselors are also encouraged to talk to their clients about the importance of incorporating excitement and the present level of excitement in their relationship. Within this particular study, excitement was categorized as adventurous, passionate, sexual, exciting, interesting, playful, romantic, or spontaneous.

The goals of the partners and couple may also affect their perception of the relationship. In one study, researchers found that an individual's motivational orientation affected his or her perception of relationship success [42]. Persons with a promotion focus value relationship growth and perceived room to grow; individuals with a prevention focus value security in their relationships. Partners with the same motivational perspective will have the same (or similar) definitions of a successful relationship.

A successful relationship can be more than just the interaction between two partners. Specifically, factors such as genetics and self-talk also play a role, and relationship success is often heavily dependent on the perceptions of each individual [3,15,16,29]. For example, placing blame is a source of relationship discord, while focusing on the overall strengths of one's partner is a factor in relationship success [3]. This can be complicated by each member of the couple's unique perspective, perceptions, and interpretations of the same situation [4,5]. From an internal perspective, an individual in a healthy relationship assumes responsibility for modifying his or her dysfunctional expectations and beliefs. From an external perspective, how one interprets the actions of the other, likely based on causal inferences from many sources, influences how she or he behaves [30].

As noted, many philosophies of emotions agree that thoughts and feelings influence behaviors [31]. Beck is more linear in his approach and theorizes that initial thoughts influence emotions, which subsequently influence behaviors and resultant consequences [3]. In healthy relationships, automatic thoughts are less likely based on a cue-interaction effect—a quick judgment based on an intense emotional situation—and more likely to be based on moderate cues in the relationship [30].

Incorporating cognitive restructuring techniques into cognitive-behavioral therapy (CBT) can improve relationships by addressing cue-interaction effects [3,30,32]. From a CBT perspective, cognitive restructuring techniques can alleviate unpleasant feelings activated by negative automatic thoughts. While individuals have limited control over automatic thoughts, they do have control in how they responded to such thoughts. Some couples benefit from counseling and learning skills to positively respond to negative cognitions in order to minimize the intensity of the resulting unpleasant emotions. Cognitive restructuring uses logic and reason to replace the distorted thoughts that can intensify heated emotions. It also involves realistically examining conflict from multiple perspectives, as opposed to solely placing blame on one's partner [3,32]. Couples may be taught to see their environment in a similar fashion during conflict, which can increase adaptive communication [5].

Although research has supported the effectiveness of cognitive restructuring alone, it can be enhanced with the selected use of other techniques [32]. In one study, researchers found success after six months with restructuring integrated with behavioral marital therapy, but this was not the case when restructuring, behavioral marital therapy, and emotional expressive training were implemented together. They reasoned that limiting the number of interventions allowed couples more concentrated time to learn and apply restructuring. For the purpose of the study, behavior marital therapy consisted of expressive communication techniques to solve problems, and emotional expressive training involved expressing emotions and receptive, active listening.

From a more global perspective of CBT, clients may benefit from interventions that address the application of thoughts and how they nurture or inhibit growth in a relationship. For example, approaching a relationship in a cognitively positive place, as per the CBT model, may result in the person behaving in ways that promote relationship growth [3,6]. Specific examples include cognitively highlighting the strengths of the partner and responding, as opposed to reacting, to emotionally tense situations [6].