Hopefocused Marriage Counseling Updated Everett L' Worthington, Jr' Virginia Commonwealth University

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Hope-focused Marriage Counseling (Updated)
Everett L. Worthington, Jr.Virginia
Commonwealth University

• A 3-hour pre-conference workshop presented at
  CAPS, Valley Forge, April 22, 2007.
• As a minor part of the workshop, I present a
  study.
• Co-authors of the Study Jack W. Berry, David E.
  Canter, Connie Sharp, Mark Yarhouse (Regent
  University), Michael Scherer. The study was
  supported by grant 239 from the John Templeton
  Foundation and a grant to the General Clinical
  Research Center at VCU M01 RR000065. And further
  by the John Fetzer Institute.

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Workshop Objectives

• By the end of this workshop, the participant will
  be able to
• Describe hope-focused marriage counseling
• Conceptualize forgiveness within psychological
  and theological frameworks and be able to promote
  it in couples
• Understand reconciliation and how to promote it
  in couples
• Understand self-forgiveness and how to promote it
  in couples

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Forgiveness in Couples
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My approach to Marital Therapy

• Worthington, E. L., Jr. (1989). Marriage
  counseling A Christian approach to counseling
  couples. Downers Grove, IL InterVarsity Press.
• Worthington, E. L., Jr. (1999). Hope-focused
  marriage counseling. Downers Grove, IL
  InterVarsity Press.
• Worthington, E. L., Jr. (2005). Hope-focused
  marriage counseling, rev. ed. Downers Grove, IL
  InterVarsity Press.

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Hope-focused Marriage Enrichment has been
designated as 1 of 4 ESTs (Empirically Supported
Treatments) for marriage enrichment

• Jakubowski, S. F., Milne, E. P., Brunner, H.,
  Miller, R. B. (2004). A review of empirically
  supported marital enrichment programs. Family
  Relations, 53, 528-536.
• It lists Hope-focused enrichment as one of four
  ESTs in marital enrichment PREP, Relationship
  Enhancement, Couple Communication Program, and
  Strategic Hope-focused Enrichment.

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Questions and Answers
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State of the Clinical Science in 1997

• Gottman ratio 5 to 1 positive to negative
• Therapists try to increase the ratio
• The action is in helping couples ACT differently
  with each othere.g., integrative behavioral,
  solution-focused approaches
• Stress makes things worse
• Focus is dyad patterns of communication and
  conflict negotiation

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A lot has happened between 1998-2005
Implications of the Review of the Literature

• Its not so much skills, communication, conflict
  resolution per se.
• Its ability to control and limit the negative
  emotional climate (and restore the positive
  emotional climate).
• Valuing, safety, security
• Hope
• Cutting short negative reciprocity
• Letting go of negative moods not ruminating
  healing ruptures in negative bonds by forgiving

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Clinical Research in Couple Therapy Suggests
Implications Similar to Couple Dynamics

• Advances in Couple Therapy
• 1. CBT, IBT, EFT, Insight-oriented couple
  therapy These all emphasize the emotional bond
  rather than skills.
• 2. Many continue to be popular without research
  base Solution-focused Therapy, some family
  systems adaptations to couples.
• 3. Note the modifications have been away from
  skills, and toward managing negative emotional
  climate

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Hope-focused Marriage Enrichment

• Journal of Counseling Psychology, Worthington et
  al. (1997) showed that 5 hours of intervention
  produced effect sizes greater than 1 for some DVs
• What causes the power of the intervention?

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FYI Previous Component Research on Hope-focused
Marital Enrichment

• Hammond Worthington (1985), American Journal of
  Family Therapy, found leaders strongly guide
  couples attention to issues in groups
• Worthington, Buston, Hammonds (1989), Journal
  for Counseling and Development, found support of
  group members gt 3 hours of information about
  communication, conflict resolution, and
  information in psychoeducational groups
• Worthington et al. (1995), Journal of Counseling
  Psychology, found that assessment and feedback to
  individual couples account for about ¼ of the ES
  in marital enrichment

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FYI Summaries of Hope-Focused Marriage Therapy

• Worthington, E. L., Jr., Ripley, J. S., Hook, J.
  N., Miller, A. J. (2007). Hope-focused
  approach Repairing and maintaining the emotional
  bond. In T. Clinton G. Ohlschlager (Eds.),
  Caring for people in marriage and family life
  (pp. ).
• Worthington, E. L., Jr., Ripley, J. S., Hook, J.
  N., Miller, A. J. (2007). Hope-focused couple
  therapy and enrichment. Journal of Psychology and
  Christianity, in press.
• Hope-focused Marriage Counseling, rev ed. (2005,
  IVP) (includes research update since 1998)
• Worthington, E.L., Jr., Lerner, A., Sharp, C.
  (2005). Repairing the emotional bond versus
  skills training for marital intervention. Journal
  of Psychology and Christianity,24, 259-262.
• Worthington, E.L., Jr. (2003). Hope-focused
  marriage. Recommendations for researchers and
  church workers. Journal of Psychology and
  Theology, 31, 231-239.
• Worthington, E.L., Jr. (2002). Aconselhando
  Relacionamentos Relationship counseling.
  Aconselhamento O Jornal do Aconselhamento Crisao
  Evangelico no Brasil Brazilian Journal of
  Counseling, 1, 39-48. original article,
  translated into Portugese by Robson Gomes
• Worthington, E.L., Jr., Ripley, J.S. (2002).
  Christian marriage and marital counseling
  Promoting hope in lifelong commitments. In T.
  Clinton G. Ohlschlager (Eds.), Competent
  Christian counseling Practicing and pursuing
  compassionate soul care, Vol. 1 (pp. 455-474).
  Denver Waterbook Press.
• Worthington (1999). Hope-focused Marriage
  Counseling (IVP)
• Worthington, E. L., Jr. (1994). Marriage
  counseling A Christian approach. Journal of
  Psychology and Christianity, 13, 166-173.
• Worthington, E. L., Jr. (1991). Marriage
  counseling with Christian couples. In G. R.
  Collins (Ed.), Case studies in Christian
  counseling (pp. 72-97). Dallas Word.
• Worthington, E. L., Jr. (1990). Marriage
  counseling A Christian approach to counseling
  couples. Counseling and Values, 35, 3-15.

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Questions and Answers
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Hope-Focused Marital Enrichment Description of
the intervention and techniques for promoting
change

• Hope
• Willpower Waypower Waitpower

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Theology of the Hope-Focused Couple Approaches
(HFCA)

• rejoice in marital sufferings, because we know
  that suffering produces perseverance
  perseverance, character and character, hope
  (Romans 53-4, NIV).
• HFMA is founded on the belief that hope is at the
  depth of the Christian experience. Christ in us
  is indeed the hope of glory (Col 127).
• Hope is one of the three most emphasized aspects
  of Christian character (1 Corinthians 1313).
• In HFMA, the strategy taught to partners for
  promoting change (see Worthington McMurry,
  1994) is faith working through love (Gal 56).
• HFMA was founded upon a theology that values
  marriage and promotes mutual submission in love
  of husband and wife (see Eph 5 25-33).

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Hope-Focused Marital Enrichment

• Strategy Promoting Love, Work, Faith

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Hope-Focused Marital Enrichment

• Areas
• Central Vision, Core Values, Confession
  Forgiveness, Communication, Conflict Resolution,
  Cognition, Closeness, Commitment

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Objective 1

• We have now achieved Objective 1 Describe
  hope-focused marriage counseling
• We will examine some of its interventions more
  closely

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Questions and Answers
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Hope-Focused Marital Enrichment

• Interventions

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Hope-Focused Marital Enrichment

• Pre-counseling (Phone, Preparation pamphlet,
  assess stage of change)

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Exercise

• Discuss in twos, how do you get the husband, who
  doesnt want to come to see a shrink, to come?
• Share some ways with the group

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Hope-Focused Marital Enrichment

• Preliminary assessment
• Report
• Worthington et al. (1995), Journal of Counseling
  Psychology, found that assessment and feedback to
  individual couples account for about ¼ of the ES
  in marital enrichment probably this is the most
  powerful single technique you could use in
  marital therapy.

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Assessment Battery

• Marital Inventories
• Dyadic Adjustment Scale
• Commitment Inventory
• Intimacy thermometers
• Discussion of an issue they disagree about
  (communication, problem solving, conflict styles)
• Forgiveness
• Decisional Forgiveness Scale and Emotional
  Forgiveness Scale and single items
• Transgression-related Interpersonal Motivations
  Inventory (TRIM)
• Religion
• Religious Commitment Inventory-10

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Questions and Answers
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Hope-Focused Marital Enrichment

• Communication
• STEPS (Situation, Thoughts, Emotions, Plans,
  Statement of Value)
• TANGO (TAN T Tell what happened clearly and
  briefly, A describe how the situation Affected
  you, N give a Nurturing statement. Then the
  listener responds with the GO G did I Get it?
  Reflect back what they heard, and O Observe the
  effects of the conversation and comment on them.
• Listening
• Requests (Making, Refusing)

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Exercise

• STEPS (Situation, Thoughts, Emotions, Plans,
  Statement of Value)
• See Sherod Miller, who has a whole program that
  teaches this systematically, and has lots of
  empirical support.

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Hope-Focused Marital Enrichment

• Conflict Resolution
• LListen and repeat
• OObserve your effects
• VValue your partner
• EEvaluate both partners interests

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Hope-Focused Marital Enrichment

• Closeness CLEAVE
• CChange actions to positive
• LLoving romance
• EEmploy a calendar
• AAdjust intimacy elsewhere
• VValue Your Partner
• EEnjoy yourselves sexually

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Discuss in Groups of Four

• How do you promote intimacy between couples who
  want to be intimate but arent succeeding?
• Share some strategies with the whole group.

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Hope-Focused Marital Enrichment

• Closeness
• Use of Space

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Demonstration and Exercise

• Role playing couple with groups of observers and
  a counselor (size of group depends on number
  present)

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Hope-Focused Marital Enrichment

• Commitment
• Joshua Memorial
• Final Assessment
• Report

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Questions and Answers
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Modifications to HFCA to Account for Increased
Understanding of the Importance of the Emotional
Bond
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Modification in Theory

• Attachment Theory
• Working models of
• Self
• Other
• God
• Schnarch (1991) and the crucible
• Wuthnow (2000) and religious dwelling and
  seekingtabernacles and tents
• Shults and Sandage (2006) spiritual
  transformations in the desert

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Modifications in Assessment

• Full battery, emphasis on intimacy, forgiveness,
  and the ways that poor communication and conflict
  resolution damage the emotional closeness between
  the partners.

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Modifications in Interventions

• Emotional softening
• Calling attention to times of empathy of one
  partner for another
• Calling attention of times of self-sacrifice of
  one partner for another.

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Objective 1

• We have thoroughly achieved Objective 1
• Lets move to Objective 2 Conceptualize
  forgiveness within psychological and theological
  frameworks and be able to promote it in couples

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Questions and Answers
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FREE Forgiveness and Reconciliation through
Experiencing Empathy

• REACH
• Bridge to Reconciliation

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Discuss in 3-somes Divine Forgiveness, and
Forgiveness between partners

• What are they?
• What if a person says, I forgive him but is
  obviously still really hurt and angry. Whats
  going on?

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Does a husband (or wife) have to repent before
the spouse is obligated to offer forgiveness?
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FREE

• Theory
• Transgressions
• Injustice Gap
• Forbearance
• Motivational-Decisional Forgiveness
• (Emotional) Unforgiveness
• Emotional Forgiveness

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What are your questions about Forgiveness?

• At least 30 minutes to discuss the topic

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Questions and Answers
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Objective 2

• We have now achieved Objective 2a Conceptualize
  forgiveness within psychological and theological
  frameworks and be able to promote it in
  couples.

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2003 Christian book
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New (2006) secular book
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Forgiveness (Theoretical Enrichment)

• Forgiveness and reconciliation are primarily
  about repairing the damage to the emotional bond
  caused by a history of transgressions at the
  hands of each other.
• Trauma damage that threatens physical existence
  leading to helplessness.
• When an attachment figure is not helpful (or is
  perceived as malevolent) during a time when a
  person is needy, an injury to the attachment
  system occurs.
• Marital problems, conflicts, and transgressions
  can traumatize, and if God isnt there or the
  partner isnt there, attachment bonds are
  strained or ruptured.
• Forgiveness is one powerful way of healing the
  wounds and scars of the trauma of experiencing
  the partner (and God) as not there during need.

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Injustice Gap

• Size of injustice gap is proportional to
  difficulty forgiving. Thus,
• Reduce injustice
• Apologize
• Offer Restitution

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Decisional Forgiveness

• Make a decision
• It is beneficial to forgive physical, mental,
  relational, or spiritual health.
• Decisional forgiveness On the basis of Scripture
  or sacred writings or appeal to virtue, do you
  want to forgive?
• Can you give decisional forgiveness now?

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Emotional Forgiveness

• Replacement of negative unforgiving emotions with
  positive other-oriented emotions, such as
  empathy, sympathy, compassion, and love. This is
  facilitated by other non-self-focused emotions,
  like hope, humility, and gratitude for having
  been forgiven.

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Questions and Answers
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Five Steps to REACH Emotional Forgiveness
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FREE

• REACH God
• We forgive because God first forgave us
• REACH God before, during, and after you REACH
  forgiveness

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FREE

• Make a decision
• Decisional forgiveness On the basis of
  Scripture, do you want to forgive?
• Can you give decisional forgiveness now?
• If you cannot, are you willing to be made
  willing?
• Have you discerned Gods heart?

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Five Steps to REACH Emotional Forgiveness of the
Partner
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FREE

• REACH
• R Recall the hurt
• Technique not victimization, not blame instead
  objective

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FREE

• REACH
• E Empathize with the one who hurt you
• Techniques
• Letter from others point of view
• Talk about others experiences
• Empty chair
• Symbolizing the experience Yellow and dark heart
• Multiple repetitions with sympathy, compassion,
  altruistic (agape) love, romantic love

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Exercise

• Get into groups of three or four (at least one
  man and woman in each group). They will role play
  as a couple. The other person is counselor.
• Counselor works with either husband or wife on an
  early hurt (pre-marital), involving the partner
  in empathizing.
• Use empty chair for the one working.

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FREE

• REACH
• A Altruistic gift of forgiveness

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FREE

• REACH
• C Commit to forgive
• Techniques certificate, letter, washing the
  hands of the transgression, Richard Marks'
  "Firststone," nail the transgression to the cross

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Exercise

• Hand-washing

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FREE

• REACH
• H Hold onto forgiveness during doubts
• Technique hurt does not equal unforgiveness,
  white bears

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Exercise

• Pair up
• Take turns explaining to each other why a person
  might forgive and yet still get angry about the
  incident later (after forgiveness has occurred).
• Share creative ways of explaining this with the
  big group.

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Objective 2

• We have now achieved Objective 2b Conceptualize
  forgiveness within psychological and theological
  frameworks and be able to promote it in couples.
• Objective 3 deals with reconciliation

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Questions and Answers
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FREE

• Bridge to Reconciliation
• Plank 1 Decide whether, when, and how to
  reconcile

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Role Play

• Couple exhibits very poor communication for
  making a reproach, for responding with an account
  or accounts

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FREE

• Bridge to Reconciliation
• Plank 2 Soft talk about forgiveness (Talking
  about Transgressions)
• Reproaches
• Accounts
• Denials
• Justifications
• Excuses
• Confessions

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FREE

• Bridge to Reconciliation
• Confessions (CONFESS)
• C Confess without excuse
• O Offer apology (convey sincere regret and
  contrition)
• N Note his or her pain (empathically show that
  you understand the pain or anger you caused)
• F Forever Value (say that you value the person)
• E Equalize (Offer to make some restitution Is
  there anything I can do to make it up to you?)
• S Swear never again (Express intent not to harm
  similarly again)
• S Seek forgiveness
• (Give reasons to promote empathy)

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Exercise

• Pair up
• Practice a good confession

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FREE

• Bridge to Reconciliation
• Dealing with the confession
• Accept (grant forgiveness)
• Reject (withhold forgiveness)
• More time needed (not yet ready to grant
  forgiveness)
• What if one feels the reproach is inaccurate (you
  want to deny) or your behavior was justified?
• Ask, Can you explain what made you think this?
  Explanation
• I see why you think the way you do. Im really
  sorry that this occurred. I feel badly that Ive
  hurt your feelings. I did not mean for that to
  happen.
• I wonder if I might explain the way I was
  looking at the incident? Explanation

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FREE

• Bridge to Reconciliation
• Plank 3 Pyramid (Five steps) Model to REACH
  Forgiveness
• Plank 4 Reverse the Negative Cascade
• Criticism ? Defensiveness ? Contempt ?
  Stonewalling

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FREE

• Bridge to Reconciliation
• Plank 5 Deal with failures in trustworthiness
• Attitude of gratitude
• Attitude of latitude

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FREE

• Bridge to Reconciliation
• Plank 6 Promote Love
• Techniques Love Bank (Harley), Increase the
  Gottman ratio (Gottman), Love languages (Chapman)

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Exercise

• Pair up
• One person is counselor and the other is a spouse
• Counselor works with couple on love bank, or on
  love languages
• Switch and the other person tackles the other
  topic.

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Questions and Answers
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Objective 3

• We have now achieved Objective 3 Understand
  reconciliation and how to promote it in couples
• Objective 4 deals with forgiving the self.

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Objective 4 Forgiving the Self
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Can I come to forgive myself and feel no
emotional unforgiveness toward myself? YES

• I am sorry for what I did (remorse facilitating
  emotion)
• I am grateful for what Jesus did for me in his
  substitutionary atonement and Gods forgiveness
  (gratitude facilitating emotion)
• I realize I dont deserve it it is grace and
  mercy (humility facilitating emotion)
• I feel empathy for Jesus, who suffered and died
  for me (replacement emotion)
• I feel sympathy for Jesus, who suffered and died
  for me (replacement emotion)
• I feel compassion for Jesus, who suffered and
  died for me (replacement emotion)
• I feel love for Jesus, who suffered and died for
  me (replacement emotion)

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Forgiving the Self A special complicated case of
forgiving

• 1. Forgiving the self is hard because
• You cant get away from your own thoughts
• You are both the one who forgives and the one who
  offends. So you have dual responsibilities.
• You did not merely hurt yourself by your acts,
  you probably hurt others and may need to make
  amends.
• You probably sinned against God, nature, or
  humanity, and you need to restore that
  relationship.
• You pressure self to forgive self.
• You not only did something to hurt another but
  you also damaged your self-concept.

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How To Forgive Yourself

• You did something that harmed others (directly or
  indirectly), and you might need to confess (to
  someone), apologize, make restitution, and repair
  damage (if this can be done without
  re-traumatizing the person). Note You might just
  have to carry the yoke of guilt.
• 2. You must make it right with God, being willing
  to accept divine forgiveness.
• 3. You must declare decisional forgiveness for
  yourself.
• 4. You must REACH emotional forgiveness for
  yourself through empathizing, sympathizing,
  feeling compassion for, and loving yourself (as
  you would do for an enemy who continually
  disappoints you).
• 5. You must accept yourself as a flawed and
  fallen person and not expect perfection. (This
  often takes years.)

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Questions and Answers
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Thank you for your attention

• Copies of these slides are available
  electronically by emailing me at eworth_at_vcu.edu

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Study

• Does This Method Work?

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Hope-focused Marital Enrichment Component
Analysis in the Current Study

• Hope-focused HOPE FREE
• HOPEHandling Our Problems Effectively
  (communication and conflict resolution
  components)
• FREEForgiveness and Reconciliation through
  Experiencing Empathy

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Method
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Design of StudyEarly Married Couples

• O HOPE O O
• O FREE O O
• O O O

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Participants

• 156 Couples in their first 5 months of marriage
• 52 per group, matched by timing of the three
  testing times (Note analyses showed no
  differences initially on any variables in the
  study)
• Ages (18 to 62)
• Recruited from newspaper advertisements
• Paid 200 for completing assessment measures
  participants in intervention paid additional 100

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Measures Reported Here

• DAS (used Marital Satisfaction item, 0-6)
• Positive Emotions about the spouse (19 bipolar
  adjectives rated 1, negative emotion, to 5
  positive emotion ex friendly to hostile)
• Forgiveness of most serious hurt (0-4)
• Single-item Forgiveness of index hurt (SIF 0-4)
• TRIM-R TRIM-A TRIM-Total (Index hurt)
• Conflict Tactics Scale (low scores better
  conflict tactics)

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Other Measures Not Yet Analyzed

• Salivary Cortisol (baseline relaxing versus when
  imagining a typical relationship interaction)
• Videotape discussions of (a) a topic which you
  disagree about and (b) a pleasant topic
• Numerous self-report instruments at dispositional
  level (e.g., trait forgivingness), process level
  (ratings of communication, intimacy, etc.), and
  level of specific interactions (e.g., how deal
  with transgressions)

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Procedure

• Couple phones in response to ad and is scheduled
  for and attends initial assessment
• Couple is assigned to condition randomly
• Couple attends either FREE or HOPE intervention
  or no treatment
• Couple assessed roughly at post-treatment, 1
  month post-treatment, 6 months post-treatment, 12
  months post-treatment

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Change in Procedure after Study Begins

• In December 1999, about 14 months after the study
  began, VCUs IRB was shut down, compromising the
  original design of the study by interrupting for
  8 months all research (which played havoc with a
  longitudinal design)
• After resumption (July 2000), to keep from
  losing, almost our first entire round of
  participants, we switched to a yoking procedure
  (using the matching variable of time of test and
  using only three measurement times instead of
  five as planned)

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Very Preliminary Results for Some Self-report
Variables

• Treatment x time (S) ANOVAs with repeated
  measures
• No main effects for Treatment or time are
  significant
• Following are interactions (Note the pattern is
  similar Control get worse HOPE gets better and
  then loses some FREE gets better continuously)

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TRIM-Revenge, Index Hurt (plt.05)
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TRIM-Avoidance, Index Hurt (pgt.10, ns)
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Single-item Forgiveness of Index hurt (plt.05)
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State Anger Scale, plt.01
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How Forgiving Are You, in General, Toward Your
Spouse? (single item), plt.01
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Forgiveness of Your Most Serious Hurt, plt.05
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Current Positive Affect toward Your Spouse, 19
bipolar adjectives, plt.02
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Marital Satisfaction, Single Item, plt.05
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Discussion

• Forgiveness intervention (FREE) affected
  variables differently over time than did HOPE
• HOPE gave an initial boost to the marriage but
  some effect eroded
• FREE helped people not erode and perhaps improve,
  especially on forgiveness matters
• The implication is that together they should be
  complementary and lasting (which is what
  Worthington et al., 1997, showed)

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