Increasing positive behavior in couples (Part 2)

A Call To Action

Attention to the relevance of the psychosocial areas of a patient’s life has yielded impressive results in patient-health research studies. The impact has crossed several areas in health­ care, including patient utilization, quality, and cost-effectiveness ofhealthcare. In 2003, Law, Crane, and Berge looked at the results of individual, marital, and family therapy on rates of high healthcare utilization. Study re­ sults indicated an overall decrease of health­ care utilization by patients who received marital and family therapy. High utilizers decreased their number of visits by 53%. Further, there was a 57% overall reduction in healthcare utilization by the group, suggest­ing that the benefits of the BPS-S approach to family therapy may in fact impact and benefit other family members beyond the patient. In 2008, Pigone also found that using a systemic approach with patients diagnosed with diabe­tes and depression not only improved clinical results but also reduced healthcare costs. Researchers also have cited numerous ben­efits of collaborative and integrated services facilitated by family therapists. In their 2012 article, Marlowe, Hodgson, Lamson, White, and Irons investigated the horizontal integra­ tion of behavioral health providers and pri­ mary care providers within the primary care setting, utilizing doctoral-level MedFTs and master’s-Ievel marriage and family therapy (MFT) behavioral health providers. Results from this study highlighted the contributions of the MedFTs!MFTs in maintaining a focus on the relational aspects of case conceptual­ ization, whether with regard to patient/family/ social supports or patient-provider relation­ ships. Also observed in this study was the positioning of MedFTs!MFTs during times of disagreement between patient and provider. MedFTs!MFTs did not side with one party or the other, but instead reframed disagree­ ments, emphasizing congruency of end goals between physicians and patients, despite dif­ ferent means used to accomplish them.

Training for Medical Family Therapy

More family therapists each year are seeking to augment their clinical training in preparation for employment in healthcare contexts. To satisfy this need, training programs have been initiated in academic institutions nation­ wide. In 2012, Tyndall and colleagues created a table outlining the existing programs, listing institution/location, level of training, program/certificate name, and curriculum, including course content and fieldwork. Currently, ten training programs are avail­able. These consist of master’s and doctoral programs, postgraduate certificate programs, and family medicine residency programs.

In 2012, the Journal of Contemporary Fam­ily Therapy published the first special issue on MedFT since its inception in the 1980s. This issue was written to help launch family therapists into healthcare settings and provide workforce development education needed to prepare them for those contexts.

Increasing positive interactions has been a longtime staple of behavioral therapy in helping couples change the nature of their re­ lationship. In the past, therapists encouraged positive exchanges among couples through the use of “caring days,” an intervention made popular by Richard Stuart (1980), and “love maps,” used by Gottman & Silver (1999). Even thqugh these methods are notas popular as they once were, therapists can find a wealth of utility by revisiting these tried-and-true techniques. As an intervention for at-risk couples, this technique of intro­ ducing five positive comments may foster an increase in the amount of positive communi­ cational exchanges between the couple, im­ proving the chances for relationship repair.


Before using this intervention with couples, it is vithlly important to assess for relational violence and abuse of alcohol, factors that may interfere with treatment. Additionally, the therapist should be aware of current or past drug-abuse issues and the misuse of prescription medications, as these and other mood-altering substances may stymie the effectiveness of this intervention.Furthermore, cross-cultural competence is warranted when administering this interven­ tion across different ethnicities and races. Finally, an inspection of noncompliance issues should be addressed by the therapist in a thoughtful, nonaccusatory way, empha­ sizing that simple changes lead to building stronger commitments and trust over time (Stuart, 1980).


Encouraging clients to proactively and noncontingently increase positive behavior is an excellent way to help couples strengthen their relationships. It is fun, easy to learn,and yields amazing results. It can be used by just one member of the pair to improve com­ munications or can be used by both partners. Adoption of this “old school” technique into your therapeutic toolbox can help couples who are seeking relationship enhancement through an exercise they can implement and conduct on their own. Your mission, should you decide to use this technique, will notonly bring romantic satisfaction into the lives of your clients, it may also vicariously in­ crease the level of positive behaviors in your own relationship as well.