Psychotherapy With group
Psychiatric mental health nursing practice is one of the newest disciplines to be licensed to provide psychotherapy As such, the majority of psychotherapy research is centered on other disciplines such as psychology, social work, marriage/family therapy, art therapy, psychiatry, and mental health counseling. This makes it essential for you to be able to translate current literature from other disciplines into your own clinical practice. For this Assignment, you practice this skill by examining literature on group work and group therapy and considering its applicability to your own clients.
Learning Objectives
Students will:
- Evaluate the application of current literature to clinical practice
To prepare:
Select one of the
article
s from the Learning Resources to evaluate for this Assignment.
Note: In nursing practice, it is not uncommon to review current literature and share findings with your colleagues. Approach this Assignment as though you were presenting the information to your colleagues.
The Assignment
In a 5- to 10-slide PowerPoint presentation, address the following:
- Provide an overview of the article you selected, including answers to the following questions:
What type of group was discussed?
Who were the participants in the group? Why were they selected?
What was the setting of the group?
How often did the group meet?
What was the duration of the group therapy?
What curative factors might be important for this group and why?
What “exclusion criteria” did the authors mention? - Explain the findings/outcomes of the study in the article. Include whether this will translate into practice with your own client groups. If so, how? If not, why?
- Explain whether the limitations of the study might impact your ability to use the findings/outcomes presented in the article.
Note: The presentation should be 5–10 slides, not including the title and reference slides. Include presenter notes (no more than a half page per slide) and use tables and/or diagrams where appropriate. Be sure to support your work with specific citations from the article you selected. Support your presentation with evidence-based literature.
article
The Effect of Cognitive-Behavioral Group Marital Therapy on Marital Happiness and Problem Solving Self-Appraisal By: Belanger, Claude, Laporte, Lise, Sabourin, Stephane, Wright, John, AMERICAN JOURNAL OF FAMILY THERAPY, 01926187, , Vol. 43, Issue 2
The American Journal of Family Therapy, 43:
103
–118, 2015
Copyright © Taylor & Francis Group, LLC
ISSN: 0192-6187 print / 1521-0383 online
DOI: 10.1080/01926187.2014.956614
The Effect of Cognitive-Behavioral Group
Marital Therapy on Marital Happiness
and Problem Solving Self-Appraisal
CLAUDE BÉLANGER
University of Quebec in Montreal (UQAM), Montreal, Canada,
McGill University, Montreal, Canada, and
The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada
LISE LAPORTE
McGill University Health Center, Montreal, Canada
STÉPHANE SABOURIN
The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada, and Laval University, Quebec City, Canada
JOHN WRIGHT
The Interdisciplinary Research Centre on Intimate Relationship Problems and Sexual Abuse
(CRIPCAS), Montreal, Canada
Problem solving self-appraisal affects problem solving performance
and marital adjustment. This study investigated the effects of
cognitive-behavioral group marital therapy on couples’ adjustment
and their self-appraisal of problem solving activities. Sixty-six cou-
ples participated in group couples therapy. Subjects were randomly
assigned to an experimental or a waiting list control group. They
completed the Problem Solving Inventory and the Marital Happiness
Scale. Therapy was effective in improving global couple adjustment
and problem solving self-appraisal. The program had a differential
effect on the improvement of self-perceived problem solving abili-
ties depending on the spouses’ initial self-appraised problem solving
ability level.
Address correspondence to Claude Bélanger, Département de Psychologie, Université du
Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, QC H3C 3P8, Canada. E-mail:
belanger.claude@uqam.ca
103
104 C. Bélanger et al.
Marital therapy based on social learning principles aims to enhance com-
munication and/or to teach problem solving skills, with the expectation
that such behavioral changes will lead to an increase in marital satisfaction
(Woodin, 2001). However, increased attention has been devoted to the
role of individual cognitive variables in mediating the relationship between
communication/problem solving behaviors and marital distress (Bélanger,
Sabourin & El-Baalbaki, 2012). The importance of cognitive processes in the
development and maintenance of marital dysfunction has been confirmed in
several investigations of the implications of spouses’ cognitions in outcome
research (Dunn & Schwebel, 1995).
Researchers have evaluated problem solving self-appraisal as a deter-
minant of individuals’ adaptational outcomes (Godshall and Elliott, 1997;
Heppner, Kampa, & Brunning, 1987). Problem solving self-appraisal refers
to a relatively stable attitude toward one’s personal problem solving reper-
toire as well as toward the self-regulatory processes at work while a problem
is being solved (Heppner & Krauskopf, 1987).
Social problem solving abilities are used in social contexts, and they af-
fect interpersonal adjustment (Elliott & Grant, 2008). For instance, family care-
givers demonstrating effective problem solving styles reported greater rela-
tionship satisfaction (Shanmugham, Cano, Elliott & Davis, 2009). Self-efficacy
in response to personal problems is related to the way the person appraises
his or her problem solving skills. Accordingly, to develop good coping ca-
pacities, it is important for a person to be able to appraise his or her problem
solving skills and style (Heppner & Dong-Gwi, 2009). Moreover, Bandura’s
work strongly supports the notion that people’s perception of self-efficacy af-
fects their motivation to face challenges, their decision-making behaviors and
their emotional reactions in difficult situations (Bandura, 1986; Carré, 2004).
Perceived self-efficacy has also been related to many personal difficulties
such as depression (Dreer, Elliott, Fletcher, & Swanson, 2005; Rivera et al.,
2007; Nezu, Kalmar, Ronan & Clavijo,1986), psychosocial impairment (Shan-
mugham, Elliott & Palmatier, 2004) and alcoholism (Elliott, Grant & Miller,
2004); it has also been associated with psychological adjustment (Heppner &
Anderson, 1985), physical health (Heppner, Kampa, & Brunning, 1987) and
personality (D’Zurilla, Maydeu-Olivares & Gallardo-Pujol, 2011).
The well-established links between problem solving self-appraisal and
relationship satisfaction have led researchers to investigate problem solving
capacities and self-appraisal in relation to coping skills and the marital
relationship. These studies were based on the basic premise that, for most
people, the quality of their marital relationship is an important predictor of
their general well-being (Hertzog, 2011). When facing stressful life events,
partners use joint efforts in problem solving interactions and other coping
strategies to reestablish satisfaction and maintain marital adjustment. A
failure in these cognitive and behavioral adaptation mechanisms often leads
to marital distress.
Impact of Group CBT on Marital Happiness and Self-Appraisal 105
Dyadic coping strategies encompass both the cognitive and behavioral
components that influence marital satisfaction. Therefore, it is necessary
to understand the relationships between the cognitive strategies and so-
cial behaviors that partners adopt during their problem solving interactions.
If there is such a link, then what is the exact nature of this interrelation,
and in what ways do these cognitive (problem solving self-appraisal) and
behavioral (problem solving efficacy) strategies influence marital satisfac-
tion? The preoccupation with understanding the cognitive and behavioral
problem solving determinants of marital adjustment can be found in a lim-
ited number of studies that have addressed these particular issues (Baucom
& Kerig, 2004). In line with these questions, an investigation in our lab-
oratory showed that problem solving self-appraisal differentiates distressed
from non-distressed partners (Sabourin, Laporte, & Wright, 1990). Distressed
spouses expressed less problem solving confidence, a stronger tendency to
avoid different problem solving activities, and less control over their behav-
ior than their non-distressed partners (Sabourin et al., 1990). Another study
that was run by the same team (Lussier et al., 1997) examined the rela-
tionship between spouses’ attachment styles, coping strategies, and marital
satisfaction. These researchers pinpointed many links between attachment
strategies, coping skills and marital adjustment. These results are consistent
with Bodenmann et al. (2006), who reported several studies showing that
positive dyadic coping significantly correlates with a better quality of mari-
tal relationship, lower levels of stress and better physical and psychological
well-being, and in some studies, these correlations are stronger for women
than for men. Kurdek (1991) tried to conceptualize these variables into a
model in which he assessed the role of cognitively and behaviorally ori-
ented problem solving determinants on the relationship satisfaction of gay
and lesbian partners. His results support a problem solving model in which
relationship satisfaction is related to strategies used by partners to resolve
their conflicts.
In a recent study, Bélanger and his colleagues (2012) investigated the
mutual contributions of a self-reported cognitive strategy, coping, observed
problem solving behaviors, and marital adjustment. In line with Kurdek
(1991), they hypothesized that the specific coping strategies would be re-
lated to the quality of the problem solving behaviors and that both these
variables would be related to marital satisfaction. Their results propose that,
for both men and women, there are significant relationships between cog-
nitive and coping strategies, problem solving behaviors displayed during
marital interactions, and marital adjustment.
Thus, because empirical studies have demonstrated that problem solving
self-appraisal is directly related to problem solving performance (Heppner
& Dong-Gwi, 2009), spouses should not only possess the problem solving
skills necessary to confront and alleviate their marital difficulties but also
believe in their capacity to do so. To be of maximum value, marital therapy
106 C. Bélanger et al.
should therefore not only aim to enhance specific problem solving skills but
also should work to alter spouses’ appraisal of their problem solving abilities.
To the best of our knowledge, very few outcome studies have investigated
such an effect of couples’ cognitive-behavioral therapy on the partners’ self-
appraisal of their problem solving abilities and marital satisfaction.
Accordingly, the main purpose of this paper is 1) to evaluate the overall
effectiveness of cognitive-behavioral group marital therapy in bringing about
positive changes in marital satisfaction and 2) to study the effects of such a
program on partners’ self-appraisal of problem solving abilities.
The specific hypotheses were that group marital therapy subjects would
report changes in a) their marital satisfaction; b) the overall appraisal of
their problem solving abilities; c) their problem solving confidence; d) their
approach to problem solving activities; and e) their strategies to control their
behavior when they try to solve a problem.
The second purpose of this study is to examine the differential effects
of cognitive behavioral group marital therapy on appraisal from spouses as
being effective or ineffective problem solvers (Nezu, 1985).
It was hypothesized that, following the program, partners who initially
appraised their problem solving as ineffective and who believed that they
had problem solving deficits would report more changes in their marital
adjustment level (Marital Happiness Scale) and in their problem solving skills
(Problem Solving Inventory) than subjects who initially appraised themselves
as effective problem solvers.
METHOD
Subjects
Sixty-six French-Canadian couples participated in the study. The subjects had
been living together an average of 12.8 years (SD = 8.7 years, range 1 to
31 years), and their age ranged from 20 to 76 years (M = 38.2 years, SD =
1.7 years). The mean number of children for the sample was 1.2 (88% of the
couples had children). The average education level was 14.5 years (SD =
2.9 years) for women and 15.7 years (SD = 3.7 years) for men.
Procedure
Subjects were recruited through publicity in various media. Couples who
expressed interest were briefly informed of the nature of the program and
invited to an assessment interview. To be selected, couples had to be living
together, free of any important individual psychopathology, free of drug or
alcohol problems, free of primary sexual dysfunctions, not in intense marital
crisis (no pending divorce or physical abuse) and not currently following
another therapy. During the assessment interview, all couples completed
a battery of questionnaires that included a demographic questionnaire, the
Impact of Group CBT on Marital Happiness and Self-Appraisal 107
Problem Solving Inventory (Heppner & Petersen, 1982), and the Marital
Happiness Scale (Azrin, Naster, & Jones, 1973). Partners completed the ques-
tionnaires independently. A research assistant remained in the same room as
the couple during the task and was available to help participants. Subjects
were ensured of the confidentiality of their responses.
Couples were randomly assigned to the experimental group (n = 30 cou-
ples) or to the control group waiting list (n = 36 couples). After completing
the program, all couples were administered the same self-report measures.
Couples on the waiting list then received the same assessment and treatment
procedures.
Treatment
The Couples Survival Program is a group marital therapy program based
on a cognitive-behavioral approach to solving marital difficulties designed
by researchers in our laboratory (Wright, 1986). Couples are taught skills
focused on effective communication, problem solving, exchange of positive
experiences and anger expression. The cognitive and behavioral compo-
nents of problem solving skills were taught for two sessions (6 hours) in
which couples learned different problem solving stages through reading, in-
structions, modeling rehearsal, dyadic practices, feedback, cognitive restruc-
turing, group discussions, and homework assignments (Dattilio & Epstein,
2005)
Each group comprised four couples. They met once a week, for nine
consecutive weeks, in three hour sessions. Each group was led by a licensed
psychologist with a minimum of two-years experience in marital therapy and
group intervention. The co-therapist had at least a master’s degree in clinical
or counseling psychology. All group leaders received 30 hours of training
and weekly supervision between sessions.
Measures
The Problem Solving Inventory (PSI; Heppner & Petersen, 1982) is a 32-
item measure that evaluates perceptions of personal problem solving behav-
iors and attitudes. It yields an overall score as well as three factor scores:
problem solving confidence (11 items), approach-avoidance style (16 items),
and personal control (5 items). High scores indicate that the subject per-
ceives himself/herself as having ineffective problem solving abilities and thus
has little problem solving confidence, tendencies to avoid different problem
solving activities, and a lack of personal control. Reliability estimates (alpha
ranges from .72 to .85) are adequate, and acceptable validity coefficients have
been reported in several investigations (Heppner & Anderson, 1985; Nezu &
108 C. Bélanger et al.
Ronan, 1988; Tracey, Sherry, & Keitel, 1986). Moreover, PSI scores have been
found to correlate significantly with observational ratings of problem solving
competence (Heppner et al, 1982). The French version of the PSI (Laporte,
Sabourin, & Wright, 1989) has demonstrated equally sound psychometric
properties (alpha ranges from .65 to .86).
The Marital Happiness Scale (Azrin, Naster, & Jones, 1973) is a self-report
questionnaire that allows the subject to rate his satisfaction on nine aspects
of his marital life (household responsibilities, money management, etc.) and
to give an overall assessment of his happiness within the relationship. The
scores range from 1 to 10, with a higher score indicating a higher level of
marital happiness. The instrument possesses good reliability and discriminant
validity. The Marital Happiness Scale has been found to be highly correlated
(.85) with the Locke-Wallace Marital Adjustment Test (Locke & Wallace,
1973), and inter-item correlations (p < .05 for all correlations) suggest the
presence of an underlying single dimension (Libman, Takefman, & Brender,
1980). The French version of the questionnaire has been demonstrated to
have equally sound psychometric qualities (alpha ranges from .71 to .80)
(Bourgeois, Sabourin, & Wright, 1990).
Pre-Treatment Equivalence
Independent t-tests were conducted to determine if there were any sig-
nificant differences between the experimental and control groups in terms
of sociodemographic variables. The results indicated that the experimental
group participants were significantly younger (t (137) = –2.38, p < .02),
had more children (t (130) = 6.02, p < .0001) and had been living together
for a shorter period (t (125) = –5.09, p < .0001) than their control group
counterparts. There were no significant differences between the two groups
in terms of income or educational level.
Data showed that a randomization of couples to groups at the onset
of the treatment did not produce optimal matching of sociodemographic
variables such as age, children and length of relationship. However, Pear-
son product-moment correlation coefficients established that the correlations
between those variables and the scores on the dependent variables under
investigation were very low. There were no significant correlations between
socioeconomic variables and problem solving self-appraisal scores (range
from .01 to .20), and there was a small relationship between the Marital
Happiness Scale’s scores and the ages of the men (p < .02). A two-way
analysis of variance was performed on the pretest scores of the experimen-
tal and the control groups to determine if there were any initial differences
between the groups in the self-appraisal of problem solving abilities and
marital adjustment prior to the program. The results indicated that there
were no significant differences between the two groups in problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 109
TABLE 1 Means and Standard Deviations of Pretest and Posttest for the Experimental and
the Control Group
Male Female
Group Experimental Control Experimental Control
Time T1 T2 T1 T2 T1 T2 T1 T2
PSI total M 91.3 77.0 86.9 80.9 94.8 82.1 102.5 97.1
SD 23.8 18.5 28.9 26.8 20.7 17.1 21.7 24.8
PSI M 24.7 23.0 26.0 23.5 27.0 22.9 29.0 28.2
Confidence SD 8.9 7.1 10.3 9.1 7.5 6.6 9.5 10.6
PSI M 49.4 39.1 44.1 42.4 48.5 42.5 52.7 50.4
Approach SD 15.1 9.3 15.5 15.2 13.5 10.2 11.9 13.0
PSI M 17.2 15.0 16.7 14.9 19.4 16.6 21.0 18.5
Control SD 5.6 4.3 6.6 5.2 4.3 3.9 4.3 4.4
Marital M 6.3 7.3 6.3 6.6 6.2 6.9 5.9 6.3
Happiness SD 1.3 1.1 1.1 1.4 1.3 1.2 1.5 1.6
Note. M = mean; SD = standard deviation; PSI = Problem Solving Inventory.
self-appraisal (F(3,60) = 0.8, p <.5) or marital adjustment (F(1, 63) = 2.2, p < 0.14).
Effectiveness of the Program
To determine the effect of treatment and sex on problem solving self-
appraisal and marital satisfaction, three series of analysis of variance were
performed. The means and standard deviations for the men and women of
the experimental and the control groups are presented in Table 1.
MARITAL HAPPINESS SCALE
A 2 (male vs. female) × 2 (pre vs. post) × 2 (experimental vs. control)
analysis of variance (ANOVA) was conducted on this scale using sex as a
repeated measure because of the interdependence of husbands’ and wives’
scores (Kenny & Cook, 1999). The results indicated a significant main effect
for Time (F(1, 63) = 26.2, p <.01), which was qualified by a significant Group
× Time interaction effect (F(1,63) = 4.1, p < .05). There was no significant
Group × Time × Sex interaction effect. The mean scores revealed that cou-
ples from the experimental group had significantly higher marital adjustment
following the program than couples on the waiting list (see Table 1).
PROBLEM SOLVING SELF-APPRAISAL
First, an ANOVA was conducted on the overall score of the PSI. The results
revealed a significant effect for Time (F(1,64) = 21.8, p < .0001), which
110 C. Bélanger et al.
TABLE 2 Means and Standard Deviations of Pre-Waiting Period, Post-Waiting Period, and
Post Program for the Subjects of the Control Group
Male Female
Moment T1 T2 T3 T1 T2 T3
PSI total score 86.5 81.2 71.4 102.9 96.8 84.3
SD 30.0 27.7 22.4 22.6 24.7 25.5
PSI Confidence 25.8 23.8 21.9 29.2 28.3 25.6
SD 10.4 9.3 9.6 9.7 10.8 8.9
PSI Approach 44.2 42.4 37.1 52.9 50.0 42.4
SD 16.0 15.6 11.8 12.4 12.9 13.5
PSI Control 16.5 15.0 12.4 20.8 18.5 16.3
SD 6.8 5.4 4.9 4.4 4.5 5.0
Marital Happiness 6.3 6.5 7.4 5.9 6.2 7.0
SD 1.3 1.3 1.2 1.6 1.5 1.6
Note. T1 = pre-waiting; T2 = post-waiting; T3 = post-treatment; SD = standard deviation; PSI = Problem
Solving Inventory.
was qualified by a significant Group × Time effect (F(1,64) = 3.9, p < .05). The Group × Time × Sex interaction effect was not significant. Couples who participated in the program generally appraised themselves as more effective problem solvers than couples who were on the waiting list.
To further explore the nature of treatment gains, a two-way MANOVA
was conducted on the three problem solving subscale scores. The results in-
dicated a significant main effect for Time (F(3, 62) = 11.16, p< .0001), which
was qualified by a significant Group × Time interaction effect (F(3, 62) =
3.11, p < .03). The Group × Time × Sex interaction effect was not signifi-
cant. Subsequent ANOVAs revealed that, compared to subjects on the waiting
list, spouses who followed the group marital therapy reported a significantly
stronger tendency to approach diverse problem solving activities (F(1, 64) =
7.2, p < .009). However, they did not rate themselves as approaching prob-
lem solving activities more readily or as having more personal control than
the subjects who did not received treatment (see Table 1).
Quasi Replication Analysis
The effect of the program on couples on the waiting list provided an own-
control analysis and represented a partial replication of the study. ANOVAs
with repeated measures were performed on the data with pre-waiting scores,
post-waiting scores and post-treatment scores as the 3 time points. Table 2
summarizes the means and standard deviations for all measures.
The 3 (pre-waiting vs. post-waiting vs. post-program) × 2 (male vs. fe-
male) analysis of variance showed a significant main effect of Time for the
Marital Happiness Scale (F(2, 31) = 23, p < .0001), for the overall score
of the Problem Solving Inventory (F(2, 31) = 16, p < .0001), and for all
Impact of Group CBT on Marital Happiness and Self-Appraisal 111
PSI subscales (F(6, 26) = 9, p < .0001). The Time × Sex interaction ef- fect was not significant. To determine the source of these differences, two series of analyses of variance were conducted. The first analyses assessed the changes from the pre-waiting to the post-waiting period, whereas the second provided the evaluation of the effect of the program (post-waiting to post-program).
The results of the first series of analyses of variance (pre- to post-
waiting) indicated a significant Time effect for marital adjustment (F(1.34) =
7.5, p < .01) and for overall PSI score (F(1, 35) = 8.1, p < .007). At the
second evaluation, waiting list subjects reported a slight increase in mari-
tal adjustment and in the appraisal of their problem solving abilities. The
MANOVA conducted on the PSI subscale scores revealed another significant
Time effect (F(4, 31) = 3.6, p < .02). Subsequent analyses revealed that
subjects reported a significant increase in their problem solving confidence
(F(1, 34) = 11.7, p < .002) following the waiting period (see Table 2).
The second series of analyses, which evaluated the effect of the treat-
ment, demonstrated a significant Time effect for marital adjustment (F(1,
32) = 26.2, p < .0001) and for PSI total score (F(1, 32) = 14.5, p < .001).
MANOVAs conducted on the PSI subscales revealed another significant Time
effect (F(429) = 9.6, p < .001). Univariate analyses demonstrated substantial
changes following the program on all subscales: problem solving confidence
(F(1.32) = 5.2, p < .03), approach to problem solving activities (F(1, 32) =
15.5, p < .0001) and strategies to control their behaviors (F(1, 32) = 2.62, p
< .02). As shown in Table 2, score increments recorded by the group follow-
ing the program were consistently superior to those reported by the same
group during the control period. The data confirm that participation in the
group marital therapy increased marital adjustment and enhanced spouses’
self-perceived problem solving efficacy.
Differential Effectiveness of the Program
To investigate the effects of group marital therapy on spouses who appraise
their problem solving as either effective or ineffective, three 2 (PSI: effective
vs. ineffective) × 2 (pre vs. post) analyses of variance were conducted on the
Marital Happiness Scale and on the Problem Solving Inventory (total score
and subscales). Because the analyses require a within-group comparison,
experimental and control group data were combined to examine the changes
from pre- to post-program. Because men and women’s Problem Solving
scores had different distributions (respectively, 33 to 161 and 47 to 154), and
because they differed significantly from one another (F(1, 61) = 9.8, p <
.003), analyses were conducted separately for the sexes using the split half
overall PSI score of both groups (men = 83 and women = 94) to subdivide
them into effective and ineffective PSI scorers.
112 C. Bélanger et al.
TABLE 3 Means and Standard Deviations of Pre-Program and Post-Program for Effective and
Ineffective Scorers
Male Female
Group Ineffective Effective Ineffective Effective
Time pre post pre post pre post pre post
PSI total M 104.3 81.5 64.5 65.4 112.6 92.4 77.5 73.1
SD 20.0 21.3 12.6 16.2 16.9 23.7 10.8 13.7
PSI M 28.7 23.9 18.9 20.6 33.6 27.1 21.2 21.4
Confidence SD 9.1 8.8 5.5 7.9 8.6 9.3 4.5 4.7
PSI M 56.7 42.6 32.9 32.7 58.5 47.7 39.2 36.6
Approach SD 12.3 10.4 6.7 8.3 9.4 12.8 8.0 7.5
PSI M 18.9 15.0 12.7 12.0 20.5 17.7 17.1 15.1
Control SD 5.1 5.1 4.1 3.8 12.8 4.4 4.0 4.2
Marital M 6.2 7.3 6.6 7.4 5.9 6.7 6.5 7.1
Happiness SD 1.3 1.3 1.2 1.3 1.4 1.5 1.3 1.2
Note. M = mean; SD = standard deviation; PSI = Problem Solving Inventory.
MARITAL HAPPINESS SCALE
The results indicated an absence of a significant difference between the
effective and ineffective scorers on the Marital Happiness scale (respectively,
for men and women, F(1, 61) = .66, p < .3); F(1, 61) = .38, p < .5)). The
mean scores revealed that both groups of men and women (effective and
ineffective scorers) reported similar improvement in their marital satisfaction
following the program (see Table 3).
PROBLEM SOLVING INVENTORY
Analyses of the Problem Solving Inventory total scores revealed a significant
PSI Group × Time effect for men (F(1, 61) = 18.55, p < .0001) and women
(F(1, 61) = 11.05, p < .001). Following the program, women who initially
perceived themselves as ineffective problem solvers reported more changes
in the overall appraisal of their problem solving abilities than women who,
before the program, perceived themselves as effective problem solvers. Sim-
ilarly, men who initially appraised themselves as ineffective problem solvers
reported more improvements in their overall PSI score following the program
than men who initially perceived themselves as effective problem solvers
(see Table 3).
The results of the MANOVAs conducted on the Problem Solving Inven-
tory subscales revealed a significant PSI Group × Time effect (F(3, 59) =
6.26, p < .001) for women and for men (F(3, 59) = 6.2, p < .001). Univari-
ate analyses of variance conducted on the group of women indicated that,
following the program, women who initially appraised themselves as inef-
fective problem solvers noted more improvement in their problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 113
confidence (F(1, 37) = 9.3, p < .004) and in their approach to problem solv- ing activities (F(1, 37) = 8.03, p < .007) than women who initially appraised themselves as effective problem solvers. The two groups of women (effective and ineffective) did not differ, however, in their perceived personal control following the treatment (see Table 3).
As for the men, subsequent univariate analyses indicated that only the
ineffective problem solvers reported improvement in their problem solving
confidence (F(1, 61) = 10.5, p < .002), in their approach to problem solving
activities (F(1, 61) = 18.4, p < .0001) and in their personal control (F(1, 61) =
9.4, p < .004) following the program (see Table 3).
DISCUSSION
The results of this study generally support the hypothesis that couples’
marital happiness increases significantly following participation in cognitive-
behavioral group marital therapy (Baucom, Epstein, Kirby & LaTaillade, 2010;
Butler, Chapman, Forman, & Beck, 2006). Furthermore, the program was
shown to significantly alter spouses’ appraisal of their problem solving effi-
cacy. More specifically, the results indicated that, following the intervention,
partners reported a significant improvement in their capacity to confront dif-
ferent problem solving activities. Moreover, in the analyses that measured
their perception of control, all measures demonstrated a significant change
in the expected direction. After completing the program, spouses appraised
themselves as having more confidence in their problem solving capacities, a
stronger tendency to face problem solving activities rather than avoid prob-
lems, and better personal control of their behaviors while solving problems
related to their dyadic interactions. Both the experimental versus control
group analyses and the perception of control analyses yielded substantially
similar results. Although from the perception of control analyses, there was
a significant change in some variables from the pre- to post-waiting period,
the impact of the treatment was made clear by the important gains in all
measures from post-waiting to post-program. This small initial gain between
the pre- and post-waiting period could have been due to habituation to the
testing situation and to the instruments and does not challenge the efficacy
of the treatment.
The results also suggest that the program helped couples improve their
marital adjustment independently of how they initially appraised their prob-
lem solving abilities. However, the results indicate that cognitive-behavioral
group marital therapy had a differential effect on the improvement of self-
perceived problem solving capacities depending on the sex of the partic-
ipant and on the initial self-appraisal of his/her problem solving abilities.
Generally, the program had a favorable impact on women’s perception of
self-efficacy, and women who initially perceived themselves as ineffective
114 C. Bélanger et al.
problem solvers reported even more positive changes following the program
than those who initially appraised themselves as effective problem solvers.
As for men, only those who initially appraised their problem solving abili-
ties as ineffective reported improvement in their problem solving appraisal
after completion of the program. However, as was the case for women, the
program was less useful in helping men who initially perceived themselves
as effective problem solvers to change their cognitions.
These results suggest that cognitive-behavioral marital therapy should
include cognitive strategies targeting self-appraisal of problem solving ac-
tivities if and only if spouses appraise themselves as ineffective problem
solvers before the beginning of the intervention. With partners who appraise
themselves as effective problem solvers, this strategy would not be pertinent,
and other targets should be identified during the initial assessment. These
data are consistent with the results of previous studies that have noted the
utility of training for subjects who perceived certain problem solving deficits
(Heppner et al., 1988). A possible explanation for the lack of improvement
in these spouses could be that they had little room for improvement. For
example, the optimal functioning score on the PSI is 32, whereas the highest
score, 192, reflects the worst functioning. Men who initially perceived their
problem solving abilities as effective had a mean score of 64.5 with a mini-
mum approximate score of 51.9, while women had an average score of 77.5
with a minimum approximate score of 66.6. Compared to Heppner’s sample
(lowest score of 60; Heppner et al., 1988), it seems that our group of effective
problem solvers had particularly strong perceptions of their problem solving
abilities. However, both groups reported similar appraisal of their problem
solving abilities following treatment.
It is also possible that the program itself might be designed to be a better
fit for the needs of subjects who initially perceived themselves as ineffec-
tive problem solvers. Group leaders focused on cognitive (beliefs, self-talk,
self-monitoring) and behavioral skills (effective concrete steps of problem
solving) during instructions, modeling rehearsal, feedback and homework
assignments. Yet, because the sessions were conducted in groups of four
couples (eight individuals) and two therapists, it was impossible to con-
stantly create individualized learning experiences. It is possible that a more
individualized focus on participants’ self-appraisal of problem solving abili-
ties would have produced higher gains in the spouses who initially perceived
themselves to be effective problem solvers.
The findings of the present study are interesting for several reasons.
First, the results support the effectiveness of group marital therapy in altering
the cognitive process of self-perceived ineffective problem solvers. Even if
treatments for couples paradigms recognize the role of cognitive variables,
very few outcome studies have paid attention to this particular aspect.
These results dovetail nicely, on one hand, with a study by Heppner
and his colleagues (1982), who have demonstrated that problem solving
Impact of Group CBT on Marital Happiness and Self-Appraisal 115
self-appraisal is directly related to problem solving competence and, on the
other hand, with a previous study by Sabourin and his colleagues (1990),
who demonstrated that problem solving self-appraisal is also related to mar-
ital adjustment and to specific coping efforts. This research showed that
distressed spouses showed less problem solving confidence, a tendency
to avoid different problem solving activities, and poor strategies to con-
trol their behavior. Thus, in the clinical evaluation of the partners before
starting couple therapy, it would be important to verify the couple’s ap-
praisal of their problem solving abilities. If partners demonstrate a lack of
empowerment, learned helplessness or self-perception of a low capacity
to solve problems, the proposed therapeutic intervention should have a
positive effect on the development and maintenance of effective problem
solving behaviors and consequently on the long-term improvement of their
relationship.
This study has some limitations. There was no follow-up after the con-
clusion of treatment to verify if changes in self-appraisal remained in the ab-
sence of therapy. Future research should replicate these findings and assess
the long-term effects of cognitive-behavioral group marital therapy on the
maintenance of effective problem solving self-appraisal and marital satisfac-
tion. Furthermore, given the interaction between the initial levels of problem
solving self-appraisal and the amount of perceptual change, it would also
be important to study subjects who are initially different in their levels of
perceived and observed problem solving efficacy (Baucom & Kerig, 2004;
Heyman, 2001). It is also possible that this treatment is not unique in its
effect on the person’s sense of self-appraisal and that individual therapy, use
of homework in therapy, and even other forms of couple therapy may also
have improved these skills.
Another limitation is related to the nature of the measurement used
for appraising problem solving abilities. Because this study focused on self-
report of problem solving efficacy, inferences regarding related changes in
overt problem solving skills are not yet warranted. Future research should
examine if problem solving self-appraisal bears a relation to the actual prob-
lem solving behaviors of spouses. Therefore, as suggested by Bélanger and
his colleagues (2012), behavioral modifications of problem solving inter-
actions should be included in future studies. Along these lines, our team
recently investigated the relationship between specific coping strategies and
problem solving/communication behaviors in close relationships (Bélanger
et al., 2012). Observed behaviors were coded using a macroscopic coding
system for dyadic interactions (Belanger et al., 1993). For both men and
women, results showed significant relationships between coping strategies,
problem solving, marital interactions, and marital adjustment (Bélanger et al.,
2012). It would be interesting to test how these interactions may change af-
ter a cognitive behavioral marital program such as the one we tested in this
research.
116 C. Bélanger et al.
It might also be of interest to see if a cognitive behavioral program for
couples that incorporated dyadic coping skills would be helpful for predict-
ing marital adjustment. Bodenmann and his colleagues (2001) tested such
a program, the Couples Coping Enhancement Training for couples. These
researchers showed that following the intervention, couples reported a sig-
nificant increase in their appraisal of a number of domains and an increase in
the quality of their marital relationship (Bodenmann, Charvoz, Cina, & Wid-
mer, 2001). It would be interesting for future studies to integrate appraisals
of coping skills and problem solving and of the actual behavioral capacities
to get involved and solve problems (Bélanger et al., 1993).
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Applying Current Literature to Clinical Practice: The effect of cognitive-behavioral group marital therapy on marital happiness
and problem-solving self-appraisal.
Adesola Turner NRNP 6650: Psychotherapy with Groups and Families
Sunday,
October 11, 2020
. 1
The type of group discussed
Cognitive behavioral group marital therapy (CBGMT). in order to bring a constructive positive outcomes in marital or matrimoni-
al satisfaction, the study assessed the effectiveness of cognitive behavioral group therapy. 2
The group evaluated the effects of cognitive behavioral programs on the self-appraisal of partners on the abilities of problem solving.
The specific hypotheses of the article were that group martial therapy subjects would account changes in; Marital satisfaction
Overall appraisal on the abilities of problem solving Problem solving confidence
Approach to problem solving activities Strategies of controlling behaviors when couples try to solve 2
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https://class.waldenu.edu/webapps/mdb-sa-BBLEARN/originalityReport?attemptId=f0462d2d-14f0-4d58-a040-4d8aad2dee44&course_id=_16726065_1&download=true&includeDeleted=true&print=true&force=true
Participants of the group and why they were selected
The study’s sample comprised of 66 Canadian couples. The effectiveness of the CBGMT was measured by how these selected couples
could adjust to their self-appraisal skills of solving a problem (Bélanger, Laporte, Sabourin & Wright, 2015). Authors selected partici-
pants who at least have lived together for about 12.8 years. The age of selected couples ranged between 20-76 years. Ø1.2 was
the mean age of the selected couple. The selected women and men’s average education level was 14.5 years and 15.7 years, respectively.
3
The couples were randomly selected to either waiting or experimental list control group. Selection was done through publicity in
several media. The couples that expressed interest were acquainted about the nature of the program, and then invited to the assess-
ment interview. The selected couples completed both Marital Happiness Scale and Problem-Solving Inventory. They completed the
Problem-Solving Inventory and the Marital Happiness Scale.
3
Setting and duration of group therapy The setting of the group was University of Quebec in Montreal (UQAM). The study took
place in the University of Quebec in Montreal. Four couples were placed in each group
Meeting was held once per week Meetings were conducted in 9 weeks period Each meeting lasted 3-4 hours 4
The behavioral and cognitive components of the problem-solving skills were taught in 6 hours (two sessions). During the two
sessions, couples learned various problem-solving skills via modeling rehearsals, instructions, reading, feedback, dyadic practices, group
discussions, cognitive restructuring, and homework assignment (Bélanger, Laporte, Sabourin & Wright, 2015). Each group was under
the guidance of a licensed psychologist with a minimum of two-year experience in group intervention and marital therapy. Group
leaders received weekly supervisions between the sessions and 30 hours training. 4
Curative factors that are important for the group
Universality
Existential factors
Group cohesiveness
5
Universality. This factor is important in helping couples attending cognitive behavioral group marital therapy realize that the prob-
lems they face in marriage is universal, that is, the problems are all over (Belanger, Sabourin & El-Baalbaki, 2012). Existential factors.
These are important in helping couples attending cognitive behavioral group marital therapy to be aware that life must go on despite re-
grets, sadness, and pain. Group cohesiveness. Provides members with a sense of security, value, belonging and acceptance. Impart-
ing information. This factor is important in educating and empowering couples with knowledge regarding to particular psychological
situation
5
Exclusion criteria mentioned by the author
Selected couples with significant individual psychopathology. Couples with primary dysfunctions. Couples with drug or alcohol problems.
Couples without intense marital crisis. Couples under any form of therapy
6
Exclusion criteria are sets of pre-determined definitions for identifying subjects that will not be incorporated in the study. Cognitive
behavioral group marital therapy is designed to help couples that have different predicaments. The above implies that individuals who are
included in the study should have problems of various forms, and should never be involved in any therapy at the present. However, these
participants can be used in the control experiment. 6
Findings/outcomes of the article It was deduced that group couples who took part in the group marital therapy were able to effectively
engage and solve diverse matrimonial issues. 7
The hypothesis of the study was that the marital happiness of the couples increases significantly when they participate in the cogni-
tive behavioral group marital therapy. Therefore, if the spouses follow the group interventions, they significantly increase their capac-
ity of confronting different activities of solving problems. These activities include modeling rehearsals, instructions, reading, feedback, and
dyadic practices (Bélanger, Laporte, Sabourin & Wright, 2015). This can translate into practice with my clients.
66
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Group interventions are important in sharing different experiences, and it is these experiences that can provide my clients with a
foundation of dealing with personal problems. 7
1 61 6
S o u r c e M a t c h e sS o u r c e M a t c h e s ( (4 54 5))
essaycops 100%
cripcas 100%
Student paper
100%
Student paper 83%
Limitations of this study and whether thy impact the ability of using the findings presented Lack of follow-up after the conclusion of
the study. Nature of the measurements that were used in appraising the activities of problem-solving
8
Lack of follow-up after the conclusion of the study – The researchers never carried out a follow-up study after concluding their study
(Bélanger, Laporte, Sabourin & Wright, 2015). This limitation will influence my ability of using the findings because of lack of verification.
The above involves lack of uncertainty, that is, whether the self-appraised changes remained in action after the withdrawal of the therapy.
Nature of the measurements that were used in appraising the activities of problem-solving – The research concentrated on self-report
regarding the efficacy of problem-solving, implying that interference associated changes, particularly for skills of problem-solving skills,
are not warranted (Bélanger, Laporte, Sabourin & Wright, 2015). This limitation is bound to affect my ability of using the findings because
the effects of the therapy on the skills of problem-solving skills are discussed.
8
References Bélanger, C., Laporte, L., Sabourin, S., & Wright, J. (2015). The effect of cognitive-behavioral group marital therapy on
marital happiness and problem solving self-appraisal. The American Journal of Family Therapy, 43(2), 103-118.
doi:10.1080/01926187.2014.956614
.
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Applying Current Literature to Clinical Practice:
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Applying current literature to clinical practice
2
Student paper
The effect of cognitive-behavioral group marital therapy on marital happi-
ness and problem-solving self-appraisal.
Original source
The effect of cognitive-behavioral group marital therapy on marital happi-
ness and problem solving self-appraisal
3
Student paper
Psychotherapy with Groups and Families
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Psychotherapy With Groups and Families
4
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Sunday, October 11, 2020.
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October 11, 2020
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Student paper 79%
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The type of group discussed
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TYPE OF GROUP DISCUSSED
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Cognitive behavioral group marital therapy (CBGMT).
Original source
Cognitive behavioral group marital therapy
7
Student paper
in order to bring a constructive positive outcomes in marital or matrimoni-
al satisfaction, the study assessed the effectiveness of cognitive behavioral
group therapy.
Original source
Evaluate the effectiveness of cognitive-behavioral group marital therapy to
create positive changes in marital satisfaction
8
Student paper
The group evaluated the effects of cognitive behavioral programs on the
self-appraisal of partners on the abilities of problem solving.
Original source
To study the effects of cognitive -behavioral group marital therapy on part-
ners self-appraisal of problem solving abilities
6
Student paper
The specific hypotheses of the article were that group martial therapy sub-
jects would account changes in;
Original source
The particular hypotheses of the article were that group martial therapy
subjects would account changes include
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Overall appraisal on the abilities of problem solving Problem solving
confidence
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Overall appraisal of their problem-solving abilities
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Approach to problem solving activities Strategies of controlling behaviors
when couples try to solve 2
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Approach to problem solving activities strategies to control their behavior
when they try to solve problems
6
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Participants of the group and why they were selected
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Participants of the group and why they were selected
11
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The effectiveness of the CBGMT was measured by how these selected cou-
ples could adjust to their self-appraisal skills of solving a problem
(Bélanger, Laporte, Sabourin & Wright,
2015).
Original source
appraisal of their problem-solving efficacy(Bélanger, Laporte, Sabourin, &
Wright, 2015)
8
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Authors selected participants who at least have lived together for about
12.8 years.
Original source
All participants were married couples who have lived together for an aver-
age of 12.8 years
12
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The age of selected couples ranged between 20-76 years.
Original source
It was a requirement that the selected couples be between the age of 20
and 76 years
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Ø1.2 was the mean age of the selected couple. The selected women and
men’s average education level was 14.5 years and 15.7 years, respectively.
Original source
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Mean age of the selected couple was 1.2 The average level of education for
the selected people was 14.5 years and 15.7 years for women and men
respectively
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The couples were randomly selected to either waiting or experimental list
control group.
Original source
Couples were selected randomly to a waiting or experimental list control
group
6
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Selection was done through publicity in several media.
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The selection was done through publicity in several media
13
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The couples that expressed interest were acquainted about the nature of
the program, and then invited to the assessment interview.
Original source
Couples who expressed interest were briefly informed of the nature of the
program and invited to an assessment interview
10
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The selected couples completed both Marital Happiness Scale and Prob-
lem-Solving Inventory. They completed the Problem-Solving Inventory and
the Marital Happiness Scale.
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The couples completed the Problem Solving Inventory and Marital Happi-
ness Scale The couples completed the Problem Solving Inventory and Mari-
tal Happiness Scale
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Setting and duration of group therapy The setting of the group was Univer-
sity of Quebec in Montreal (UQAM).
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The setting of the group was the University of Quebec in Montreal (UQAM)
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The study took place in the University of Quebec in Montreal.
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University of Quebec in Montreal
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Four couples were placed in each group
Original source
Each group comprised four couples
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The behavioral and cognitive components of the problem-solving skills
were taught in 6 hours (two sessions).
Original source
The cognitive and behavioral components of problem-solving skills were
taught for two sessions (6 hours)
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During the two sessions, couples learned various problem-solving skills via
modeling rehearsals, instructions, reading, feedback, dyadic practices,
group discussions, cognitive restructuring, and homework assignment
(Bélanger, Laporte, Sabourin & Wright, 2015).
Original source
Couples learned different problem-solving stages through reading, instruc-
tions, modeling rehearsal, dyadic practices, feedback, cognitive restructur-
ing, group discussions, and homework assignments (Bélanger, Laporte,
Sabourin, & Wright, 2015)
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Each group was under the guidance of a licensed psychologist with a mini-
mum of two-year experience in group intervention and marital therapy.
Original source
Each group was led by a licensed psychologist with a minimum of two-year
experience in marital therapy and group intervention
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Group leaders received weekly supervisions between the sessions and 30
hours training.
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All group leaders received 30 hours of training and weekly supervision be-
tween sessions
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Curative factors that are important for the group
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Curative factors that are important for the group
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This factor is important in helping couples attending cognitive behavioral
group marital therapy realize that the problems they face in marriage is
universal, that is, the problems are all over (Belanger, Sabourin & El-Baal-
baki, 2012).
Original source
This factor is important in helping couples attending cognitive behavioral
group marital therapy realize that the problems they face in marriage are
universal, that is, the problems are all over (Belanger, Sabourin & El-Baal-
baki, 2012)
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These are important in helping couples attending cognitive behavioral
group marital therapy to be aware that life must go on despite regrets,
sadness, and pain.
Original source
These are important in helping couples attending cognitive behavioral
group marital therapy to be aware that life must go on despite regrets,
sadness, and pain
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Provides members with a sense of security, value, belonging and
acceptance.
Original source
Provides members with a sense of security, value, belonging and
acceptance
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This factor is important in educating and empowering couples with knowl-
edge regarding to particular psychological situation
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This factor is important in educating and empowering couples with knowl-
edge regarding the particular psychological situation (Belanger, Sabourin &
El-Baalbaki, 2012)
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Exclusion criteria mentioned by the author Selected couples with signifi-
cant individual psychopathology. Couples with primary dysfunctions. Cou-
ples with drug or alcohol problems.
Original source
Exclusion criteria mentioned by the author Selected couples with signifi-
cant individual psychopathology Couples with primary dysfunctions Cou-
ples with drug or alcohol problems
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Couples without intense marital crisis.
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Couples without intense marital crisis
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Exclusion criteria are sets of pre-determined definitions for identifying sub-
jects that will not be incorporated in the study. Cognitive behavioral group
marital therapy is designed to help couples that have different predica-
ments. The above implies that individuals who are included in the study
should have problems of various forms, and should never be involved in
any therapy at the present. However, these participants can be used in the
control experiment.
Original source
Exclusion criteria are sets of pre-determined definitions for identifying sub-
jects that will not be incorporated in the study Cognitive behavioral group
marital therapy is designed to help couples that have different predica-
ments The above implies that individuals who are included in the study
should have problems of various forms, and should never be involved in
any therapy at the present However, these participants can be used in the
control experiment (Bélanger, Laporte, Sabourin & Wright, 2015)
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The hypothesis of the study was that the marital happiness of the couples
increases significantly when they participate in the cognitive behavioral
group marital therapy.
Original source
The findings of this study generally support the hypothesis that couples’
marital happiness increases significantly following participation in cogni-
tive-behavioral group marital therapy
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Therefore, if the spouses follow the group interventions, they significantly
increase their capacity of confronting different activities of solving prob-
lems. These activities include modeling rehearsals, instructions, reading,
feedback, and dyadic practices (Bélanger, Laporte, Sabourin & Wright,
2015).
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2015).
Original source
Therefore, if the spouses follow the group interventions, they significantly
increase their capacity of confronting different activities of solving prob-
lems These activities include modeling rehearsals, instructions, reading,
feedback, and dyadic practices (Bélanger, Laporte, Sabourin & Wright,
2015)
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This can translate into practice with my clients. Group interventions are im-
portant in sharing different experiences, and it is these experiences that
can provide my clients with a foundation of dealing with personal
problems.
Original source
This can translate into practice with my clients Group interventions are im-
portant in sharing different experiences, and it is these experiences that
can provide my clients with a foundation of dealing with personal
problems
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Limitations of this study and whether thy impact the ability of using the
findings presented Lack of follow-up after the conclusion of the study. Na-
ture of the measurements that were used in appraising the activities of
problem-solving
Original source
Limitations of this study and whether thy impact the ability to use the find-
ings presented in the article Nature of the measurements that were used
in appraising the activities of problem-solving
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Lack of follow-up after the conclusion of the study – The researchers never
carried out a follow-up study after concluding their study (Bélanger, La-
porte, Sabourin & Wright, 2015). This limitation will influence my ability of
using the findings because of lack of verification. The above involves lack
of uncertainty, that is, whether the self-appraised changes remained in ac-
tion after the withdrawal of the therapy.
Original source
There was follow-up following the study The researchers never carried out
a follow-up study after concluding their study (Bélanger, Laporte, Sabourin
& Wright, 2015) This limitation will influence my ability to use the findings
because of lack of verification The above involves a lack of uncertainty, that
is, whether the self-appraised changes remained in action after the with-
drawal of the therapy
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Nature of the measurements that were used in appraising the activities of
problem-solving – The research concentrated on self-report regarding the
efficacy of problem-solving, implying that interference associated changes,
particularly for skills of problem-solving skills, are not warranted (Bélanger,
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particularly for skills of problem-solving skills, are not warranted (Bélanger,
Laporte, Sabourin & Wright, 2015). This limitation is bound to affect my
ability of using the findings because the effects of the therapy on the skills
of problem-solving skills are discussed.
Original source
The research concentrated on self-report regarding the efficacy of prob-
lem-solving, implying that interference associated changes, particularly for
skills of problem-solving skills, are not warranted (Bélanger, Laporte,
Sabourin & Wright, 2015) This limitation is bound to affect my ability of us-
ing the findings because the effects of the therapy on the skills of problem-
solving skills are discussed
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References Bélanger, C., Laporte, L., Sabourin, S., & Wright, J.
Original source
References Bélanger, C., Laporte, L., Sabourin, S., & Wright, J
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The effect of cognitive-behavioral group marital therapy on marital happi-
ness and problem solving self-appraisal.
Original source
The effect of cognitive-behavioral group marital therapy on marital happi-
ness and problem solving self-appraisal
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The American Journal of Family Therapy, 43(2), 103-118.
Original source
American Journal of Family Therapy, 43(2), 103–118
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doi:10.1080/01926187.2014.956614.
Original source
doi:10.1080/01926187.2014.956614