Preventing Marital Disorder

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CHAPTER12Fraenkef'P' ' & Markman, H' J. (2002). Preventionof marital disorders. n D. S. Glenwick & L.A' Jason Eds'), rnltolltne- ytrategies or promoting health and mental health acrossthe lifespan pp.245-271).New york: Springer.

PreventingMarital DisorderPeterFraenkelandHoward Markman

TIn this chapter,we describe he currentstateof theory, ntervention, ndresearch ertaining o the preventionof maritaldisorder. n the first sectionwe review he stateof marriage n the UnitedStates ndabroadand hemen-tal,physichl, ndsocial roblems ssociatedith maritaldistress nddisrup-tion (i'e', separation nddivorce).These indingsprovidea powerful ationalefor developing nddisseminating reventiventerventions.Wealso eview heliterature n thevariablesha tdistinguish istressedrom satisfied ouples, swell as those hat predictmaritaldistress nd disruption rom groupsor lini-tially) happypremaritalor newlywedcouples.n thesecond ectionwe describethe typical contents nd rangeof formatsof preventiventerventionsor cou-ples,and eview he empiricaloutcome iterature n thesenterventions.n thethird section, sa caseexample,we describehe development ndcontents fonesuch ntervention,ocusingon issues f program mplementationnddis-semination'n the fourthand inal sectionwe discussuturedirections f pre-ventive nterventionsor couples.Before urning o the irst section, few noteson language re n order.Thenotion of preventionof maritaldisordermarksa territory ha t ncludesboththe goal of preventing erious istress r disharmonyn marriage,as well asthe marital disruptionor dissolution ha t often follows rom suchdistress,nrecent ears'some n thebroader rofession f couple nd amily therapy ndbeyond ave ookedwith somedegree f suspiciourn.r, ndalarmat theirow_ing field of preventive ouple nterventions hen heactivitiesof this ield are245


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246 PROBLEMS N ADULTHOODcastasdivorceprevention. eminist amily therapists,n particular e.g.,Lair41999),have aisedconcerns bout he so-called marriagemovement"oftenassociated ith preventive rograms, specially ecause omewithin themove-ment seek o tightendivorce awsand redirect e{eral funding from welfareprograms which largelysupportpoor,single,or divorcedwomenwith chil-dren) o marriageeducation rograms.Our position s to cast he field asmaritaldistress, onflict,or discord pre-vention ather hanas divorceprevention er se.Not only does his languagepotential ly l lowgroupsof varying eligious, olit ical,andsocialpolicyper-suasionsegarding ivorce o agreeon the unquestionableoa lof promotingcouplewellness nd reducing isk of serious onflict,but it also s, in fact, amoreaccurate escription f the focusof preventive fforts.The reader f thisbook is no doubt familiar with the termsprimary, secondary,and ertiary pre-vention Glenwick& Jason, g93).In the domainof couples, rimarypre-vention efers o interventionsargetingnondistressed,ell-functioning ouplesto help them remainso, with the reasoning hat currentlyhigh divorce atessuggesthatall couplesareat risk simplyby virtue of beingmarried.Secondaryprevention efers o interventionsargetingeithergroupsof happycouplesknown o be particularlyat risk, or couples eginning o showsignsof dis-tress.As in otherareas f mentaldisorder or which prevention rograms redeveloped,ertiary prevention omprises reatmentof thosecouplesalreadyexperiencing ignificantdistress nd/orconsidering eparation r divorce.Technically peaking,he sortsof interventions nd ormats typicallybriefcontact n a groupsetting) ha tcharacterize ostpreventive rograms reno tadequateo assista couple n movingback rom thebrink of divorce. ndeed,assisting istressedoupleswhenoneor bothpartners reconsidering ivorcemay requirea specializedorm of marital herapy whichFraenkel 1999)hasentitled"last chancecouple herapy") o work with the damagedone o thecouple's evelof commitmentand rust.Two heoriesof thepath owardmar-ital dissolution Gottman,1993;Stanley, 995) ocate houghts f separationanddivorceas several teps nto this sequence, ndsomedata Notarius&Buongiorno,1992)suggestha t he averageengthof time couples xperiencedistrOss rior to seekingmarital herapy not necessary ith divorceyet inmind) is 6 years.Thus, rue preventiveeffortsarebettercastasdistressor con-flict prevention,erms hatcharacterize uchof what s meantby maritaldis-order. f effective, ucheffortshave he addedbenefitof assisting ouples ndchildren o avoid he extrapainoftenassociated ith divorce.However.o theextent hatdivorce s associated ith negative equelaeor adultsandchildrenalike, t appearso be due,at least nitially, o the high conflict ha toftenpre-cedes ndaccompaniesivorce Howes& Markman,1984). ndee4separa-t ion and/ordivorcemay be the bestopt ionwhenhigh conf l ic t ,especial lyaccompanied y violenceor abuse, eems nlikely to abatebecause f the


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unwillingness f oneor bothpartners o engagen changeefforts.We alsowould ike to note hatalthough his chapter ocuses xclusivelyon preventionof marital disorder, nd huson research ith heterosexual.legallymarried, r engagedo be marriedcouples,we believe hat hebasicpreventive rinciplesand practices escribed pplyas well to other ormsoflong-termcommitted elationships,ncludingcommon-lawmarriages ndgayand esbian ommitted elationships. lthough herearea numberof excellentstudies ndclinicalwritingson gayand esbian elationshipsJulien,Arellano,& Turgeon,1997; urdek,1998;Laird & Green,1996),muchmore esearchis needed,which might in turn indicate mportantadaptationsn the preven-tive practices es tsuited o promoting hem.

DESCRIPTION OF THE PROBLEMThe Stateof Marriage

Althoughdivorceprevalence tatistics ary somewhat mongstudies, epend-ing on time frameandothersampling ssues, y all accounts, ivorcehasbeenan alarmingly requentoutcomeof marriage or manyyears-alarming espe-cially whenoneconsidershat his outcome s the astone newlyweds xpector intendas heyconfirmplans o share l i fe together.n 1970, he divorcerate or f irst marriages as 50% (Cherl in,1981)andby the mid-1980swasfound to be 670/oMartin & Bumpass,1989). t is common or divorcedper-sons o marry again,but the divorce ate or secondmarriagess estimatedobe evenhigher han or first marriages Brody,Neubaum,& Forehand" 998;Cherlin, 1992), nd,according o Glick (1984),up to 10%higher.More recentstatist ics uggesthatbeginningn the ate1980s NationalCenter or HealthStatistics, 996)up to the mostcurrentestimate ublishedn the ate 1990s(U.S.Bureauof theCensus, 998) herehasbeena steady ecline n divorcerates.Evenso, current indings ndicate ha tbetween 0o/oNorton& Miller,1992)and50oh Teachman,edrow, Crowder, 000)of coupleswill divorce.Although or manyyears he United States eld the dubiousdistinctionofworld leader n divorce, nternational tatist icsndicate hatdivorce ates nmanyothercountries renowquitehigh, ncluding42o/on the United Kingdom,35oh nAustralia,and37o/on Germany Berger& Hannah 1999).Inaddition,althoughevenmorecouplesmay experience eparation ithout divorce,sep-arated ouplesare75ohmore ikely to divorce han o reconci le Bloom,Hodges,Caldwell,Systra, Cedrone, 977).Of course,most couplesdo not divorcewithin daysof first experiencingconfl ict.Althougha largepercentage f marriages nd within 2 years,and


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248 PROBLEMS N ADULTHOODthe averageengthof marriage s only six years olson & Defrain 1997), hepath o divorce ypically involvesmanymonthsor yearsof conflict.Thus, nanyperiodsampledor divorce ates, percentagef intactmarriagesha tmayor maynot eventually nd n divorceareexperiencing ignificant evelsof dis-cord.Mace andMace (1980) eported hatapproximately alf of thosewhoremainmarr ieddo so unhappi ly, nd others o 'Leary, Barl ing,Arias, &Rosenbaum, 989;Straus& Gelles,1990)have ound hatmanymarriages recharacterizedy high levelsof discord, nd evenviolenceandabuse.Giventhe central ole of marriage o an individual'soverall ife satisfaction Glenn& Weaver, 981),he indingof a significant ecrementn maritalqualitysincerhemid-1970s Glenn,1991,Rogers Amato,1997) uggestshe mportanceof efforts o staveof f maritaldisorder.

correlates and sequelaeof Marital Discordand DisruptionMarital discordanddissolution re ypicallyhighly stressful ndaredescribedby the majority of peopleseekingany form of therapyas heprimary sourceof theirmalaise Veroff,Kulka, & Douvan, 98l), Indeedresearchncreas-ingly has dentif iednegativementalhealthcorrelates f maritaldiscordanddissolution.Wedescribehese onditions scorrelated ith, rather hancausedby,maritaldisorder ecause,o date,mostof the research asnot clearlyestab-lisheda causal elationbetweenhese ariablesBradbury, incham,& Beach,2000;Got l ib& Mccabe, 1990). n addi t ion,we mustnote hatmostof theresearch n the effectsof maritaldisorderhasno t teasedapart he impactofdistress rom the mpactof divorce,nor fbr that matterhas t usuallysimulta-neouslystudiedpredictorsof distress ersus redictors f divorce Karney&Bradbury,1995;Rogge& Bradbury,1999). iven hatdivorces almostalwayspreceded ndaccompaniedy maritaldistress,t maybe difficult if not impos-sible o definit ivelyestablishheirseparatempact.Evenwhencertain eque-laeonly appearollowingdivorce, hesemightalsobe due o theaccumulatedimpactof maritaldistressather handivorce er se.Froma systemicheoretical nd nterventive erspectiveha t ooksat prob-lems rom a circularor reciprocalcausal ramework ather han a linearuni-directional ramework Fraenkel, 997),t maybe ust as mportanr o note hecorrelationbetweenmarital discordand an individualmentalhealthdisorderas t would be to identify a clearcausalpathway rom discord o sucha disor-der.For nstance, numberof researchersndclinicians Gotl ib& McCabe,1990;Papp,2000)haveargued oherentlyor a systemic erspectiven therelationship etweenmaritaldiscord nddepression,oting hata discordantmarrlagemayelicit andmaintaindepressionn an ndividual artner, nd in


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contrast, posit ive,supportivemarriagemay providea powerfulbuffer ormediatoragainst onmarital auses f depression. rom hisperspective, re-ventivemarital nterventionsowerwhatever ercentage f risk for depressioncan be attributed o marital conflict and strengthen rotective factorsattribut-able o a satisfyingmarriage.A similarperspective aptures ontemporarythinking about he relationship etweenmaritaldiscordor dissolution ndphys-ical health Schmaling& Sher,1997),as well as othernegative orrelates fmaritalproblems, uchasemploymentssuesBarling,1990). ndeed"his con-ceptualization f preventiventerventions s simultaneouslyecreasingiskand ncreasing rotection epresentshe currentparadigm n prevention ci -ence Coieet al. 1993).

Keeping hesepoints n mind, we can summarizehe findingson the cor-relatesof marital distress nddivorce.Distressanddivorceare related o anincreasedisk for psychopathology,ncludinganxietyand depressiveisor-ders,aswell as substance ndalcoholabuse seeextensiveeviewsby Bloom,Asher,& White, 1978;Gotl ib& McCabe,1990; elly & Fincham,1999; ndseveral haptersn Halford& Markman, 1997).ln addition o its relation o ahigher ikelihoodof psychopathology,aritaldissolutionseparationr divorce)is predictiveof a higher isk of automobileaccidents nd resulting ata lities,a higher isk of suicide ndhomicide, greaterikelihoodof physical l lnessand mortality rom disease, nd overallshorter ifespan see eviewsn Gottman,1994a,1999).The emerging iterature Burman& Margolin, 1992;Kiecolt-Glaseret al. 1993;Schmaling& Sher,1997)documentshephysicalhealthrisksof marital distress nddivorce-A largebody of l i teraturedocumentshe impact of maritaldistress nddivorceon the mental andphysicalhealthand the socialadjustment f chil-dren(see eviewsby Amato, 2000; Emery, 1982;Gottman,1994a,1999;Grych& Fincham 1990;Jenkins, 000;Luthar&. Zigler, 1991).Many of the stud-ies are cross-sectiona lnd cannotestablish causal ink betweenmarital dis-tress,divorce,andchild problems.However, t leastone ongitudinal tudyassessedelationship uality beforemarriageand after he birth of the childand found a causal ink between remarital elationship atisfaction,evel ofpremaritalandmarital confl ict and communication uality,andquality ofmother-child ttachmentHowes& Markman, 1984).As alluded o earl ier,research Amato,2000; Emery, 1982;Gottman,1999;Markman& Jones-Leonard,1985)suggestshat t is marital conflict or parental onflict duringand ollowingseparation nd divorce, ather han he separation r divorceperse , hat hasa negativempacton children.In sum, here s much evidence inking marital distress nd dissolution oall mannerof mental andphysicalhealthproblems or both adultsand chil-dren.Aside from the enormous ufferingentailed"he economic ostsof mar-i ta l st r i fe for fami l iesand societyas a whole due to heal thcareneeds,


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250 PROBLEMS N ADULTHOODengagement f the egalsystem, nd decreased ork productivity s estimatedto be in the billions of dollars yearly (Forthofer,Markman,Cox, Stanley,&Kessler,1996).Preventive pproacheso maritaldisorder,herefore, oten-tial ly couldhaveenormousmpacton thegeneralwell beingof society.

Limitations of Marital TherapyAnotherproblemwith maritaldisorder s that t is difficult to reverse. num-ber of studies nd reviews Gottman,1999;Hahlweg& Markman,1988;Jacobson Addis, 1993)suggest hat althoughmarital herapymay result nstatistically ignificant mprovement scomparedwith no treatment,he major-it y of treated ouples o not move rom distressedo nondistressedtatus, ndthere s a high rateof relapse.Furthermore, lthough t is estimated hat themajority of distressed ouplesdo not seek reatment Bradbury& Fincham,1990;Kelly & Fincham,1999), f they did, the needwould far outstrip heavailabil i ty f competent ervices.

What GoesWrong in Distressed nd Disrupted Marriages?

There area numberof excellent eviewsof longitudinalstudieson the vari-ables hatpredictseparation nddivorce,aswell asa growingnumberof stud-ies hatexamine he nterpersonal nd ntrapsychic i.e.,cognitive, motional,physiological)processeshat charactenze istressed ouplesor thoseboundfor futuredistressGottman,1994a,1999;Gottman& Levenson,1999a,1999b;Karney& Bradbury,1995;Rogge& Bradbury,1999).As the focus of thischapter s more on the natureof preventiventerventionsor couples han ona careful eviewand crit iqueof thesestudies,we wil l summarizehe mainfindings, particularlyas hey provide he basis or creationof interventions.

KarneyandBradbury 1995) eviewed115 ongitudinal tudies,many ofwhich had seriousmethodological laws. Their review dentified a few pre-dictive variables hat we would describe s stableattributes f persons, heirbackgrounds, r their contexts-those not readily amenable r impossible opreventor change hroughshort-term nterventions. hese ncludedivorceofone'sown parents, oung ageat marriage,poverty,andpersonality ariablessuchas "neuroticism"(which s essential lyhe tendencyo view life nega-tively). Other variables dentified can be described s dynamic, n that theyaremore amenableo changeor prevention hroughacquisition f skills andideas Stanley, arkman,St.Peters, Leber,1995).


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Foremost mong hesedynamicvariables re he qualityandpatterning fcommunication,n-cludirrghe typesof affectsexpressed articularlyarounddiscussing nd solvingpioblemt. rn. paradigmatic esearch rocedure en-erating heseobseruational ata nvolves he couple dentifying the topic ordomain (e .g . ,housework ,ch i l dcare ,t imetoge ther 'money 'sex)abou twh ichthey experienceheir greatestevel of conflict and discussinghe topic withan attempt o resolv. it . Th.r. discussions revideo- or audiotaped nd atercodedby independent bservers sing

oneof a numberof available odingsystems Gottman& Notarius,2000;Notarius& Markman,1987)' ndeed' na recent eviewof predictors f divorce,RoggeandBradbury 1999,p.338)found hat bothbehavioral bservation nd self-report tudieswith follow-upperiods anging rom 2 to 12years reportedratesof accuracy etween75%and95o/o"n predictingdichotomous ategories f eithermarriedversus ep-arated/divorcednr satisfiedversusunsatisfied,based argelyon thesevari-ables.Thus, t is widely acceptedhat particularpatterns f affectexpressionandcommunication haracteiize istressed ersusnondistressedouplesandpowerfullypredictmaritaloutcomes'

A numberof studies DeMaris,2000;Rogge& Bradbury,1999)alsohave

found ncidentsof physical iolenceandaggiessiono be strongpredictors fmaritaldissolution.Suchstudies upport he need or prevention rograms oaddresshe precursorso relationalviolence'Although he anguage sed o describe estructive ommunication ehav-iors variessomewhal rio* laboratories,here s generalagreement s o thepatterns hat characterrzethenteractionsof distressed ouplesmorethan sat-isf ied couplesand hat arestrongpredictors f laterproblems n presentlyhappyn.*ly*.Jor.ngug.d coupiei.Problempatternsncludecontempt' rit-icism,defensiveness,ithdrawal,stonewalling a particularstyleof withdrawalmorecommon n men, n which themusculature f the faceassumes frozen'inexpressivestate),negativeescalation(describedindifferentstudieseitherasrepetitive xchanieso-1 egative ffect,particularly hose istedabove'or asapowerfullynegative esponseo a neutralor mildly negative omment)' nval-idation(puttingdown he thoughts,opinions,andeffortsof th l partner)'andnegative nterpretations/mindreadingstatements hat assume egativententon thepartof thepartner Gottmanlgg3,l994a,Igg1b,1999; Gottman'Coan'C a r r e r e , & S w a n s o n , 1 9 9 8 ; M a r k m a n ' 1 9 8 1 ; M a r k m a n ' F l o y d ' S t a n l e y ' &Storaasl i , l988;Markman,Renick,Floyd"Stanley,&Clements1993;Roberts,2000). mportanirv, "u*.n andhis "oueaguesound hatexpression f angerper se (without contemptor crit icism) was not predictiveof latermaritald i f f icul t ies(Got tman,1993;Got tman,Coan,Cafrere,& Swanson, 998;Gottman& Krokoff, lggg), correctinga myth perpetuated y numerous ro-fessional ndpopularpsychology ooksGot tman(1993,1994a,1999)hasprov ided themostcomprehens ive theory


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252 PROBLEMS N ADULTHOODof the "cascade"towardmarital dissolution.The theoryprovidesconceptualand empirical inks amongmoment-to-momentmarital interaction,prcep-tions/cognitions,ndphysiology.n brief, the heorysuggestshatmarital nter-actionscharacterized y the above-describedestructive ehaviors esult ntheexperience f physiologicalloodingand houghts itherof hurt and..right-eous ndignation" (accompanied y feelingsof sadness, nger, ontempt)orhurt and perceived ttack accompanied y internalwhining,sense f .iinno-centvictimhood"" ear,and worry). In addition,hypervigilanceo behavioralcuesassociated ith flooding leads o interpretation f otherwiseaffectivelyambiguouspartnerbehavioras negative.Over time, these nterpretationsbecome odified nto fixed attributionshat cast he partner's ehavior sself-ish, characteristic f them in multiple contexts globality),and stable basedon a trait rather han on currentstateor context) seeFincham,Bradbury,&Scott,1990,andKarney& Bradbury,2000, or reviewsof the mpactof neg-ativeattributions n marriage). heseattributionshen guideperception fsubsequentnteractions ndevents hrough he process f confirmationbias,vrhich n turn leads o morenegative ehaviorand looding.In addition,Gottmanhaspresented atasupportinghe notion hat he crit-ical issue s to achieve alance oth within eachsubsystemnvolved n mari-tal functioning (interactional ehavior, ognition,physiology)and among hesesubsystems.n this model,balance s not necessarily chievedhroughequaloccurrence f opposite ehaviors. or nstance,Gottman 1994a) ound hataratioof 5:1 for positive o negative ehaviors redictedmaritalstabiliry whereasa ratiocloser o 1:1predictedmaritaldisruption.n addit ion, snotedabove,not all "negative"behaviors ave he same nterpersonal ffects,and he eripres-sionof contemptor criticism,even f less requent, anundo he relationship-strengtheningmpactof posit ivestatementsNotarius& Markman,1993).

REVIEW AND CRITIQUE OF THE LITERATUREEfforts to strengthen ouplesso as to preventserious evelsof distressanddivorceactuallycharacterized anyof theactivitiesof theearlymaritalcoun-selorsas far back as he 1930s Gurman& Fraenkel,2000).However, irtu-ally noneof theseearlyeffortswerebased n empirical esearch, nd n manycases ot evenon clear heoryaboutprocesseselated o preventing egativemaritaloutcomes. he contemporaryield of maritaldistress revention eganin the early 1970swhen ntervent ions egan o be basedon the researchreviewedn the previous ection,which nvolvedcarefulempiricalstudyofvariableshat distinguishdistressedrom happycouplesand hatpredictdis-tressanddivorce.At around he same ime, a numberof more heoretically


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based pproachesmerged.n this sect ion,we descrtbehe charactertst tc.o-po*ts of preventiventerventionsor couplesand he rangeof theo-reticalpremises, nd we review he efficacyandeffectivenessesearch nthese nterventions.

Componentsof Preventive nterventions and R'ange fTheoreticalPremises

All programs esignedo strengthen arriages rebased n aphilosophy f psy-choeducation-thenotionthat deasandskillsbelieved o enrichmarriages nd/orprotect hem rom destructiveonflict canbe directly aught o couplesn a fairlytrief period of time, mostly n a group setting,and hat coupleshen can putthese deasand skills nto practicewithoutmuchongoingassistance.irtuallyall programsnclude nformationaboutcommunication nd,usually, kills rain-ing;utl.ast someattentiono partners'beliefsbout ntimacyandmarriage; ndsome ocusandioractivitiesdesignedo increasehepleasurablespects f rela-tionship,suchas un, friendship, ndsensuality' owever' sa group hepro-grams vary greatly n terms of theoreticalpremisesabout the natureofielationships, roblems, nd change,with al l major heories f couple herapyrepresentedi.e.,cognitive-behavioral,sychodynamic,ntergenerational,xpe-riential),aswell as somemorereligiousor cosmological eliefsystems'Although somehavesuggestedhat only programsdirectly focusedondecreasing arital isk factorsandenhancing rotectiveactorsbe consideredtruepreventive pproaches,sopposedo those hat ocussolelyon enrichingr-nuriiug., Kelly & Fincham,1999),we view al l of theseprograms spoten-tially pieventive nterventions.n our view,whetheror not an intervention sp..u.ntiu. mustbe determined ntirelyby empirical, ongitudinalstudyof itseffectivenessn assisting appycouplesor thoseust beginning o showsignsof distress o remain stableand to maintain elativelyhigh levelsof qualityyearsafter he program,ascomparedwith couples hat did no t participatenih . p.ogrum.Research emonstratinghepositive mpactof a program mme-alatetypost-interventionoesno t establisht aspreventive.For a meta-analy-,1, of ru.t studies oncluding hatenrichment rogramsaregenerallyeffective'seeGiblin, Sprenkle,& Sheehan, 985'However, eealsocrit iquesof thisanalysisn Bradbury& Fincham, 990,andKelly & Fincham'1999')Likewise'studies emonstratinghe effectivenessf these nterventions ith distressedsamples o not establishhem aspreventive, s heseconstitute reatment tud-ies,whetheror not theyareconductedwithin the contextof a programstatedto be preventiveseeDeMaria,1998,andDurana,1996, Orexamples f thisconfusion).


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254 PROBLEMSN ADULTHOODOur hope s thatall programsnterestedn theprevention f maritaldistressand divorcewill engage n the hardbut excitingwork of conducting andom-ized, ong-termclinical rialsaswell asmorenaturalistic ffectivenesstudies

with primary or secondary revention amples.However, o date,only thePrevention ndRelationship nhancement rogram PREP) asbeensubjectedto thissortof rigorous crutiny Kelly& Fincham,l9g9). hus,our reviewofefficacy and effectivenessesearchocuses n PREP.

Efficacy and Effectiveness f Preventive nterventionsThe originaleff icacystudyof PREPwas eported y Markmanet al. (1988)andby Markmanet al. (1993).Nondistressed,remarital ouples articipat-ing in a largercommunitystudy of predictors f maritalquality and stabilitywerematched n dyadsor triadson the basisof variables ound in previousresearchMarkman, 98 l ) to predict uturesatisfaction ndstability engagedversusplanningmarriage, elationship atisfaction, elf-ratings f communi-cation mpact,confidence n gettingmarried).one or two couples n eachmatched etwere henrandomly nvited o participaten the ntervention,whilethe otherserved n an untreated ontrol group.Half of those nvited nto theintervention eclined, o that herewere hreegroups: ntervention, eclinecontrol,andno-treatment ontrol.With respecto relationship tability, t ltlz-and 3-year ollow-up, ntervention ouplesweresignificantlymore ikeiy thanno-treatment ontrolcouples o be together datawerenot presentedn the1988article or declinecontrolcouples), ndat 4- and 5-year ollow-up, nter-ventioncouplesweresignificantlymore ikely thaneithercontrolgroup o betogether.With regard o maritalquality,as expectedn a prevention tudy, herewereno groupdifferencesmmediatelyafter ntervention.However, t IIlz-,3-, and4-year ollow-up, ntervention ouples howed igher elationship at-isfaction handid controlcouples, nd, or men, his difference ontinued t 5years. n addition,at 3 years, ntervention ouples howed igher sexualsat-isfactionand owerproblem ntensity, s well as morepositiveself-ratings fcommunicationmpact.

Concerningnteraction rocesses,tpost ntervention REPcouples emon-stratedmorepositiveand essnegative ommunication, s determined y rat-ingsof independentoders. his ndicateshat ntervention ouples earnedandused he skills.At 4-year ollow-up, ntervention ouples howed reateruseof communicationkill, greater ositiveaffect,moreproblem-solvingkill,andmoresupport ndvalidationhandid controlcouples, nd essdenial,dom-inance, egative ffect,conflict,and overallnegative ommunicationhandidcontrols. imilar esults istineuishedhe nterventionrom thedecline on-


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l v l l l l \ l L t ' L L ' rJ rJ \ ) - l \ v L l \ LJ J

trol group.Thesedifferences id no t appearat 5-year ollow-up (except orgr.ulr useof communication kill by interventionmen),possiblydue o attri-tion of the eastskilledcontrolcouplesby that time or possiblydue o a fad-ing of the nterventionmpact.Thesebehavioral indingssuggesthatcouplescan sustainmproved ommunication ndproblem-solving kills or years ol-lowing a relativelybrief program,bu t that boostersessionsmight be criticalto promote ong-ierm use. ndeed,at the completionof the

workshopmanypaiticipants aveasked or suchsessions,nticipating he decline n theiruseor memoryof the skills.

one otherstriking inding was hat at 5-year ollow-up, ntervention ou-plesweresignificanily ess it.ty thancontrolcouples o report nstances fphysical iolence.As well as urthersuggestinghat PREPhelpscouples an-dle conflict more successfully,t maybe that he nterventionowers he ike-lihood of someof theprecursorso violence n somemen,suchasphysiologicalflooding and withdrawal/stonewallingJacobson Gottman,1998)'Otherstudies ave eplicatedPREP'seffectivenessn decreasingelation-shipdissolutionandmaintaining elationship uality over ime' For nstance'a study Hahlweg, vlarkman, hurmaier,Engl, & Eckert,1998)conductednGermanycompared oupleswho took PREPwith thosewho engagedn thetypical premarital raining offered n their churches, swell as o thosewhotltt no^p.emaritalraining.Five years ater,PREPcouples ad significantlylowerdivorce atesandhigher elationship atisfactionhaneithercontrolgroup,However, he findingt ut. limited becauseack of randomassignmentto conditionsmeant ha tcoupleswho chosePREPmight havebeensystemat-ically different rom the othercouples'

Several ngoingstudiesareattempting o replicateand extend hese ind-ings.For instance,-Fraenkelnd his colleagues reconductinga longitudinalstudyof the mpactof PREPon partners' ualityof l i fe, stress' ealth'andhealth-related ehavior. his studyalso s designedo examine he variablesthatenhance r impede mplementation f program deasandskil ls n cou-ples' daily lives. n-depth nterviewswith intervention ouples and2 yearsafter he course ound amongother hings, ha t hemajority of couples xpe-rienced t asusefulbut did not frequentlyuse he skil ls exactlyas aught'However,heybelieved he skills rainingandpractice essionso be essentialin theirbecomingmoreattuned o theneed o respectheirpartners' ifferingopinionsand orlesolving problemswithout resorting o destructive atterns(Fraenkel Whittet,1998).

One studyhasreportednull findings on PREP'sefficacy'VanWidenfelt'Hosman,Schaap, ndVun Der Staak f qqO)conducted controlledstudy nHolland and found no benefits or interventioncouples omparedwith con-trols immediately ollowing the course,or 6 months ater,or 2 years ater'However, herewerecertainmethodological roblemswith this study, nclud-


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256 PROBLEMS N ADULTHOODing relianceonly on self-reportmeasures, sample hatwasalreadysome-what distressedgroupdifferencesn lengthof relationships, nd differentialattri t ion.

CASE EXAMPLE

In this sectionwe describePREP's ontentand ormat n moredepth,anddis-cussour efforts o disseminatehe program. n doing so ,we alsoaddresshe"barriers"(Bradbury& Fincham,1990)and challengesacingefforts o pro-moteprimaryand secondary reventive rogramsor couples.

Program Content

PREP ocuses n teaching kills, deas, nd ife practices esignedo decreaserisk factorsand o enhance rotectiveactors.Content ocusedmostlyon reduc-ing risk factors ncludes a) identifyingand llustrating with videotaped xam-Bles)commondestructive ommunication atterns;b) teaching constructiveapproacho expressing oncerns r complaints, ne hatactsagainst he ten-dency o developglobal,stable, nd negative ttributions y focusing nsteadon specificpartnerbehaviors nd he emotional eactionshesegenerate;c)teaching he speaker-listenerechnique, form of structuredactive istening,as well as a problem-solving equence;d) discussinghe negativempactofunrecognized r undisclosed xpectationsboutmarried ife, which can esultin conflict aswell as orm the basisof negative ttributionswhen hepartnerviolates heseexpectations;e) raisingawarenessf potentialconflict arounddifferencesn religiousand ethicalvaluesandpractices, hich manycouplesseem o overlookuntil these oncerns re aisedby certain ife events, uchasthe birth of the first child; (f presenting model for identifying he hiddenissues r relationshiphemes, uchascontrol,caring, espect nd ecognition,commitment, rust,and acceptance,hat oftenunderlie epetitive, nresolvedissuesor those hat typically generate xplosive eactions r avoidance; nd(g) encouraging artners o commit to enacting ertainground ules or han-dling conflict and maintainingpositiveaspects f the relationship.Content ocusedmostly on increasing rotective actors ncludes a) lec-turesand suggested ctivit ies or increasing nd maintaining ime for fun,friendship,and sensuality nd (b) lectures n the wo aspects f commitment(dedication ndconstraint) nd he mportance f forgiveness,ndsuggestionsabouthow to strengthenhese rotective spects f relationship. igure12.1


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depicts he program's orecomponents, ith the sequence f confl ictman-agement kil ls shown n a flow chartand he protective ctivit iesarrangedaround heperimeter o represent ow these an orm a criticalboundaryaroundconfl ict andbetween he coupleand he stressorshat can mpingeon theirrelationship.

Program Format

PREPcombines roup ectures elivered y one or two workshop eaders ndindividualskil lspractice essionsor eachcouple, acil i tated y coaches r"consultants"trainedand supervised y the workshop eader. he full PREPcourse s 15hours ong.The originalschedulenvolved ive meetings f 3hourseach.Oneof us (Fraenkel) ound hat busyNew York City coupleshaddifficulty attending achweek,and created formatof I weekend ay(8 hours)followedby two Thursday venings f 3tlzhourseach.This formatresultednvirtually zeromissed essionsfor both research ndpayingcouples) ver hepast6 years approximately 4 workshopsand roughly 120 couples).PREPhasnow adoptedhis format (1 weekend ayplus2 Thursday venings) s hebasicschedule. weekend ersionhasbeenused n Denverand n the Germanstudydescribed arlier.A 1-dayworkshopalsohas been mplemente{ and aspecialmanualcreatedor it. Shorter ersions repossible swell (for exam-ple,an ntroductory learningevening"or "half-dayintensive"),with the under-standing ha treduced rogramcontent andparticularly,ess n-session killspractice)may mean educedong-termeffectiveness.

Although he ongitudinal indings rom Germany uggesthat couples anbenefit asmuchfrom a weekend ersionasone hat extendsovera few weeks,no study has yet directly compared he two versions o determinewhich"dosage"is most effective.One mportant uturedirection or researchs todetermine he bareminimum of intervention ecessaryor couples o notablybenefit n a sustainedmanner.

ProfessionalTrainingA key aspectof preventionprogramdisseminations training others o pres-ent the materials.Since1990PREPhasoffereda 3-day nstructor rainingas a requiremento conduct he full 15-hourprogramand o train coachesoassistn workshops. raining n the 1-dayworkshop ormat s now availableaswel l .


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No time to talk?

PREPAT A GLANCEGripe/Concern/Complainr

XYZ StatementWhenyou do Xin situationI feelZ Time o talk?

Character ssassination?Mind Reading?Catastrophicnterpretation?Blaming? itchenSinking?

Speaker/ListenerRules or Speaker Rules or Listenerl. Speakor yourself. on'tmindreadl l. Paraphrasehatyouhear.2. Keepstatementsrief.Don't go 2. Focus n the speaker,s essage.on andon, Don,t ebut.3. Stop o et he istener araphraseRules or BothL The speaker as he loor2. Speakereeps he loorwhile istener araphrases3. Sharehe loor

IssueResolved?

Problem-Solvingmpasse? Problem Resolved?Congrats-Go on with lifel

Figure 12.1 Major components f thePrevention ndRelationshipEnhancement rogram PREP@).e 1999PeterFraekel,Ph.D & AmandaSalzhauer, SW

PREP!a t NYU Chi ld SrudvCenter 2 tZ\ 263 8664

Congrats-Goon with ife!

Identify Hidden IssueSpinningyour wheels?Avoiding a specific issue? ntenseemotional eaction?Look for hidden issuesaround Power and Control, Closenessand Car.ing,Respectand Recognition

CallaSTOPACTION

Problem-SolvingAgenda etBrainstorm

Combine, ompromise, ontractFollowUp

f PrPr"br.rilI *-'tt'-------.--


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Initiallywe imited raining o mentalhealthprofessionalsndpastoral oun-selors r those n graduate chool n these rofessions.n recent earswe haveoffered he rain ing o selected araprofessionalssuchasclergyor senior er -sons n a churchcongregation, ho generally rovide heprogram n particu-lar settings, uchas n their religiouscommunities. rainingof professionalsand paraprofessionalsachpresents articularchallenges.Our experiencesthat experiencedmentalhealthprofessionals ften havea difficult time stay-ing within the role of coaching ki l ls;on the otherhand,paraprofessionalsmustbecomeacquaintedwith fundamental ulesaboutconfidentialityand withhow to respond ensitivelyo personalmaterial.As in the previoussteps n developingPREP,we areattempting o answerquestions bout he relativestrengths f professional ersusparaprofessionaltrainers hroughempiricalstudy.We (Stanley t aI.2001)currentlyare con-ducting a long-termeffectiveness tudy comparingoutcomes or couples nchurchand synagogue ommunitieswho wererandomlyassignedo receiveeitherPREPpresentedn the usualacademic ettingby our workshop eaders,PREPpresented y the community'sown clergymenor clergywomen, r theusualpremarital rograms rovided n that church. nit ial preipost indingssupportedhe conclusion hatparaprofessionalsan deliver he programaswell asmentalhealthprofessionals. ata ndicated o differences etweenhecoupleswho received he program n the universitysett ingand hosewhoreceivedt from their clergy, ut a significantdifference etweenPREPdeliv-ered n eithercontextand he usualpremaritalprogrampresentedn the reli-g ious inst i tut ion.These indings are extremelypromising,as rel ig iousinstitutions rovidea naturalcontext or implementation f preventiventer-ventions, iven hat over75o/o f couples till marry in a churchor synagogueand often already eceivesomesort of premarital nformationor counseling.MaterialsWe find a varietyof writtenandaudiovisualmaterials ritical o program res-entationand dissemination, ither n groupworkshops r individual ounsel-ing settings. self-administeredersionof theprogram hat relies xclusivelyon thesematerialss currentlyunderstudy.We useprofessional-qualityideo-tapes hat presentPREP'score deasand demonstrate oth problempatternsandskills.Theprograms alsocontainedn a manual, nd he nstructor's an-ua l providesdetailedectureoutlines eyed o videotaped emonstrationsndPowerPoint lidesor overheads.or couples'further tudy, n audiotape eriessummarizingheprogram s available, swell as several ooks seeespecially,Markman,Stanley, Blumberg,1994,which providesnstructionsor theskil lsand he material f each ecture).


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260 PROBLEMSN ADULTHOODChallengesn Program mplementationand DisseminationThose nterestedn establishing ommunity-based revention rograms acemany challenges, nd our experience ith PREP s no exception.Challengesarepresented y widespread ulturalbeliefsaboutmarriageand couples, ymentalhealthprofessionals,ndby the argersocialcontext.BradburyandFincham 1990)described numberof these hallenges,ncluding a) generalpessimism bout he institutionof marriageand he possibilityof long-termhappy elationships,esulting n a passive,atalisticattitude; b) low motiva-ticn of huppycoupleswho typicallybelieve heold adage, if i t ain't broke,don't fix it;" (c) a concern n thepartof oneor theotherpartner typically heman) hatprogramswill requiregroupexperiential xercisesn which heyareurged o "get in touch,"cry,or expressntimacy n public; (d) culturalmyths,suchas he notion hat couples houldn't eveal hat heyhaveproblems oreven hat hey might needs kills for futureproblems)and hemyth of "natu-ralism"(i.e., he belief hat relationshipshoulddo well withoutany educa-tional nput or support, ike in the moviesandothermedia hatportray omanticrelationships san effortless, onsistentlyhrilling experience);e)manymen-tal healthprofessionals'viewhatpreventive ork is less nterestinghan her-apy,not lucrativeenough,or is a threat o their livelihood; 0 beliefsof fundersof mentalhealthservices ha tpreventivework is lessof a priority for limitedfunds han s money or treatment ervices; nd (g) largersocial ssues, uchaseconomic ardship nd ncreased emands f the workplace,ha tmayerectfinancialor temporalbarriers o participation n suchprograms.Webelieve hat a coresolution o thesechallengess imaginative ndper-sistent xposure f alternativeso the views istedabove,ncludingclearlypre-sented esearch ata hat support hesealternative iews.Preventionists ustuse he media,short nformational essions nd demonstrations,nd othermodalities o promote he deas hat all couples aceproblemsat one ime oranother; hat this shouldno t be a reason or shameand secrecy ut ratherareasonor preventive kill-buildingandcreating ommunities f careand sup-port; and hat marriage an be a challenging nd enjoyable,ong-livedadven-ture that with useof skills and a proactiveattitudeof teamworkwill requiresomework but not necessarilyhard work." Useful would be advertisementsandpublic serviceannouncementshatcontrast he costsof maritaldistressanddisruptionwith thecostsof participatingn prevention rograms.With respecto concerns bout heactivitieswithin theworkshop, e clearlydescribePREP o prospective ttendeess a course, ot therapy.We alsoassurethem hat hey will not need o discuss rivatematerial n a groupsettingandcanchoosewhetherand how much o discuss uchmaterial n theprivatecoach-ing sessions.Probably hebest ong-termapproacho shift ing he attitudes f the pro-


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graduate raining n psychiatry, sychology, astoral ounseling, ocialwork,andallied professions. s we do in our respective octoralprograms, radu-ate students nd nternscanbe involvedascouplecoaches nd n conductingresearch nd therebyhopefullybecome hooked,'on prevention. ost-gradu_ateprofessionalsanbe encouragedo view conducting revention orkshopsas one component f their career ather hanas a substituteor clinicalwork.Periodicworkshopswith lessdistressed r nondistressedouples anprovidea welcome hange f pace rom thechallenges f workingwith moredistressedcouples. s an extra ncentive, uchworkshops ftengenerate rivatepracticereferrals.Regarding he challenge f providing he program o thosewith limitedfinancialresources,rograms realreadybeingoifered n religiousandcom-munity settings t little or no cost.We areclear ha t relationship-strengthen-ing programswil l not in themselvesolveall theproblems f economicallyand sociallymarginalized ersons, ut theymayrepresent usefulcomponentin assistinghese ouples o facemultiplechallenges resented y poveity.weagreewith those Bradbury& Fincham,1990; radbury t al.2000;Fraenkel,1999)who maintain ha totherprograms reneededo addresshe argercon-textual orces hatnegatively ffect he well-beingof couples nd imil ies.For coupleswho are "temporallychallenged"and feel too busy to attend,short forms of the programare available.However,we hope hat the above-described ublic educationeffortswill increase eneralenthusiasmor pro-grams hat require elatively ittle time commitmentcomparedwith the vastamountof t ime expended n relationship istress nddisruption.

FUTURE DIRECTIONSAlthough he empirical iteratureon determinants f distress nd divorcehasproduced wealthof rigorouslyderivedanduseful nformation o guidedevel-opmentof preventionefforts,and ntervention tuclieso dategenerally up-port theefficacyof preventive rograms,herearemanyareas or furtherwork.we agreewi th the cr i t ique eveledby some Bradbury& Fincham 1990;Bradbury, t al' 2000;Kelly & Fincham ggg) thatmoreartention eedso beplacedon researchinghe mpactof thebeliefs,emotional ulnerabilities, ndphysiological-responseensit ivit ieshateachpartnerbrings o the relation-ship' andon incorporatingnterventionsha taddresshese;'enduring ulner-abil i t ies" Kelly & Fincham,1999).For instance, iven hat,self-selectionbiases side, pproximately alf of al l peoplewho enroll n preventive ro-gramswill be adult childrenof divorce,and hat those ndividualsmay havemore nsecurity boutmarriage,end o experience orestress ndhavemoreanxietyanddissatisfaction ith family and riends hanadults rom ntact am-i l ies Glenn& Kramer,1985;Kulka& weingarten,g7g),programsmight


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262 PROBLEMS N ADULTHOODwant o includespecial ttentiono these ssuesKelly & Fincham,1999).Thefield of maritalstudies ndprevention lsoneedso makeuseof theburgeoningdevelopmental/personalityliteratureon the impactof differing adult attach-mentsty les Klohnen& Bera,1998;Kobak&Hazan,199l) on relat ionshipfunctioningand stability,as well as examine he relatedareaof differencesntemperament nd heir mpacton thresholdsor physiologicalloodingandoverall oleranceor various ormsof marital nteractionandemotionalexpres-sion' Likewise, t couldbe interestingo examine he mpacton communica-tion of differing cognitivestyles for example,divergentversusconvergentthinking),or the mpactof onepartnerhavinga learningdisability Walker&Shimmerlik,1994).Findings ouldbe ranslaiedntopsychoeducationalod-ules hat guideeffectivecopingwith suchbiologicailyand developmentallydetermined ifferencesn a manner hat promot.s .esilienceand acceptance(Jacobson Christensen, 996).Kelly and Fincham 1999)alsonoted he seeming veremphasisf pre_ventionprograms n containment f conflictandavoidance f negative ehav-ior, rather han promot ionof posi t ivebehavior. hey ci ted he growingliteratureshowing he critical impactof suchbehaviors sagreement, mpa-thy, dentifyingproblems n a gentle ashion,creative ndcollaborative rob-lem-solving,andspendingenjoyable ime together.Webelieve hat both riskreductionand enhancement f protective actorsare mportant.However,data(Behrens& Hal ford, 1994;Renick,Blumberg,& Markman, 1992;Stanleyet al.200l) suggesthatwith a l imited amountof t ime in which todelivera preventive ervice o coupres, reateremphasis hourdbe placedon helpingcouplesmastercommunication nd protlem-solvingskil is thatcan safeguardhemfrom the primary intrarelationshipisk factoiof destruc-tive interaction round he nevitable ifferences ndproblems hatemergewhen wo peopleshare life.It is alsoworthnoting hat many opicsandactivities rimarily focused nreducing isk may simultaneouslyncrease rotective actorsand vice versa.For nstance, scouplesearneffective, ositivecommunication ndproblem-solvingskills thathelp hemmanage onflict, hey reateachothermore gen-

tly (even n conflict)andcome o takeprideandhaveconfidencen their ointcapacit ies nd eamwork,whichNotariusandYanzetti1983) ermed ,rela-tionshipefficacy."Positive onrmunication nd pride n relationship fficacythenserveasprotective actorsby strengtheninghecouple's ond.Likewise,ascouples uild a "bankaccount"of good eeling hrough un, friendship, ndsensuality,hey maybe more nclined o approach iscussingheir nevitabledifferencesmore calmly andeffectively-without disrupting he basicsenseof "we-ngss."Somehavesuggestedha tpreventive ffortsneed o be mounted o addresslargercontextual ariablesha taffectmaritaloutcomesBradbury& Fincham,


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1990;Bradbury, incham,& Beach, 000;Kelly & Fincham, 999), uchasunemployment Aubry, Tefft, & Kinsbury, 1990),poverty, acism,andworkpr.rru..i that ead o negative pilloverand ime away rom family (Fraenkel& Wilson,2000;Halford,Gravestock, ower,& Scheldt,1992)-We agree, ndoneof us (Fraenkel) as developed program n an urbansetting o supporthomeless amilies and couplesof color as they move from welfare o work(Fraenkel, ameline,& Shannon,2000; raenkel& Shannon, 999)'However,shortof directpreventive ffortsor public policy initiatives

addressingheselargersocietalorr.r, existingdistress revention rograms ould ncludemod-ulei that help couples ecognizehe powerful mpactof these orceson theirstressevelsand amountof time together Fraenkel& Wilson,2000)'programsalsocoulddo moreto recognizehe argerculturalbelief systems,sharedo a greater r lesser egree y eachparticular ouple, ha t nform com-mon problematic atterns. or nstance,he ubiquitouspursuer-distancerat -tern, n whichwomen ypically pursueandbecomecriticalwhile menwithdrawandbecomedefensivechristensen Heavey, 990), s partly he resultofstereotypedender eliefs, einforced y suchpopularbooksasMenAre FromMars. Women re From VenusGray, 1992), ha t women aremore suitedbynature o be the emotional managers"of relationships ndmenare ncapableof expressingheir feelings. t might assist ouples o becomemore flexibleand equitable n their interactions f preventionprograms ncludedmaterialthat,,deconstructs"r closelyexamineshesepowerfrrl ulturalmessagesndhelpscouples externalize" or separatehesebeliefs rom their own life nar-rativesandpreferredwaysof being(White & Epston,1990).

In addition,newchallenges reemergingaspreventionandenrichment ro-gramsare ncreasingiy isseminatedmongspecificculturai,ethnic,and eli-!iou, groups Crohn,Markman,Blumberg,& Levine,2000;Stanley, rathen,McCain, & Bryan, 1998;Whitfield" Markman,& Stanley,n press), pecificsocialcontexts n which couplesshareparticularconditionsand challenges(suchas the armed orces),or whole societies ifferent rom the ones romwhich participantsweredrawn or the basicmarital research ndefficacystudies. t behooves s to conductmoreresearch n marriage n thesegroupsand societies, nd o reviseprogram ormatsand content o addresshe par-ticularneeds f marriages ithin them(Fraenkel, 998,1999). ikewise,morepreventive rograms hould argetcouplesat ife-cyclestages nown o involveincreasedisk, suchas he transition o parenthood Cowan& Cowan'1992;Jordan,Stanley,& Markman,1999;Matese,Shorr,& Jason,1982), he"emptynest" (Arp, Stanley, rp, Markman,& Blumberg,2000),and he ransit ionto retirement.More basic esearchs needed n therelationship etweenmar-ital disorderandvarious orms of psychopathology,ndpreventive rogramsmustbe developed nd ested o addresshe particularvulnerabilities f suchcouples,


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264 PROBLEMSN ADULTHOODInformationsuchas hat summarizedn this chapter houldbe presentedo

those n positions o fundprograms n a broadscale. n addition,maritaldis-tresspreventioneffortsmust continue o be empiricallyevaluated ndextendedso that a steadystreamof solid datasupports heir importance nd viability.In summary,much progress asbeenmadeover he past hreedecadesndeveloping esearch-basedrograms or preventingmarital disorder.Manychallengesemain,however, articularlywith regard o promotingpreventionin the broadersociety.With the evergrowingbody of datadocumenting henegativempactof distress nddivorce,and he mountingevidencehatskill-basededucational rograms or couples anmake a difference,we believesocialscientists, l inicians, ommunity eaders, olicy makers, ndcouplesthemselves ould do well to invest ime, money,and effort n prevention.

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D. Fincham& T. N. Bradbury Eds.),Thepsychology f marriage pp,226-257).New York: Guilford

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Gottman, .M.(1994a). What redictsdivorce?Hil lsdale,NJ: Erlbaum.Gottman,J. M. (1994b).Whymarriages ucceed r fail. New York: Simon&Schuster.Gottman, . M. (1999).Themarriageclinic: A scientif ically-based aritaltherapy.New York: Norton.Gottman. .M., Coan, .,Carrere,S.,& Swanson, . (1998).Predictingmar-ital happinessand stabil i ty from newlywed nteractions. ournal of

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ACI(NOWLBDGMIINT

Support or the first authorduring prepat'ation f this chapterwasprovided ttpart by a gellerous rant rom th e RobertGocletFoundationo the FanrilyStudies rograrn f thc New Yoll

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Preventing Marital Disorder