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

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

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

3. Forgiveness in Couples

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

6. Hope-focused Marriage Enrichment has been designated as 1 of 4 ESTs (Empirically Supported Treatments) for marriage enrichment Jakubowski, S. F., Milne, E. P., Brunner, H., & Miller, R. B. (2004). A review of empirically supported marital enrichment programs. Family Relations, 53, 528-536. It lists Hope-focused enrichment as one of four ESTs in marital enrichment: PREP, Relationship Enhancement, Couple Communication Program, and Strategic Hope-focused Enrichment.

7. Questions and Answers

8. State of the Clinical Science in 1997 Gottman ratio: 5 to 1 positive to negative Therapists try to increase the ratio The action is in helping couples ACT differently with each other�e.g., integrative behavioral, solution-focused approaches Stress makes things worse Focus is dyad patterns of communication and conflict negotiation

9. A lot has happened between 1998-2005: Implications of the Review of the Literature It�s not so much skills, communication, conflict resolution per se. It�s ability to control and limit the negative emotional climate (and restore the positive emotional climate). Valuing, safety, security Hope Cutting short negative reciprocity Letting go of negative moods; not ruminating; healing ruptures in negative bonds by forgiving

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

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

12. FYI: Previous Component Research on Hope-focused Marital Enrichment Hammond & Worthington (1985), American Journal of Family Therapy, found leaders strongly guide couple�s attention to issues in groups Worthington, Buston, & Hammonds (1989), Journal for Counseling and Development, found support of group members > 3 hours of information about communication, conflict resolution, and information in psychoeducational groups Worthington et al. (1995), Journal of Counseling Psychology, found that assessment and feedback to individual couples account for about � of the ES in marital enrichment

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

14. Questions and Answers

15. Hope-Focused Marital Enrichment: Description of the intervention and techniques for promoting change Hope = Willpower + Waypower + Waitpower

16. Theology of the Hope-Focused Couple Approaches (HFCA) �rejoice in [marital] sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope� (Romans 5:3-4, NIV). HFMA is founded on the belief that hope is at the depth of the Christian experience. Christ in us is indeed the hope of glory (Col 1:27). Hope is one of the three most emphasized aspects of Christian character (1 Corinthians 13:13). In HFMA, the strategy taught to partners for promoting change (see Worthington & McMurry, 1994) is faith working through love (Gal 5:6). HFMA was founded upon a theology that values marriage and promotes mutual submission in love of husband and wife (see Eph 5: 25-33).

17. Hope-Focused Marital Enrichment Strategy: Promoting Love, Work, Faith

18. Hope-Focused Marital Enrichment Areas: Central Vision, Core Values, Confession & Forgiveness, Communication, Conflict Resolution, Cognition, Closeness, Commitment

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

20. Questions and Answers

21. Hope-Focused Marital Enrichment Interventions

22. Hope-Focused Marital Enrichment Pre-counseling (Phone, Preparation pamphlet, assess stage of change)

23. Exercise Discuss in twos, how do you get the husband, who doesn�t want to come to see a shrink, to come? Share some ways with the group

24. Hope-Focused Marital Enrichment Preliminary assessment & Report Worthington et al. (1995), Journal of Counseling Psychology, found that assessment and feedback to individual couples account for about � of the ES in marital enrichment; probably this is the most powerful single technique you could use in marital therapy.

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

26. Questions and Answers

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

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

29. Hope-Focused Marital Enrichment Conflict Resolution L=Listen and repeat O=Observe your effects V=Value your partner E=Evaluate both partners� interests

30. Hope-Focused Marital Enrichment Closeness: CLEAVE C=Change actions to positive L=Loving romance E=Employ a calendar A=Adjust intimacy elsewhere V=Value Your Partner E=Enjoy yourselves sexually

31. Discuss in Groups of Four How do you promote intimacy between couples who want to be intimate but aren�t succeeding? Share some strategies with the whole group.

32. Hope-Focused Marital Enrichment Closeness Use of Space

33. Demonstration and Exercise Role playing couple with groups of observers and a counselor (size of group depends on number present)

34. Hope-Focused Marital Enrichment Commitment Joshua Memorial Final Assessment Report

35. Questions and Answers

36. Modifications to HFCA to Account for Increased Understanding of the Importance of the Emotional Bond

37. Modification in Theory Attachment Theory Working models of Self Other God Schnarch (1991) and the crucible Wuthnow (2000) and religious dwelling and seeking�tabernacles and tents Shults and Sandage (2006) spiritual transformations in the desert

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

39. Modifications in Interventions Emotional softening Calling attention to times of empathy of one partner for another Calling attention of times of self-sacrifice of one partner for another.

40. Objective 1 We have thoroughly achieved Objective 1 Let�s move to Objective 2: Conceptualize forgiveness within psychological and theological frameworks and be able to promote it in couples

41. Questions and Answers

42. FREE: Forgiveness and Reconciliation through Experiencing Empathy REACH Bridge to Reconciliation

43. Discuss in 3-somes Divine Forgiveness, and Forgiveness between partners What are they? What if a person says, �I forgive him� but is obviously still really hurt and angry. What�s going on?

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

45. FREE Theory Transgressions Injustice Gap Forbearance Motivational-Decisional Forgiveness (Emotional) Unforgiveness Emotional Forgiveness

46. What are your questions about Forgiveness? At least 30 minutes to discuss the topic

47. Questions and Answers

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

49. 2003 Christian book

50. New (2006) secular book

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

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

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

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

55. Questions and Answers

56. Five Steps to REACH Emotional Forgiveness

57. FREE REACH God We forgive because God first forgave us REACH God before, during, and after you REACH forgiveness

58. FREE Make a decision Decisional forgiveness: On the basis of Scripture, do you want to forgive? Can you give decisional forgiveness now? If you cannot, are you willing to be made willing? Have you discerned God�s heart?

59. Five Steps to REACH Emotional Forgiveness of the Partner

60. FREE REACH R = Recall the hurt Technique: not victimization, not blame; instead objective

61. FREE REACH E = Empathize with the one who hurt you Techniques: Letter from other�s point of view Talk about other�s experiences Empty chair Symbolizing the experience: Yellow and dark heart Multiple repetitions with sympathy, compassion, altruistic (agape) love, romantic love

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

63. FREE REACH A = Altruistic gift of forgiveness

64. FREE REACH C = Commit to forgive Techniques: certificate, letter, washing the hands of the transgression, Richard Marks' "Firststone," nail the transgression to the cross

65. Exercise Hand-washing

66. FREE REACH H = Hold onto forgiveness during doubts Technique: hurt does not equal unforgiveness, white bears

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

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

69. Questions and Answers

70. FREE Bridge to Reconciliation Plank 1: Decide whether, when, and how to reconcile

71. Role Play Couple exhibits very poor communication for making a reproach, for responding with an account or accounts

72. FREE Bridge to Reconciliation Plank 2: Soft talk about forgiveness (Talking about Transgressions) Reproaches Accounts Denials Justifications Excuses Confessions

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

74. Exercise Pair up Practice a good confession

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

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

77. FREE Bridge to Reconciliation Plank 5: Deal with failures in trustworthiness Attitude of gratitude Attitude of latitude

78. FREE Bridge to Reconciliation Plank 6: Promote Love Techniques: Love Bank (Harley), Increase the Gottman ratio (Gottman), Love languages (Chapman)

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

80. Questions and Answers

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

82. Objective 4: Forgiving the Self

85. Can I come to forgive myself and feel no emotional unforgiveness toward myself? YES I am sorry for what I did (remorse; facilitating emotion) I am grateful for what Jesus did for me in his substitutionary atonement and God�s forgiveness (gratitude; facilitating emotion) I realize I don�t deserve it; it is grace and mercy (humility; facilitating emotion) I feel empathy for Jesus, who suffered and died for me (replacement emotion) I feel sympathy for Jesus, who suffered and died for me (replacement emotion) I feel compassion for Jesus, who suffered and died for me (replacement emotion) I feel love for Jesus, who suffered and died for me (replacement emotion)

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

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

88. Questions and Answers

90. Thank you for your attention Copies of these slides are available electronically by emailing me at eworth@vcu.edu

91. Study Does This Method Work?

92. Hope-focused Marital Enrichment Component Analysis in the Current Study Hope-focused = HOPE + FREE HOPE=Handling Our Problems Effectively (communication and conflict resolution components) FREE=Forgiveness and Reconciliation through Experiencing Empathy

93. Method

94. Design of StudyEarly Married Couples O HOPE O O O FREE O O O O O

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

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

97. Other Measures Not Yet Analyzed Salivary Cortisol (baseline relaxing versus when imagining a typical relationship interaction) Videotape discussions of (a) a topic which you disagree about and (b) a pleasant topic Numerous self-report instruments at dispositional level (e.g., trait forgivingness), process level (ratings of communication, intimacy, etc.), and level of specific interactions (e.g., how deal with transgressions)

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

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

100. Very Preliminary Results for Some Self-report Variables Treatment x time (S) ANOVAs with repeated measures No main effects for Treatment or time are significant Following are interactions (Note the pattern is similar: Control get worse; HOPE gets better and then loses some; FREE gets better continuously)

101. TRIM-Revenge, Index Hurt (p<.05)

102. TRIM-Avoidance, Index Hurt (p>.10, ns)

103. Single-item Forgiveness of Index hurt (p<.05)

104. State Anger Scale, p<.01

105. How Forgiving Are You, in General, Toward Your Spouse? (single item), p<.01

106. Forgiveness of Your Most Serious Hurt, p<.05

107. Current Positive Affect toward Your Spouse, 19 bipolar adjectives, p<.02

108. Marital Satisfaction, Single Item, p<.05

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