A Comparison of the Generalization of Behavioral Marital Therapy and Enhanced Behavioral Marital Therapy W. Kim Halford Department of Psychiatry University of Queensland Matthew R. Sanders Department of Psychiatry University of Queensland Brett C. Behrens Department of Psychiatry University of Queensland ABSTRACT This study examined the generalization of behavioral marital therapy (BMT) and enhanced behavioral marital therapy (EBMT), which added cognitive restructuring, affect exploration, and generalization training to BMT. Couples' communication and cognitions were assessed in the clinic and at home. Both BMT and EBMT were effective in decreasing negative communication behaviors and cognition across settings, but there was little evidence of differential generalization or change between the treatments. A series of regression equations showed no significant association between the extent of change in communication or cognitions and change in frequency of marital disagreements or marital satisfaction. It is concluded that BMT results in impressive generalization of communication and cognitive change, but it remains to be demonstrated that these changes are crucial to improvements in marital satisfaction. We thank Sue Osgarby and Rinu Patel, who were therapists; Margot Ffrench and Robyn Bishop, who coded data; and Jill Faddy, who prepared the manuscript. This research was supported by University of Queensland Special Projects Grant 88124 to W. Kim Halford and Matthew R. Sanders. Correspondence may be addressed to W. Kim Halford, Department of Psychiatry, University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, Herston, Queensland, Australia, 4029. Received: January 6, 1992 Revised: May 20, 1992 Accepted: July 7, 1992 Behavioral marital therapy (BMT) traditionally has focused on promoting positive behavior exchange and communication and problem-solving skills training ( Jacobson & Margolin, 1979 ). Although this approach consistently has been found to be superior to no treatment ( Hahlweg & Markman, 1988 ), a substantial minority of couples show no improvement after BMT ( Jacobson et al., 1984 ). Relapse following initial gains in marital satisfaction is very common ( Jacobson, Schmaling, & Holtzworth-Munroe, 1987 ), and the majority of couples' marital satisfaction 4 or 5 years after BMT is not significantly higher than pretreatment levels ( Snyder, Wills, & Grady-Fletcher, 1991a ). As the limitations of traditional BMT have been recognized, two general suggestions have been offered for improving BMT. First, a number of authors have suggested that the focus of BMT be broadened to Journal of Consulting and Clinical Psychology © 1993 by the American Psychological Association February 1993 Vol. 61, No. 1, 51-60 For personal use only--not for distribution. Page 1 of 1411/27/2000http://spider.apa.org/ftdocs/ccp/1993/february/ccp61151.htmlencompass cognitive and affective change strategies ( Baucom & Epstein, 1990 ; Beach, Sandeen, & O'Leary, 1990 ; Jacobson, 1991 ). Second, others have suggested that the effects of BMT may not generalize adequately to crucial interactional settings and that additional attention to generalization enhancement is needed ( Behrens, Sanders, & Halford, 1990 ; Halford, Gravestock, Lowe, & Scheldt, 1992 ). In the sections following, we consider these suggestions in turn. Attempts to enhance BMT by adding treatment components have not been demonstrated to improve outcome. Cognitively focused marital treatments do modify maladaptive relationship beliefs and improve marital satisfaction ( Emmelkamp et al., 1988 ), but the addition of such interventions to BMT does not increase marital satisfaction gains significantly ( Baucom & Lester, 1986 ; Baucom, Sayers, & Sher, 1990 ). Two new approaches to modifying marital affect recently have been described: emotional expressiveness training (EET; Baucom et al., 1990 ) and exploration of the individual partners' experience of repetitive patterns of emotionally charged marital interactions (affect exploration; Greenberg & Johnson, 1986 ; Jacobson & Holtzworth-Munroe, 1986 ; Snyder & Wills, 1989 ). The EET approach trains labeling and self-disclosure of emotions but adding EET does not enhance BMT effects significantly ( Baucom et al., 1990 ). Interventions focusing on affect exploration have been proposed by insight-oriented ( Greenberg & Johnson, 1988 ; Snyder & Wills, 1989 ) and behavior-oriented researchers (e.g., Jacobson & Holtzworth-Munroe, 1986 ). Elements that are common to the various affect exploration strategies are the encouragement of partners to focus on subjective experience of emotion arising from marital interaction and to verbalize their sense of meaning about the experience and interpretation by the therapist of the clients' verbalizations in terms of recurrent relationship and personal themes. There is dispute as to the extent to which the affect exploration procedures advocated by different therapists are similar ( Jacobson, 1991 ; Snyder, Wills, & Grady-Fletcher, 1991b ). Two recent studies found that affect exploration—based therapy produces better long-term improvement in marital satisfaction than traditional BMT ( Johnson & Greenberg, 1985 ; Snyder et al., 1991a ), though it has been argued that current practice of BMT incorporates many of the procedures labeled as affect focused ( Jacobson, 1991 ). The possible additive effect of affect-focused interventions to traditional BMT is untested. One hallmark of behavior therapy is its commitment to affecting changes in clients' behaviors that generalize across settings and time ( Baer & Roberts, 1981 ; Stokes & Baer, 1977 ). Yet the generalization of the effects of BMT, or its various suggested enhancements, rarely has been assessed. Setting variables have a significant impact on marital conflict, and high risk of conflict has been associated with being at home and staying busy in the kitchen during the working week, discussing topics arising from current activity, and having higher life stress ( Halford et al., 1992 ). The couples who do not respond to BMT, and those who relapse after initially successful therapy, may reflect failures of the effects of therapy to generalize from clinic to critical home settings. For example, training in communication and problem-solving training is central to traditional BMT, yet couples report at 2 years posttherapy that they rarely apply trained skills at home, and the
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