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Couple Assessment in Clinical Settings

Introduction

The process for assessing couples is both quantitatively and qualitatively distinct from that for assessing individuals. With couples one has not only both partners to evaluate, but also the patterns of interaction that define their relationship. Whereas persons pursuing individual therapy typically acknowledge some culpability for their distress and assume at least token responsibility for change, partners entering couple therapy often attribute greater responsibility for relationship difficulties and burden for change to each other. A unique advantage to assessing couples is the opportunity to observe directly many of the patterns of communication and interaction that partners describe as problematic.

A Conceptual Model for Assessing Couples

Snyder and colleagues (Snyder, Cavell, Heffer & Mangrum, 1995) advocated a comprehensive model for directing and organizing assessment strategies for couples and families. They proposed five construct domains: (a) cognitive, (b) affective, (c) behavioural and control, (d) structural/developmental, and (e) communication and interpersonal. Constructs relevant to each of these domains can be assessed at each of the multiple levels comprising the psychosocial system in which the couple or family functions: (a) individuals, (b) dyads, (c) the nuclear family, (d) the extended family and related social systems, and (e) the community and cultural systems. Each of the five target domains may be assessed with varying degrees of relevance and specificity across each of the five system levels using both formal and informal assessment approaches to self-report and observational techniques.

Specific Assessment Strategies

The Clinical Interview

The initial clinical interview serves as a means for obtaining important information, informally observing partners' communication patterns, and establishing a collaborative alliance for subsequent interventions. Snyder and Abbott (2002) advocated an extended initial assessment interview lasting about two hours in which the following goals are stated at the outset: (a) first getting to know each partner as an individual separate from the marriage; (b) understanding the structure and organization of the marriage; (c) learning about current relationship difficulties, their development, and previous efforts to address these; and (d) reaching an informed decision together about whether to proceed with couple therapy and, if so, discussing respective expectations.

L'Abate (1994) recommended attending to the following questions when conducting the initial interview: What types of communication and relational patterns exist between partners? To what degree have partners been able to develop a coalition enabling them to set goals, solve problems, negotiate conflicts, handle crises, and complete individual and family developmental tasks? To what extent have the partners and extended family members been able to negotiate mutually acceptable patterns of separateness and connectedness? To what extent are members emotionally supportive of each other? What are the recurrent themes in the marriage and the extended family? Information regarding transgenerational family structures, dynamics, and critical family events potentially influencing family members' interactions with one another can be graphically depicted using the family genogram method (McGoldrick, Gerson & Shellenberger, 1999).

Observational Approaches

More than 30 years of observational research indicate that distressed couples: (a) are more hostile; (b) start their conversations with greater hostility and maintain more hostility during the course of conversation; (c) are more likely to reciprocate and escalate their partner's hostility; (d) are less likely to edit their behaviour during conflict, resulting in longer negative reciprocity loops; (e) emit less positive behaviour; and (f) are more likely to show ‘demand → withdraw’ patterns (Heyman, 2001). These findings affirm the importance of integrating 5–10 minute observations of non-structured problem-solving discussions without therapist intervention into the initial assessment process. How does the conversation start? Does the level of anger escalate, and what happens when it does? Do the partners enter repetitive negative loops? Are the couple's communication patterns consistent across different domains of conflict?

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