Category: Couple and Family

Your Child Is Struggling. Could Your Marriage Be to Blame?

Posted on by Melonie Bell

David Scharff, MD

The health of your partnership plays a major role in your child’s mental health.

KEY POINTS

  • Maintaining marital and personal satisfaction creates a huge benefit for the mental health of families and their children.
  • Research shows a link between the parents’ relationship and their child’s social and academic outcome.
  • Therapists should consider the parental dynamic when addressing mental health issues in children.

Well-documented research cites trauma, socioeconomic status, education, peer effects, parental bonding, nutrition, and sleep habits as clear contributors to a child’s overall health outcomes. But one unique area of research — and one not often addressed — has shown that the role of the parental couple’s relationship also has a hugely significant effect on the health of their children.

Study: The couple relationship and children’s health

Both born in Toronto, Drs. Phil and Carolyn Cowan are both professors emeritus at UC Berkeley. When they began their work in the 1970s, there was no research on the role of the couple relationship on the outcomes for children’s health or overall adjustment. And many child therapists did not even allocate regular time to seeing parents at all. There was a fair bit of research on parenting — as well as John Bowlby’s pioneering work on attachment theory — but nothing that looked at the couple’s dynamic, in and of itself, as a cause for a child’s emotional health.

The Cowans’ research considered this dynamic. They noted that marital satisfaction and happiness decline after having children, and surmised that this decline adversely affects their children’s wellbeing. (The decline in marital and personal happiness in parenthood is well documented. Many couples never regain their pre-child levels of satisfaction with their lives, or perhaps not until the children leave home, and by then divorce has often intervened.)

The Cowans devised an intervention: a 16-week peer couples’ group, facilitated by clinically trained co-leaders. Two similar group interventions were designed. Each provided a similar curriculum, but with a different focus. After the unstructured opening segment of each week, the curriculum then focused on either (1) improving the couple’s wellbeing as a couple or (2) improving their parenting skills.

Results

The most impressive gains resulted in the first group: Couples maintained (though did not improve) their previous level of satisfaction with their marriage. Other significant improvements did occur in the second group: fathers’ parental participation rates, children’s academic performance, and the parental relationship as it related specifically to their shared parenting.

To be more specific, both groups showed improvement, but the group that focused on the relationship between the parents talking about their own issues showed superior results, especially in supporting their children’s social and academic achievement. While the parenting-focused group did help with parenting, the relationship-focused groups did both that and also affected the quality of the relationship between the parents. (A surprising bonus came when the researchers discovered an unintended consequence: Overall, the families also increased their income.)

 

Over subsequent years, the Cowans have validated that initial finding: Maintaining marital and personal satisfaction and reducing couple conflict creates a huge benefit for the mental health of families and their children. The emotional challenges of having children are well known; we all know that having young or adolescent children in our lives — while very much worth the pain — is indeed often a pain! Never before has a research project looked at the toll this change can take on parents’ mental health and marital health, and then intervened with treatment intended to reverse the damage this inflicts on their children.

The intervention trials originally were conducted with working- and middle-class couples, but in the last two decades, in collaboration with Marsha Kline Pruett and Kyle Pruett, they have shown that the same curriculum and format leads to positive results for parents and children in more than 1,000 ethnically diverse low-income families.

Carolyn and Phil Cowan. Source: Photo supplied by authors.
Carolyn and Phil Cowan.
Source: Photo supplied by authors.

The Cowans’ work has been replicated in other countries, including Canada, Malta, Poland, and England. In England in particular, the government has funded a large project through Tavistock Relationships (TR), with the collaboration of the Cowans. So far, the British program is the only one that actually showed an increase in marital satisfaction! Phil Cowan guesses that is due to the advanced skill of the group leaders at TR.

The Cowans’ discoveries and research deserve to be more widely known as the groundbreaking work that it is. I recommend their work and that of their collaborators as basic reading for family, couple, and child therapists everywhere.

References

Cowan, C. (1970, August 1). Transitions to parenthood: His, hers, and theirs – Carolyn Pape Cowan, Philip A. Cowan, Gertrude Heming, Ellen Garrett, William S. Coysh, Harriet Curtis-Boles, Abner J. Boles, 1985. SAGE Journals. Retrieved October 25, 2021.

Cowan, C. P., & Cowan, P. A. (2000). When partners become parents: The Big Life Change for couples. Lawrence Erlbaum Associates.

Cowan, P. (2019, March 1). Fathers’ and mothers’ attachment styles, couple conflict, parenting quality, and children’s behavior problems: An intervention test of mediation. Taylor & Francis. Retrieved October 25, 2021, from https://www.tandfonline.com/doi/abs/10.1080/14616734.2019.1582600.

Lawrence, E., Rothman, A. D., Cobb, R. J., Rothman, M. T., & Bradbury, T. N. (2008, February). Marital satisfaction across the transition to parenthood. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43). Retrieved October 25, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367106/.

McGreevey, S. (2018, April 16). Study flags later risks for sleep-deprived kids. Harvard Gazette. Retrieved October 25, 2021, from https://news.harvard.edu/gazette/story/2017/03/study-flags-later-risks-….

Pauly, C., Cowan, P., and Cowan, C. (2017). Parents as partners: A U.K. trial of a U.S. couples … (n.d.). Retrieved October 25, 2021, from https://www.researchgate.net/publication/316456407_Parents_as_Partners_….

Parker, G., Tupling, H., & Brown, L. B. (2011, July 14). A parental bonding instrument. British Psychological Society. Retrieved October 25, 2021, from https://bpspsychub.onlinelibrary.wiley.com/doi/abs/10.1111/j.2044-8341….

Putnam, F. W. (2009, July 14). The impact of trauma on child development. Wiley Online Library. Retrieved October 25, 2021, from https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1755-6988.2006.tb0011….

Robert H. Bradley and Robert F. CorwynCenter for Applied Studies in Education. (n.d.). Socioeconomic status and child development. Annual Reviews. Retrieved October 25, 2021, from https://www.annualreviews.org/doi/abs/10.1146/annurev.psych.53.100901.1….

 

David E. Scharff, MD, is the Co-Founder and Former Director, the International Psychotherapy Institute, and a Supervising Analyst in The International Institute for Psychoanalytic Training, IPI’s analytic program. He is Co-Chair of APsaA’s COVID-19 Advisory Committee and a member of APsaA’s Distance Analysis Study Group. He also directs training programs in China and Russia.

For Some Psychotherapists, the Work Has Always Been Virtual

Posted on by Melonie Bell

A therapist shares knowledge gained from two decades of teaching online.

  • Familiarity with the experience of online therapy can help ameliorate stress, both on therapists and our patients.
  • Online learning opportunities abound for mental health professionals, particularly in this era.
  • The ongoing stressors of the pandemic will affect individuals, couples, and families differently.

It has been a difficult year for patients and psychotherapists everywhere. As all therapeutic work moved online, my colleagues at the International Psychotherapy Institute and I had one advantage: We have been at a distance-learning institution for 25 years. As a result, we were ready when suddenly everything was forced onto online platforms. In particular, we were prepared to treat couples and families negatively affected by lockdowns, and to help our students do the same.

Even as vaccines offer a light at the end of the tunnel, online therapy and training are not going away. Here’s what I think therapists can learn from our experience:

Online therapy is better than ever. Our initial close partnership with the Tavistock Clinic, the Tavistock Institute for Marital Studies (now called Tavistock Relationships), and Westminster College in Salt Lake City, Utah, used early shaky technology and unreliable internet to establish distance training. At first, all of our students had to be in the same room at one of four locations; that was all the platforms would support. Over time, we adapted to each iteration of improving technology, and eventually we could reach people on their own computers, beginning about 15 years ago. We have now been conducting online trainings and supervision in China and Russia for a decade, even as the technology has continued to improve dramatically.

Opportunities for online training have grown enormously in the pandemic. A real paradox, for us, is that our training programs have grown enormously. Through offering Town Hall meetings and online trainings, we have colleagues and students joining us at IPI from around the world in much larger numbers, and despite the time zone differences. The need to put all our conferences online has meant that people could come to courses and conferences without the expensive need to travel. I do miss seeing my friends and colleagues at in-person conferences, which IPI has always held four or five times a year. But I am reaching and interacting with more people from all over – throughout the U.S. and Canada, India, Pakistan, Europe, the Americas, Australia and New Zealand, China, Romania, and Russia. For some in India, China, and Australia, our programs happen in the middle of the night, but still they come.

Online therapy allows for international insight: you’re not alone, and neither are your patients. Because I work with therapists worldwide, especially in China and Russia, I could see how much the pandemic affected couples and families everywhere, not just in the United States. Some were positively affected when they had more time together, and solved the problems of quarantine and risk reduction together. But as we all know, other couples and families were adversely affected, with more conflict while confined together in marriages that went from contentious to unbearable familiarity, and often then to an urgent need to divorce.

A spike in divorce rates, for example, was reported in Wuhan, China from the outset of the pandemic. Couples that had maintained their marriages by spending very little time at home together, usually with one member of a couple working in another city or traveling for work, were now locked in together. Some were suddenly much happier together. But many found themselves with a new and unbearable closeness, and their therapists had a new problem to deal with.

Some takeaways from our experience. Patients—especially couples—have had increased need this year, which has kept me and my colleagues even busier than usual. For therapists still learning the ropes of online appointments, here are a few ways to support the couples you work with:

  • We are all experiencing “PTSE” – Pandemic Traumatic Stress Experience. It’s not a disease. It is not PTSD. It is a shared experience of stress common to therapists and patients alike.
  • Acknowledge the differences in the way of working online that color the therapy.
  • Look for analogous differences in patients’ and couples’ lives that are highlighted by the experience in online couple therapy.
  • Connect their distress as a couple or family with the wider distress that we are all living with – our shared PTSE.

Thankfully, my colleagues and I are surviving the covid pandemic. Though we miss our freedom, we have been able to use our expertise to benefit both our students and patients in the newly virtual world. We’ll be glad to be able to meet patients in the office again and to meet each other in person at our conferences, but we all know that our ways of conducting therapy and training will never be the same again.

 

David Scharff, M.D., is Clinical Professor of Psychiatry at the Uniformed Services University of the Health Sciences, as well as at Georgetown University. He is also Co-Founder and Former Director of the International Psychotherapy Institute; Chair of the International Psychoanalytic Association’s Committee on Family and Couple Psychoanalysis;  Co-Chair, APsaA Advisory Committee on COVID-19, and editor-in-chief of Psychoanalysis and Psychotherapy in China. He directs training programs in analytic couple and family therapy in Beijing and Moscow.

IACFP conference, Lyon, July 2018

Posted on by Melonie Bell

 

A few members of IPI recently returned from the beautiful city of Lyon at the confluence of the Rhône and Saône rivers in the Auvergne-Rhône-Alpes region of France. This was the site of the 3rd International conference on couple and family psychoanalysis organized by the International Association of Couple and Family Psychoanalysis in July, 2018. The program was packed with multiple tracks of small presentations in one or another single language. At the center of the conference venue lay the main auditorium where panel presentations with translation to English, French and Spanish succeeded one another in rapid succession. There was provision for audience response in the form of written questions on scraps of paper. These questions were not to be answered in the open forum but would be addressed in subsequent small group sessions at which the presenters would not necessarily be present. This felt constraining to us, but we respected that it was the conference design and appreciated why the organizers adhered to it to make room for many points of view and global perspectives.

We were grateful to hear in translation some interesting presentations that we could not have understood otherwise. But we found the design so different from what we are used to at IPI that we experienced quite a bit of culture shock. We did not have the leisure to listen to a fully developed presentation and to engage in a multilogue within the large group of the audience as we do at IPI. We experienced frustration as we submitted to the frame within which we found ourselves. As presenters on the dais ourselves, the best we could do was create a dialogue between presenter and discussant so as to avoid the tedium of presentation and discussion being read aloud and without the benefit of immediate audience response.

at the Lyon IACFP Conference, July 2018
Rosa Heiten, Chair of the International Association of Couple and Family Psychoanalysis presents IACFP concerns in dialogue with The IPA committee on Couple and Family Psychoanalysis (Chair, David Scharff) at the Lyon IACFP Conference, July 2018

Imagine our amazement and delight when one of our colleagues from Tavistock Relationships took action. Chris Clulow having kept his discussion short, asked the audience a question. But the audience, previously compelled to silent acquiescence, hesitated to respond. In an astonishing act of freedom, he left the dais and plunged into the audience brandishing his hand-held microphone like a liberating white knight with his lance lowered for the charge. A few hands went up in response, and Clulow extended the microphone towards them as they tentatively negotiated who would go first. Unable to wait, the presenter himself answered the discussant’s question, which gave the conference organizers time to caucus. They reasserted control, and insisted that all questions be written and delivered to the Chair for use in other venues. Chastened, the rebellious Clulow withdrew. A wonderful opportunity was lost, not to be regained in that conference.

It was a moment that highlighted the cultural differences we had come to learn about. It brought home to the English speaking group what a minority we are. Perhaps that is why we hung out together, Americans, British, and Australians. At the end of the day, we Uber’ed to a wonderful dinner that evening at Au Sud where we toasted our new champion, the intrepid Chris Clulow.