Effects of couple exposure to direct and indirect therapy styles in marital therapy on therapist-couple struggle, cooperation, and responsibility

The occurrence of therapist-couple struggle versus cooperation has been empirically linked to specific negative outcomes in therapy. No study, however, has yet investigated therapist-offered treatment process as it related to struggle versus cooperation. This study operationalized Murray Bowen's construct of promotion of responsibility in an indirect therapist style and contrasted it with a direct therapist style in an experimental design. In counterbalanced order, 25 couples in therapy were exposed to 12 minutes of a direct therapist style and 12 minutes of an indirect therapist style during one regular therapy session. After reviewing a videotape of the first therapist style episode, couples reported on their perceptions of struggle, cooperation, and responsibility within that therapist style. The same procedure was then followed for the second episode. Results indicated moderate support of hypothesized effects. Responsibility was higher and struggle was lower within an indirect therapist style. No difference in cooperation was found between therapist styles. A consistent inverse association was found between responsibility and struggle within both direct and indirect therapist styles, and a positive association was found between responsibility and cooperation within an indirect therapist style. Yet results indicated that significant proportions of the variance in struggle and cooperation are not explained by therapist style. Additional analyses were conducted to eliminate alternative explanations of the differences observed between the direct an indirect therapist style conditions. Some potential confounds to interpretation of therapist style effects were found. The findings suggest that an indirect therapist style, as represented by use of enactments (behavioral rehearsal), accommodation (couples' language and interaction patterns), and inductive process (eliciting dialogue and absence of direct teaching), relate to couples' experience of less therapist-couple struggle and a higher sense of personal responsibility for the outcome of therapy.