Couple walks out from under bridge into snow with shared umbrellaRelationship enhancement therapy uses an educational approach to teach couples and families skills to better communicate feelings to each other and work together to develop coping strategies. This brief approach to treatment is designed to help couples, individually or in groups, both learn these practical skills and develop the ability to maintain them once therapy has concluded.

People of all ages who are seeking therapy and wish to address relationship concerns or family concerns may find this approach to be helpful. 

History and Development

During the 1960s, the field of mental health was primarily driven by a medical model that focused on diagnosing and treating concerns as if they were medical diseases. Relationship enhancement therapy, founded by Bernard and Louise Guerney in 1969 as an alternative to this medical model, emphasized education and skills instead. Many of the approaches to therapy practiced during this time period looked on the therapist as an omnipotent type of presence who had a measure of "control" over the therapeutic relationship and the treatment of the individual. Relationship enhancement therapy differed from the prevailing approach of the time, as it focused on the relationship between two people (the couple in treatment) instead of the relationship between the therapist and the person seeking treatment. 

The ideas of Carl Rogers and B. F. Skinner contributed to relationship enhancement therapy. Both of these influential individuals also questioned the concept of a therapist's omnipotence in session. In line with their views, the Guerneys worked to develop a treatment approach grounded in collaboration and the resources and personal abilities of those in treatment. This type of therapy is often offered in group format but can be tailored to address the needs of individual couples and families.

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How Does Relationship Enhancement Therapy Work?

Designed to provide therapy participants with the skills to develop, maintain, and/or strengthen healthy relationships, this approach is grounded in five core skills: owning expresser, empathic responder, discussion-negotiation/emotional engagement, generalization, and maintenance. Learning and developing these skills can help people better understand their interpersonal reflexes, or the ways in which they relate to others. One major tenet of relationship enhancement therapy is the belief that an individual's personality is molded by the relationships that person has had, and that personality, in turn, impacts a person's relationships throughout life. This knowledge is especially important in the context of an intimate relationship, as over time, two people typically develop an automatic way of relating to each other, and difficulty or conflict in this interpersonal relation can have a negative impact on the relationship. 

Therapists who offer relationship enhancement therapy work to maintain a safe environment for couples to explore their relationships, using and modeling skills to engage couples and encourage them to express positive feelings for each other. Operating under the belief that it is possible for anyone to learn these skills and utilize them to improve their relationships, relationship enhancement therapists take on a teaching role to help those in therapy thoroughly understand and learn to apply the skills. 

Understanding the Three Core Skills

Owning expresser: This skill helps individuals develop the ability to express themselves without judging either the self or others. This is accomplished typically through an understanding of the feelings motivating and conveying meaning onto that which they wish to express. By doing so, people are less likely to place responsibility outside themselves and are thus more likely to have a better understanding of what they desire and why, without fear of judgment from others.

Empathic responder: Learning and developing this skill can help individuals realize how important empathy is to good communication and strong relationships. Using empathy to respond to a partner's experience can be of significant benefit to a relationship, as both partners may find it easier to be open and accepting. A major goal of relationship enhancement therapy is for couples to be able to practice this skill naturally, in therapy and in the context of their own lives. 

Discussion-Negotiation/Emotional Engagement: Relationship enhancement theory holds that, in order for partners to become more emotionally engaged with each other, it is important for them to demonstrate their engagement in the relationship by acknowledging the importance of their partner and the relationship. To achieve this, partners take turns acting as the listener and the speaker, with each partner expressing their feelings and the other partner expressing how that knowledge makes them feel.

Relationship enhancement therapy sessions do not focus on what may be "wrong" with the relationship but are instead structured to help couples work to further develop skills. 

Generalization: After both partners have learned the relationship enhancement skills, they are encouraged to utilize them in daily life through homework assignments, scheduled practice sessions, and daily review. 

Maintenance: Without extending these skills to their daily lives, couples are unlikely to see much success from this form of therapy. By practicing maintenance, people may be better able to readily access these skills through day-to-day events and occurrences. Those who experience regression of skills or simply desire further assistance to maintain skills may choose to schedule refresher or booster sessions with the relationship enhancement therapist.

What Happens in a Therapy Session?

Relationship enhancement therapy focuses on the identification and exploration of the adaptive skills a couple uses to relate to each other, and a session of therapy does not focus on what may be "wrong" with the relationship but is instead structured to help couples work to further develop these skills. 

Relationship enhancement sessions, which are highly structured, take place in four stages: 

  • The first phase of the therapy is an introductory one, in which the therapist models skills for relating to those in therapy and works to establish trust and safety.
  • In the second phase, the principles of the core skills are taught, and skills practice begins. Those in therapy are supervised as they learn and begin to practice the skills. Homework assignments help reinforce the skills outside of the therapeutic session. 
  • The third phase centers on generalizing the newly learned skills to help couples translate them to everyday life. Couples record themselves at home and bring the recordings to therapy sessions, where they are given feedback and further direction based on how they used the skills while at home. 
  • The final phase emphasizes the importance of maintaining the newly developed relating skills. This maintenance is typically achieved through the use of booster sessions, which occur less frequently than do the sessons in the first three phases but are still considered essential to check in with the couple and ensure they are successfully utilizing the core skills to maintain emotional engagement. 
  • Maintenance of the three core relationship skills is done through the use of booster sessions, which take place less frequently than sessions are conducted during the first three stages of relationship enhancement therapy but are considered vital to ensure that the relationship pairs are still using the core skills to maintain emotional engagement.​

Who Offers Relationship Enhancement Therapy?

Relationship enhancement therapy may be offered by couples, family, or group therapists, and the National Institute of Relationship Enhancement and Center for Couples, Families, and Children offers extensive workshops and certifications to therapists who wish to offer the relationship enhancement psychoeducational model in their practice. Trainings can be completed through homestudy or on-site skills training workshops. 

How Can Relationship Enhancement Therapy Help? 

Couples and families experiencing conflict or distress may find that relationship enhancement therapy can help them learn the skills to resolve current difficulties and become better equipped to handle similar concerns in the future or even potentially help prevent future difficulties from arising. Though primarily designed to address the needs of couples seeking relationship counseling, this approach has also been applied successfully in family therapy. 

Relationship enhancement therapy may also be helpful to individuals who find it challenging to build and maintain a relationship, as therapy can provide a safe space for them to learn and practice new relating skills. Some researchers believe relationship enhancement skills may be benefit partnerships in which one member has been diagnosed with borderline personality, as these skills may increase individual differentiation as well as a person's ability to communicate effectively. BPD is often characterized by unstable relationship patterns, and relationship enhancement skills may help. 

Concerns and Limitations

Empirical studies have provided support for the effectiveness of relationship enhancement therapy, as research participants report improved quality of communication and satisfaction after going through relationship enhancement therapy.

One limitation to the approach is the need for therapists to complete extensive training before they are qualified to provide the highly structured educational program. While thorough training increases the effectiveness of relationship enhancement therapy, the need for extensive and costly training can limit the number of therapists who are fully qualified to provide relationship enhancement training.

Education level may be a potential barrier to treatment for some individuals. Relationship enhancement therapy sessions are educational in nature and highly structured, and homework handouts may involve reading or writing at times. 

References:

  1. Ginsberg, B. G. (2006). Relationship enhancement couple therapy and couple group therapy. Group (30)2, 5-24. Retrieved from https://daring.memberclicks.net/circle/discussion/60/1311/relationship%20enhancement-ginsburg.pdf
  2. Jakubowski, S. F., Milne, E. P., Brunner, H., & Miller, R. B. (2004, September 17). A review of empirically supported marital enrichment programs. Family Relations, 53(5), 528-536. doi: 10.1111/j.0197-6664.2004.00062.x
  3. Relationship Enhancement Couple & Family Therapy (2015). Retrieved from http://www.nire.org/professional-training-supervision-and-certification-programs/relationship-enhancement-couple-family-therapy
  4. Waldo, M., & Harman, M. J. (1993). Relationship Enhancement Therapy with Borderline Personality. The Family Journal, (1)1, 25-30. 
    doi: 10.1177/106648079300100105