Journal of Marital and Family Therapy

doi: 10.1111/j.1752-0606.2011.00264.x

CHANGES IN NEGATIVE ATTRIBUTIONS DURING

COUPLE THERAPY FOR ABUSIVE BEHAVIOR:
RELATIONS TO CHANGES IN SATISFACTION AND
BEHAVIOR
Katie M. Hrapczynski, Norman B. Epstein,
Carol A. Werlinich and Jaslean J. LaTaillade
University of Maryland

This study examined effects of cognitive-behavioral couple therapy (n = 25 couples) and

a variety of systems-oriented couple therapy models (n = 30 couples) in reducing nega-
tive attributions and degrees to which decreases in negative attributions were associated
with improvements in other aspects of relationship functioning. Couples seeking treatment
at a university clinic and experiencing psychological and ⁄ or mild-to-moderate physical
abuse completed 10 weekly sessions. Attributions, relationship satisfaction, psychological
abuse, communication, and negotiation were assessed before and after treatment. Women
and men in both treatments exhibited decreased negative attributions, which moderated
increases in satisfaction and decreases in negative communication, as well as increases in
positive communication for men. The findings reinforce the importance of modifying nega-
tive attributions when intervening to reduce abuse.

Prior research has linked biased cognitive processing, in particular partners’ negative
attributions about each other’s motives and personal characteristics, with reports of relationship
distress (Baucom et al., 1996; Bradbury, Fincham, & Beach, 2000; Fincham, Harold, & Gano-
Phillips, 2000). Cropley and Reid (2008) found that partners who make more positive
attributions about each other are more likely to be satisfied with their relationship. Longitudi-
nal findings suggest that attributions also predict later satisfaction (Fincham & Bradbury, 1993;
Fincham et al., 2000; Karney & Bradbury, 2000). Some studies indicate a bidirectional relation-
ship between relationship satisfaction and attributions (Fincham & Bradbury, 1993; Fincham
et al., 2000). Treatment outcome studies targeting modification of partners’ negative attribu-
tions have been based on an assumption that reducing negative attributions will increase rela-
tionship satisfaction. Although there has been some support for this assumption in past clinical
trials (Baucom, Sayers, & Sher, 1990), research on this important aspect of treatment for dis-
tressed couples has been quite limited.
Partners’ negative attributions about each other’s behavior also have been linked to nega-
tive behavior toward each other during problem-solving discussions of relationship issues
(Bradbury, Beach, Fincham, & Nelson, 1996; Bradbury & Fincham, 1992; Miller & Bradbury,
1995; Sanford, 2006), and social support discussions (Miller & Bradbury, 1995). Prediscussion
negative attributions were associated with negative communication and reciprocation of a part-
ner’s negative behavior (Bradbury & Fincham, 1992). Sanford (2006) found that in newlywed
couples, negative attributions about a partner predicted more negative communication, less
positive communication, and less understanding of the partner during problem-solving discus-
sions 2 weeks later. Within-person change in cognitions predicted within-person variance in
behavior. Some studies found a stronger association between attributions and behavior for

Katie M. Hrapczynski, MS, LGMFT is a doctoral graduate student in Family Science at the University of
Maryland; Norman B. Epstein, PhD is the Director of the Couple and Family Therapy Program and Professor
of Family Science at the University of Maryland; Carol A. Werlinich, PhD is the Clinic Director of the Center
for Healthy Families and Instructor in the Department of Family Science at the University of Maryland; Jaslean
L. LaTaillade, PhD is an Adjunct Assistant Professor of Family Science at the University of Maryland.
Address correspondence to Norman B. Epstein, PhD., 255 Valley Drive, Room 1142 School of Public
Health Building, University of Maryland, Department of Family Science, College Park, Maryland 20742; Email:
nbe@umd.edu

JOURNAL OF MARITAL AND FAMILY THERAPY 1

wives than husbands (Bradbury et al., 1996; Miller & Bradbury, 1995) and among distressed
than nondistressed couples (Miller & Bradbury, 1995).
Research also has implicated negative attributions as a risk factor for intimate partner vio-
lence (O’Leary, Smith Slep, & O’Leary, 2007). Individuals who behave aggressively toward their
partners commonly make negative attributions that blame the partner for relationship problems
and ascribe negative intentions such as disrespect and malicious intent to the partner’s behav-
iors, (Holtzworth-Munroe, Meehan, Rehman, & Marshall, 2002; Murphy, Meis, & Eckhart,
2009). For example, Holtzworth-Munroe and Hutchinson (1993) and Tonizzo, Howells, Day,
Reidpath, and Froyland (2000) found that violent men were more likely than nonviolent men
to attribute negative intentions and selfish motivation to their wives and to see the wives’
behavior as blameworthy. Most research has focused on differences between violent and nonvi-
olent male perpetrators, despite the potential for women to engage in aggression as well. Addi-
tionally, the literature has largely ignored the relation between attributions and psychological
abuse, focusing mostly on physical violence. Because psychologically abusive behavior has neg-
ative effects on recipients similar to those of physical violence (e.g., depression, anxiety, and
lowered self-esteem) and often leads to physical violence (Murphy & O’Leary, 1989), under-
standing how attributions are related to psychological abuse is important, as is knowledge of
how changes in attributions and abusive behavior over the course of therapy are related.
Based on knowledge of links between negative attributions and relational problems,
cognitive-behavioral interventions developed to treat distressed couples who engage in forms of
psychological abuse and physical aggression commonly include a component targeting the
modification of negative attributions (Holtzworth-Munroe et al., 2002; LaTaillade, Epstein, &
Werlinich, 2006; O’Leary, Heyman, & Neidig, 1997). Although O’Leary et al. (1999) found
that couple therapy increased husbands’ taking responsibility for their aggression rather than
blaming their wives, little else is known about the extent to which interventions modify
negative attributions and whether cognitive changes are related to an increase in relationship
satisfaction, improvement in communication behavior, and decreased aggression. The present
study was intended to extend knowledge about the effect of couple therapy on reducing
partners’ negative attributions within a sample of couples experiencing psychological and
mild-to-moderate physical aggression, as well as about the relation between attribution change
and improvements in relationship satisfaction, positive communication, negative communica-
tion, negotiation, and psychological aggression. This study examined these effects in both
female and male partners.

Couple Therapy for Intimate Partner Violence

Traditional treatment for couples experiencing violence has involved splitting partners into
gender-specific groups, usually for male perpetrators and female victims. However, many perpe-
trators participating in anger management groups continue to engage in abusive interactions
with their partners (Murphy & Eckhardt, 2005). Although separation of perpetrators and vic-
tims may be necessary to ensure safety in severe cases of physical abuse, couples experiencing
mild-to-moderate psychological and ⁄ or physical abuse may benefit from couple therapy. Con-
joint treatment provides the optimal context, when deemed safe, to intervene in couple interac-
tions contributing to abusive behavior, while holding individuals fully responsible for their own
aggression and not blaming victims (Holtzworth-Munroe et al., 2002; LaTaillade et al., 2006;
Stith & McCollum, 2009). Concerns that treating couples who have experienced violence would
place victims at risk of further abuse have been countered by the realization that gender-specific
group treatments have had limited effectiveness (Murphy & Eckhardt, 2005), and leaving cou-
ples untreated who have poor conflict resolution skills but who stay together may be inappro-
priate and risky.
A few theoretical approaches have been described in the literature for treating couples
experiencing violence, such as cognitive-behavioral couple therapy (CBCT) (Holtzworth-
Munroe et al., 2002; LaTaillade et al., 2006; O’Leary et al., 1999), solution-focused couple ther-
apy (Stith & McCollum, 2009), and emotionally focused couple therapy (Beckerman &
Sarracco, 2002). To date, studies provide evidence for the effectiveness of the cognitive-
behavioral and solution-focused approaches. Despite a lack of empirical research, other models

2 JOURNAL OF MARITAL AND FAMILY THERAPY

of couple therapy, such as structural, strategic, narrative, and Bowen systems, are applied
clinically in cases of violence.
In spite of substantial evidence that individuals’ negative attributions are associated with
aggressive behavior toward their intimate partners, there is minimal knowledge about the
degree to which attributions are modified in the course of the various models of couple therapy
that are applied in treatment for abusive behavior. Consistent with a common factors approach
to understanding the active ingredients of treatments (Sprenkle & Blow, 2004), we expect that
the cognitive-behavioral model is not the only approach that reduces partners’ negative attribu-
tions. Sprenkle and Blow (2004) note that the common factors approach includes nonspecific
agents that are shared by various models and produce change across models. For example,
solution-focused therapy (e.g., Hoyt, 2002) emphasizes collaboration between partners to
replace adversarial positions; reframing interventions in the strategic and structural models
(e.g., Keim & Lappin, 2002) are intended to help partners view each other’s distressing behav-
iors in more benign ways; emotionally focused therapy (e.g., Johnson & Denton, 2002)
enhances partners’ expression of vulnerable feelings and increases their empathy for each other;
narrative therapy (e.g., Freedman & Combs, 2002) alters perceptions of a presenting problem
through problem externalization interventions, such that partners increasingly view the problem
as something separate from each of them. Those interventions, among others, seem likely to
reduce individuals’ negative attributions regarding their partners’ motives, traits, etc. Conse-
quently, the present study investigated the degrees to which alternative approaches to couple
therapy for psychological abuse and mild to moderately severe physical abuse decreased part-
ners’ negative attributions about each other, as well as increased relationship satisfaction,
improved couple problem-solving communication, increased negotiation, and reduced psycho-
logically abusive behavior. Although the cognitive-behavioral approach most specifically targets
attributions, it was expected that the other models would reduce negative attributions as well.
The current study is a secondary analysis extending the evaluation of the outcomes of a
study at a university-based family therapy clinic comparing effects of CBCT and usual treat-
ment (UT) from a variety of systems-oriented couple therapy models (e.g., emotionally focused,
narrative, and solution-focused). In contrast to most prior treatment studies that specifically
recruited community couples who exhibited violence, the study screened all couples for psycho-
logical and physical abuse who sought therapy for a variety of relationship problems and
offered participation in the treatment evaluation to those who met inclusion criteria. Initial
results of the study were reported by LaTaillade et al., (2006). They reported that relationship
satisfaction significantly increased for men in both conditions and among women in the UT
condition, with a trend toward an increase for women in the CBCT condition. The two condi-
tions produced similar significant decreases in psychological abuse. Negative communication
behavior coded from video recordings of couples’ problem-solving discussions decreased in the
CBCT condition but not in the UT condition. There was a trend toward increased positive
communication for men in the CBCT condition but not for women receiving CBCT or for
either sex in the UT condition. The treatments had minimal impact on physical aggression
owing to a low frequency of violent acts within the sample.
LaTaillade et al.’s (2006) initial evaluation did not examine effects of the therapies on part-
ners’ negative attributions or the relation between attribution change and improvements in
aspects of relationship functioning such as satisfaction, communication, negotiation, and psy-
chological abuse. Consequently, this study addressed an important gap in knowledge by exam-
ining effects of alternative couple therapies in reducing partners’ negative attributions and the
degrees to which decreases in negative attributions were associated with improvements in other
aspects of relationship functioning.
It was hypothesized that, regardless of type of couple therapy, male and female partners
would exhibit decreases in negative attributions. However, it was expected that CBCT, which
focuses on modification of inappropriate cognitions (Epstein & Baucom, 2002), would have a
larger effect on negative attributions than would the UT condition. Finally, given that in the
cognitive-behavioral model it is assumed that reduction in problematic cognitions facilitates
improvements in couples’ relationship satisfaction and behavioral interactions, it was hypothe-
sized that across treatment models the degree of decrease in partners’ negative attributions

JOURNAL OF MARITAL AND FAMILY THERAPY 3

would be associated with increases in relationship satisfaction, negotiation, and positive
communication, and decreases in psychological abuse and negative communication.

METHOD

Sample
This study was reviewed and approved regarding protection of human subjects by the Insti-
tutional Review Board of the University of Maryland, College Park. The study involved sec-
ondary analysis of data from couples who sought assistance at a university-based family
therapy clinic that serves as the major training site for an accredited couple and family therapy
program. The couples whose data were used had sought assistance for a variety of relationship
problems, had been identified through pretherapy assessments as experiencing psychologically
abusive behavior and mild-to-moderate physical violence in their relationship, and consented to
participate in a study evaluating effects of couple therapies for aggressive behavior.1 All couples
treated at the clinic complete standard assessments and are screened for abusive behavior by
means of questionnaires and individual interviews. Couples reporting severe forms of physical
violence are not treated conjointly; they are referred to other agencies, such as emergency shel-
ters, or in some cases are provided separate therapies for the individual partners. Couples were
eligible for inclusion if (a) partners were at least 18 years old; (b) one or both reported mild-to-
moderate physical abuse during the past 4 months which did not result in injury, based on
responses on the Revised Conflict Tactics Scale (Straus, Hamby, Boney-McCoy, & Sugarman,
1996) and psychological aggression based on responses to the Multidimensional Measure of
Emotional Abuse (MMEA; Murphy & Hoover, 2001); (c) they expressed a desire to improve
their relationship; (d) they spent time together each week; and (e) they were not receiving con-
current couple treatment. The exclusion criteria were (a) either partner reported use of a
weapon or reported physical abuse in the past 4 months resulting in an injury that did or
should have resulted in medical treatment; (b) either partner had an untreated drug or alcohol
problem; or (c) either individual feared living with and ⁄ or participating in therapy with their
partner.
Couples who qualified for the study were alternately assigned to the CBCT condition or to
usual treatment at the clinic (UT) in the order that they contacted the clinic for services. The
sample consisted of 25 couples in the CBCT condition and 30 couples in the UT condition, and
it was restricted to heterosexual couples because an insufficient number of homosexual couples
attend the clinic to examine sexual orientation. The sample sizes were unequal because several
fewer couples completed the CBCT treatment than the UT treatment. There were no differences
in pretherapy negative attributions between CBCT and UT for couples who dropped out of
treatment and couples who completed treatment. This was the case for women [F(1,
83) = 0.56, p = .46] and men [F(1, 83) = 1.54, p = .22]. The mean ages for women and men
in the CBCT condition were 30.16 (SD = 7.41) and 31.84 (SD = 6.50), respectively, whereas
the mean ages for women and men in the UT condition were 32.43 (SD = 7.91) and 33.87
(SD = 8.29), respectively. CBCT couples indicated being together a mean of 6.09 years and
UT couples a mean of 6.14 years. Couples in the CBCT and UT conditions did not differ
significantly in the age of the men [t (53) = )0.99, p = .32], the age of the women
[t (53) = )1.09, p = .28], or the length of the relationship [t (45) = )0.04, p = .97]. The sam-
ple was racially diverse. Women in the CBCT condition identified as 52% Caucasian, 28%
African American, 8% Asian ⁄ Pacific Islander, 8% Hispanic, and 4% other, whereas women in
UT identified as 60% Caucasian, 13% African American, 3% Asian ⁄ Pacific Islander, 17% His-
panic, and 7% other. Men in CBCT identified as 68% Caucasian, 16% African American, 4%
Hispanic, and 12% other, whereas men in UT identified as 63% Caucasian, 20% African
American, 7% Hispanic, 3% Native American, and 7% other. Couples in the conditions
did not differ significantly in the race of the woman [v2 (4) = 3.15, p = .53] or the man
[v2 (4) = 1.60, p = .81]. Most couples reported their relationship status to be married and liv-
ing together.
The mean incomes for women and men in CBCT were $29,913 (SD = $27,773) and
$48,400 (SD = $31,179), respectively, and for women and men in UT were $23,924

4 JOURNAL OF MARITAL AND FAMILY THERAPY

(SD = $23,398) and $42,546 (SD = $20,932), respectively. Couples in CBCT and UT did not
differ significantly on women’s income [t (51) = 0.85, p = .40] or men’s income [t (51) = 0.81,
p = .42]. Most of the sample was highly educated, with a majority of women and men in both
treatment conditions attending some college or attaining advanced educational degrees. The
level of education did not differ for the CBCT and UT conditions for women or men.

Procedure
In the original study from which the data for the present study were derived, partners inde-
pendently completed an assessment including a demographics form and questionnaires assessing
relationship quality, couple communication patterns, psychologically and physically abusive
behavior, and individual psychological functioning. The couple also was interviewed jointly
regarding their relationship history, relationship strengths, and presenting concerns; then each
partner was interviewed separately regarding current and past individual functioning, both part-
ners’ substance use, any incidents of physical violence in the relationship, and any fear about
living with the partner or participating in couple therapy.
Couples who met the inclusion criteria were informed by the co-therapists who conducted
their assessment of their eligibility for the program designed to help couples handle conflict and
anger constructively. Following informed consent, they returned for a second assessment
involving a 10-min communication sample and additional questionnaires. For the communica-
tion sample, therapists instructed the partners to attempt to resolve an issue that both had des-
ignated on a 28-item Relationship Issues Survey (RIS) as being a source of moderate conflict.
Potential areas of conflict listed on the RIS include relationships with friends, finances, sexual
relationship, trustworthiness, and how decisions are made, among others. The therapists
watched the discussion through a one-way mirror to ensure the couple’s safety.
Each couple then completed 10 weekly 90-min sessions in their assigned treatment within a
3- to 4½-month period. The CBCT therapists followed a detailed intervention protocol for
each session, although they were trained to apply intervention components flexibly to take into
account each couple’s needs. The UT couples received treatment as usual at the clinic from
family systems orientations (e.g., emotionally focused, solution-focused, narrative, and struc-
tural), with a general focus on preventing abusive behavior and improving relationship func-
tioning. Couples in both conditions would be removed from the study if they experienced an
incident of violence resulting in physical injury needing medical attention. Each member of the
couple would be offered individual therapy until it was determined that conjoint treatment was
safe and appropriate, but further couple therapy would not be within the study. No violent inci-
dents requiring this contingency occurred. Couples were allowed to continue therapy beyond
the prescribed 10 sessions if they and their co-therapists determined that further treatment was
warranted, but they were required to continue with the same therapy approach.
Following the treatment sessions, couples completed a posttherapy assessment, including
the same questionnaires and communication sample used in the pretherapy assessment. The
communication samples were coded by undergraduate raters who were unaware of a couple’s
treatment condition or pre- versus posttherapy status. The measures used for evaluating effects
of the CBCT and UT interventions were the pre- and posttherapy behavioral data from the
communication samples and partners’ scores on a subset of the questionnaires.

Measures
Demographics. A form was used to gather information about age, relationship duration,
relationship status (e.g., cohabiting, separated), race, level of education, and income.
Attributions. The four subscales of the Marital Attitude Survey (MAS; Pretzer, Epstein, &
Fleming, 1991) that focus on an individual’s attributions about their partner’s responsibility for
relationship problems were used as a composite index of negative attributions. The subscales
include Attribution of Causality to Partner Behavior (e.g., ‘‘The way my partner treats me
determines how well we get along.’’), Attribution of Causality to Partner Personality (e.g., ‘‘My
partner’s personality would have to change for us to get along better.’’), Attribution of Mali-
cious Intent to Partner (e.g., ‘‘It seems as though my partner deliberately provokes me.’’), and
Attribution of Lack of Love of Partner (e.g., ‘‘When things are rough between us it shows that

JOURNAL OF MARITAL AND FAMILY THERAPY 5

my partner doesn’t love me.’’). Participants indicated how much they agreed with each MAS
statement on a five-point scale ranging from 1 = strongly agree to 5 = strongly disagree.
Responses were coded so that higher scores on the composite index represented more negative
attributions about the partner. The MAS subscales previously were found to have adequate
internal consistency reliability, as well as construct validity (Heim & Snyder, 1991; Pretzer
et al., 1991; Sayers, Kohn, Fresco, Bellack, & Sarwer, 2001). In this sample, the Cronbach’s
alphas for the MAS composite were .80 and .75 for women and men, respectively.
Relationship satisfaction. Relationship satisfaction was assessed with the Dyadic Adjust-
ment Scale (DAS; Spanier, 1976), a widely used measure of the quality of an intimate relation-
ship. Although Spanier designed the DAS with four subscales, factor analytic studies have
found a variety of solutions rather than consistent support for the intended dimensions, sug-
gesting use of the total score as an index of overall relationship quality (Eddy, Heyman, &
Weiss, 1991; Thompson, 1988). Many studies have demonstrated the internal consistency and
construct validity of the DAS as an index of relationship quality (Spanier, 1988). In this study,
Cronbach’s alphas for the total DAS were .94 and .90 for women and men, respectively.
Psychological abuse. The MMEA (Murphy & Hoover, 2001) was used to assess frequency
of psychologically abusive behaviors by oneself or one’s partner during the past 4 months. Each
individual rated the frequencies of each behavior by self and by the partner using a scale of
0 = not at all, 1 = once, 2 = twice, 3 = 3–5 times, 4 = 6–10 times, 5 = 11–20 times,
6 = more than 20 times, or 9 = this has never happened. The 28 MMEA items comprise four
subscales based on a principal components analysis (Murphy & Hoover, 2001): Hostile With-
drawal (e.g., ‘‘Acted cold or distant when angry’’), Domination ⁄ Intimidation (e.g., ‘‘Threatened
to hit the other person’’), Denigration (e.g., ‘‘Called the other person worthless’’), and Restric-
tive Engulfment (e.g., ‘‘Secretly searched through the other person’s belongings’’). Ro and Law-
rence (2007) found the internal consistency of the total MMEA to be high, whereas Cronbach’s
alphas of subscales vary considerably, so they recommended using the total score. Therefore,
each person’s psychological abuse score was his or her partner’s report of the person’s behav-
iors on the total MMEA, consistent with common practice in intimate partner violence research
owing to concerns about individuals underreporting their own aggressive behavior (Rathus &
Feindler, 2004). In the present sample, the Cronbach’s alphas for women and men, respectively,
were .95 and .94.
Negotiation. Positive negotiation behavior was measured using the negotiation subscale of
the widely used Revised Conflict Tactics Scale (CTS2; Straus et al., 1996), which assesses fre-
quency of conflict behaviors utilized by oneself or one’s partner during a specified period (in
the present study, the past 4 months). Participants rated the frequency of each behavior by self
and by the partner using the scale of 0 = not at all, 1 = once, 2 = twice, 3 = 3–5 times,
4 = 6–10 times, 5 = 11–20 times, 6 = more than 20 times, or 9 = not in the past 4 months,
but it did happen before. Sample items are ‘‘Showed respect for my partner’s feelings about an
issue’’ and ‘‘Suggested a compromise to a disagreement.’’ Each individual’s negotiation score
was based on the partner’s report of the person’s behaviors. The internal consistency of the
subscale is high, as Straus et al. (1996) found Cronbach’s alphas of .86 for ratings by each sex,
and in the present sample, the alphas were .80 and .82 for women and men, respectively. Straus
et al. (1996) provide evidence of the construct validity of the CTS2.
Communication behavior. Positive and negative communication behaviors were assessed
with a global observational coding system, the Marital Interaction Coding System—Global
(MICS-G; Weiss & Tolman, 1990). The MICS-G was developed as an alternative to the micro-
analytic Marital Interaction Coding System (MICS; Heyman, Weiss, & Eddy, 1995) that
requires more time-consuming coding of each expressed thought by each partner. The MICS-G
assesses three major forms of positive communication (problem solving, facilitation, and valida-
tion) and three of negative communication (conflict, invalidation, and withdrawal), based on
prior research with the MICS. Within each of these summary codes are subcategories of verbal
and nonverbal behavior consisting of content and affect cues (e.g., for conflict, there are subcat-
egory behaviors of complain, criticize, negative command, hostility, and angry voice tone).
Coders made separate ratings of the male and female partners on each subcategory for each
2-min interval of the 10-min communication sample. The frequency and intensity of behaviors

6 JOURNAL OF MARITAL AND FAMILY THERAPY

were used to assign a rating to each subcategory, ranging from 0 (none) to 5 (very high). The
subcategory ratings within each major category for each 2-min interval were averaged to create
a summary rating for the 10-min discussion for each of the six major codes, ranging from 0
(none) to 5 (very high) for each partner. Weiss and Tolman (1990) found adequate inter-rater
reliability for the six categories for both men and women and found support for the criterion
validity of the MICS-G, as it differentiated distressed from nondistressed couples.
Undergraduate coders were trained for approximately 100 hr to apply the coding system
with practice communication samples. The training involved 15 2-hr weekly meetings to learn
the MICS-G codebook and discuss practice samples and approximately 70 hr of practice apply-
ing the MICS-G to nonstudy communication samples. Coders only began coding the samples
for the study after reaching a level of agreement in which two coders’ ratings were within one
point of each other on the 5-point rating scale 100% of the time. For each communication
sample, two coders independently rated the partners’ behaviors. Then, the coders compared
their ratings of the six dimensions for each partner for each 2-min interval. They reviewed any
pair of ratings that differed by more than one point and reached a consensus rating. In such
instances, the coders explained to each other the content and affect cues that contributed to
their ratings, and they discussed the discrepancy until one or both adjusted their scores to differ
less than one point. Thus, all ratings used to calculate communication scores represented initial
or eventual consensus between coders. The coders’ preconsensus ratings displayed 98% inter-
rater agreement on a random sample of 24 pretherapy samples.

Treatments
Following their assessment, each couple completed 10 weekly 90-min therapy sessions in
their assigned condition of CBCT or UT, and then a posttherapy assessment. Both CBCT and
UT sessions were conducted by co-therapists who were graduate student interns at the clinic
and were supervised weekly by faculty members who are licensed therapists. The therapists
received training in CBCT within two required couple and family therapy courses in their mas-
ter’s degree curriculum, through training workshops conducted by the second author (a major
developer of CBCT) that focused on the specific protocol used in this study and through weekly
supervision by licensed faculty supervisors who viewed video recordings of the therapists’ ses-
sions with the couples. The supervisors required that therapists identify their model as CBCT,
monitored delivery of the treatment, and regularly provided feedback to the therapists. The
CBCT was based on established cognitive-behavioral interventions for couples (e.g., Epstein &
Baucom, 2002) and followed session protocols emphasizing psychoeducation regarding forms of
psychological and physical aggression and their negative effects on the individuals, their rela-
tionship, and any children they may have; anger management strategies; communication skills
for expression and listening; problem-solving skills; and strategies for recovering from past
hurts and broken trust, as well as for increasing intimacy. Cognitive-restructuring interventions
were integrated within all sessions. Reattribution techniques were the primary interventions and
were designed to counteract individuals’ negative attributions about their partners’ characteris-
tics and motives. Examples include asking an individual to think of alternative explanations for
their partner’s behavior, asking the partner to provide feedback about the intentions underlying
his or her actions, and countering trait attributions with evidence of variability in the partner’s
behavior. Other cognitive-restructuring interventions focused on modifying unrealistic relation-
ship standards and assumptions that support aggression toward one’s partner (e.g., challenging
a standard that aggression is justified if someone treats you poorly, or an assumption that
anger is uncontrollable). Therapists also used behavioral interventions to modify negative attri-
butions. For example, communication training coaches partners in working together, shifting
their view of one another from adversarial to cooperative. Communication and problem-solving
training also are used to provide partners with evidence that they are able to attend to each
other’s feelings and make decisions together.
The therapists received training in the major systemic models used in the UT condition
within two required couple and family therapy courses in their master’s degree curriculum and
through weekly supervision by licensed faculty supervisors who viewed video recordings of the
therapists’ sessions with the couples. The supervisors required that therapists identify their UT

JOURNAL OF MARITAL AND FAMILY THERAPY 7

model, monitored delivery of the treatment, and regularly provided feedback to the therapists.
In the UT condition, therapists utilized one or a combination of systems-oriented models that
are regularly practiced at the clinic, including but not limited to solution-focused, strategic,
structural, narrative, and emotionally focused couple therapy. The co-therapists and supervisor
for each couple decided on the model for each case, based on their assessment of the presenting
issues. As described in our Introduction section, although there are differences in the central
concepts and methods of the systemic models, in some way each addresses cognitive as well as
behavioral change. Thus, the UT models commonly addressed cognitive and behavioral factors
associated with couples’ aggressive responses to their conflicts, although often not as explicitly
as CBCT. Therapists adhered to their therapeutic model(s) throughout treatment.

RESULTS

Overview of Analyses
First, to determine whether couple therapy reduced partners’ negative attributions, repeated
measures analyses of variance for female and male partners were used to test the Time (pre-
versus posttherapy) main effect across types of therapy and the Time by Treatment interaction
(pretherapy versus posttherapy by CBCT versus UT) for negative attributions. Then, repeated
measures analyses of covariance were used to test whether degree of change in attributions was
associated with changes in relationship satisfaction, psychological abuse, negotiation, positive
communication, and negative communication. In these ANCOVAs, the Time main effect indi-
cated pre- posttherapy change in each dependent variable across types of couple therapy while
controlling for the covariate of attribution change (post- pretherapy change scores on the attri-
bution measure), and the Time by Treatment interaction effect tested whether CBCT and UT
were differentially effective while controlling for attribution change. In addition, the Time by
Attribution Change interaction effect indicated whether change in a dependent variable from
pre- to posttherapy was moderated by degree of change in negative attributions. Post hoc anal-
yses were used to explore any significant interaction effects. If a Time by Attribution Change
interaction was significant, the pattern was explored by categorizing participants as exhibiting
greater or less change in attributions based on a median split of the attribution change score
distribution, and the pattern of dependent variable means for the four combinations of pre-
versus posttherapy and more versus less change in attributions was examined. Owing to prob-
lems with audio that made several couples’ communication tapes uncodable, the analyses for
communication behavior were based on a smaller sample.

Pretherapy Correlations between Negative Attributions and Indices of Relationship Functioning

Pearson correlations were computed to determine whether pretherapy attribution scores
were related to the indices of relationship functioning (see Table 1). For women, pretherapy
negative attributions were associated with lower relationship satisfaction and less positive com-
munication. Pretherapy attributions were not significantly related to women’s negative commu-
nication, psychological abuse, or negotiation. For men, pretherapy negative attributions were
significantly related to lower relationship satisfaction and more negative communication, but
not to levels of positive communication, psychological abuse, and negotiation.

Effect of Couple Therapy on Negative Attributions

In the repeated measures ANOVAs for negative attributions (see Table 2), a significant
main effect for Time indicated that, across CBCT and UT, negative attributions significantly
decreased for women [F(1, 50) = 6.52, p = .01] and men [F(1, 50) = 12.47, p = .001]. The
mean pretherapy attribution score for women was 66.42 (SD = 6.83), and at posttherapy, it
was 62.90 (SD = 8.19), indicating a decrease in negative attributions. The mean pretherapy
attribution score for men was 68.00 (SD = 7.59), and at posttherapy, it was 62.94
(SD = 11.19), indicating decreased negative attributions. The lack of a significant Time by
Treatment interaction indicated no difference between CBCT and UT in the degree to which
negative attributions were decreased for women [F(1, 50) = 1.31, p = .26] or for men [F(1,
50) = 0.13, p = .72].

8 JOURNAL OF MARITAL AND FAMILY THERAPY

 Table 1
Correlations between Pretherapy Negative Attributions and Indices of Relationship
Functioning

Measure 1 2 3 4 5 6

1. Negative attributions — ).67*** ).13 .35* .19 ).09

2. Relationship satisfaction ).59*** — .05 ).23 ).20 .26
3. Positive communication ).38* .36* — ).56*** ).08 .19
4. Negative communication .30 ).21 ).44** — .30 ).11
5. Psychological abuse .08 ).42* ).25 .16 — ).05
6. Negotiation ).22 .53*** .12 ).28 ).20 —

Note. Coefficients above diagonal are for men and below diagonal are for women.
*p < .05, **p < .01, ***p < .001 (2-tailed).

Table 2
Repeated Measures ANOVA for Women’s and Men’s Negative Attributions

Sum of Mean
Source squares df square F p

Women’s negative attributions

Time 299.10 1 299.10 6.52 .01
Time by treatment 60.25 1 60.25 1.31 .26
Error 2294.24 50 45.89
Men’s negative attributions
Time 650.78 1 650.78 12.47 .001
Time by treatment 6.93 1 6.93 0.13 .72
Error 2608.48 50 52.17

Change in Negative Attributions and Relationship Satisfaction

Consistent with the findings from the original study reported by LaTaillade et al. (2006),
the repeated measures ANCOVAs (with posttherapy minus pretherapy attribution change
scores as the covariate) (see Table 3) indicated a significant main effect for Time, indicating that
relationship satisfaction scores changed from pre- to posttherapy, across CBCT and UT forms
of therapy, for women [F(1, 50) = 7.32, p = .009] and men [F(1, 49) = 8.09, p = .007]. The
mean relationship satisfaction score for women increased from 86.81 (SD = 21.74) at prethera-
py to 99.19 (SD = 20.44) at posttherapy. Similarly, the mean relationship satisfaction score for
men increased from 91.69 (SD = 20.72) at pretherapy to 102.06 (SD = 19.72) at posttherapy.
The Time by Treatment interaction for relationship satisfaction was not significant, indicating
that the increase in relationship satisfaction during therapy did not differ by treatment for
women [F(1, 50) = .06, p = .81] or for men [F(1, 49) = .19, p = .67].
The significant Time by Attribution Change interaction [F(1, 50) = 7.83, p = .009] indi-
cated that pre- to posttherapy increases in women’s satisfaction were moderated by amount of
change in their negative attributions. Women with greater attribution change had a larger dif-
ference between pre- and posttherapy relationship satisfaction scores than women with less
attribution change. The satisfaction mean for women with more attribution change increased
from 82.67 (SD = 26.24) to 102.85 (SD = 19.44), whereas the mean for women with less attri-
bution change increased from 91.12 (SD = 15.15) to 95.38 (SD = 21.14). Similarly, the
increase in men’s satisfaction from pre- to posttherapy was moderated by amount of decrease

JOURNAL OF MARITAL AND FAMILY THERAPY 9

 Table 3
ANCOVA Results for Women’s and Men’s Relationship Satisfaction, Psychological
Abuse as Reported by Partner, and Negotiation as Reported by Partner

Sum of Mean
Source squares df square F p

Women’s relationship satisfaction

Time 1375.88 1 1375.88 7.32 .009
Time by treatment 11.07 1 11.07 0.06 .81
Time by attribution change 1472.35 1 1472.35 7.83 .007
Error 9402.22 50 188.04
Men’s relationship satisfaction
Time 834.01 1 834.01 7.92 .007
Time by treatment 19.51 1 19.51 0.19 .67
Time by attribution change 1653.42 1 1653.42 15.69 <.001
Error 5162.28 49 128.61
Women’s psychological abuse as reported by men
Time 20966.24 1 20966.24 32.90 <.001
Time by treatment 1634.18 1 1634.18 2.56 .12
Time by attribution change 647.24 1 647.24 1.02 .32
Error 31227.29 49 637.29
Men’s psychological abuse as reported by women
Time 18365.92 1 18365.92 23.68 <.001
Time by treatment 576.77 1 576.77 0.74 .39
Time by attribution change 1049.81 1 1049.81 1.35 .25
Error 38001.23 49 775.51
Women’s negotiation as reported by men
Time 228.52 1 228.52 10.23 .002
Time by treatment 37.53 1 37.53 1.68 .20
Time by attribution change 45.63 1 45.63 2.04 .16
Error 1049.46 47 22.33
Men’s negotiation as reported by women
Time 640.99 1 640.99 23.87 <.001
Time by treatment 23.94 1 23.94 0.89 .35
Time by attribution change 6.77 1 6.77 0.25 .62
Error 1262.38 47 26.86

in their negative attributions [F(1, 49) = 15.69, p < .001]. The satisfaction mean for men with
greater attribution change increased from 85.74 (SD = 20.34) to 102.44 (SD = 14.63), whereas
the mean for men with less attribution change increased from 98.12 (SD = 19.12) to 101.64
(SD = 24.38). These differential increases in satisfaction do not appear to be due to a ceiling
effect, in that posttherapy DAS scores of approximately 100 are barely into the nondistressed
range.

Change in Negative Attributions and Psychological Abuse

Consistent with findings by LaTaillade et al. (2006), the repeated measures ANCOVAs (see
Table 3) indicated a significant main effect for Time in which psychological abuse significantly
decreased for women [F(1, 49) = 32.90, p < .001] and men [F(1, 49) = 23.68, p < .001]. Mean
abuse by women decreased from 46.44 (SD = 37.57) at pretherapy to 17.42 (SD = 15.05) at
posttherapy, and mean abuse by men decreased from 49.28 (SD = 40.30) to 17.15
(SD = 15.37). Insignificant Time by Treatment interactions indicated that the decrease in psy-
chological abuse did not differ by treatment for women or men. The insignificant Time by

10 JOURNAL OF MARITAL AND FAMILY THERAPY

Attribution Change interaction for each sex indicated that decrease in partners’ psychological
abuse was not moderated by change in their negative attributions.

Change in Negative Attributions and Negotiation

As LaTaillade et al. (2006) did not investigate changes in partners’ negotiation as an out-
come, the results of these ANCOVAs constitute new findings regarding effects of the treatments
(see Table 3). Significant main effects for Time indicated that negotiation significantly increased
across CBCT and UT for women [F(1, 47) = 10.23, p = .002] and men [F(1, 47) = 23.87,
p < .001]. Women’s negotiation mean increased from 18.54 (SD = 8.00) to 22.58
(SD = 7.27), and men’s negotiation mean increased from 16.62 (SD = 7.13) to 22.18
(SD = 6.90). Insignificant Time by Treatment interactions indicated no difference in change in
negotiation behavior between CBCT and UT by women [F(1, 47) = 1.68, p = .20] or men
[F(1, 47) = 0.89, p = .35]. The insignificant Time by Attribution Change interactions indicated
that an increase in negotiation was not moderated by change in partners’ negative attributions,
for women [F(1, 47) = 2.04, p = .16] or men [F(1, 47) = 0.25, p = .62].

Change in Negative Attributions and Negative Communication

Consistent with findings of LaTaillade et al. (2006), the repeated measures ANCOVAs (see
Table 4) indicated no significant overall Time effect for negative communication behavior for
women [F(1, 33) = 1.14, p = .29] or men [F(1, 32) = 0.58, p = .45], such that across types of
therapy the treatment did not significantly reduce negative communication. However, the Time
by Treatment interaction effects indicated a significant difference in amount of change in nega-
tive communication between CBCT and UT for women [F(1, 32) = 1.86, p < .05], but not for
men [F(1, 32) = 1.10, p = .30]. Women in CBCT had a decrease in negative communication,
from a mean of 1.27 (SD = 0.94) to .53 (SD = 0.41), whereas women in UT evidenced no
change, with pre- and posttherapy means both being 1.10. Furthermore, the significant Time by

Table 4
ANCOVA Results for Women’s and Men’s Negative and Positive Communication

Sum of Mean
Source squares df square F p

Women’s negative communication

Time 0.46 1 0.46 1.14 .29
Time by treatment 1.86 1 1.86 4.61 <.05
Time by attribution change 1.74 1 1.74 4.32 <.05
Error 12.89 32 .40
Men’s negative communication
Time 0.15 1 0.15 0.58 .45
Time by treatment 0.29 1 0.29 1.10 .30
Time by attribution change 4.41 1 4.41 17.00 <.001
Error 8.31 32 0.26
Women’s positive communication
Time 0.12 1 0.12 0.18 .68
Time by treatment 0.14 1 0.14 0.20 .66
Time by attribution change 1.43 1 1.43 2.14 .15
Error 21.44 32 0.67
Men’s positive communication
Time 0.00 1 0.00 0.00 .99
Time by treatment 0.01 1 0.01 0.012 .91
Time by attribution change 3.62 1 3.62 7.04 .01
Error 16.45 32 0.54

JOURNAL OF MARITAL AND FAMILY THERAPY 11

Attribution Change interaction indicated that the decrease in women’s negative communication
across types of couple therapy was moderated by degree of decrease in their negative attribu-
tions [F(1, 32) = 4.32, p < .05]. Women with greater attribution change exhibited a larger
decrease in negative communication from pre- to posttherapy compared to women with less
attribution change. The negative communication mean for women with greater attribution
change decreased from 1.27 (SD = 0.88) to .60 (SD = 0.49), whereas the mean for women
with less attribution change decreased from 1.10 (SD = 1.07) only to 1.03 (SD = 0.82). The
decrease in men’s negative communication from pre- to posttherapy was moderated by degree
of change in their negative attributions [F(1, 32) = 17.00, p < .001]. Men with greater attribu-
tion change had a larger decrease in negative communication compared to men with less attri-
bution change. The negative communication mean for men with more attribution change
decreased from 1.63 (SD = 1.00) to .91 (SD = 0.90), whereas the mean for men with less attri-
bution change only decreased from 0.72 (SD = 0.65) to 0.71 (SD = 0.58).

Change in Negative Attributions and Positive Communication

Also consistent with findings of LaTaillade et al. (2006), the ANCOVA results for observed
positive communication (see Table 4) indicated an insignificant treatment main effect for Time,
such that across types of couple therapy there was no change in positive communication behav-
ior among women [F(1, 32) = 0.18, p = .68] or men [F(1, 32) = 0.00, p = .99]. Additionally,
the Time by Treatment interaction was not significant for women or men, indicating that there
were no differences in change in positive communication between CBCT and UT. However, the
Time by Attribution Change interactions indicated that change in positive communication from
pre- to posttherapy was moderated by degree of change in negative attributions for men [F(1,
32) = 7.04, p = .01] but not for women [F(1, 32) = 2.14, p = .15]. Men with greater attribu-
tion change had a larger increase in positive communication compared to men with less attribu-
tion change. The positive communication mean for men with greater attribution change
increased from 3.30 (SD = 1.18) to 3.79 (SD = 1.14), whereas the mean for men with less
attribution change began and ended at 3.46 (SD = 1.08).

DISCUSSION

The purposes of this study were to (a) examine the effects of alternative forms of couple
therapy on negative attributions of couples experiencing psychological abuse and mild to mod-
erate levels of intimate partner violence and (b) determine the extent to which a decrease in
negative attributions was associated with other positive outcomes including increased relation-
ship satisfaction, increased negotiation, decreased psychological abuse, increased positive com-
munication behavior, and decreased negative communication behavior. Literature points to the
importance of targeting negative attributions in interventions designed to improve the function-
ing of aggressive partners, and a variety of couple therapy models implicitly or explicitly have
cognitive change as a goal. Although cognitive-behavioral therapy most explicitly focuses on
reducing individuals’ negative attributions regarding their partners’ relational behavior, we
expected that the systems approaches to therapy would reduce negative attributions as well,
although less so. We also expected that attribution change would be associated with improve-
ment in partners’ relationship satisfaction and behavior toward each other.
The present study addressed a gap in knowledge regarding effects of diverse couple therapy
models in reducing partners’ negative attributions that have been implicated in relationship dis-
tress and aggressive behavior (O’Leary et al., 2007). The findings indicate that couple therapy,
including approaches other than cognitive-behavioral, is an effective modality for modifying
partners’ negative attributions about each other. Contrary to expectations, CBCT did not have a
larger impact on attributions than the UT models did. The lack of a group difference may be due
to the characteristics of the CBCT protocol. Although CBCT traditionally emphasizes cognitive
restructuring in addition to skill development (Dattilio, 2010; Epstein & Baucom, 2002; Rathus
& Sanderson, 1999), the protocol used in the clinic focuses on development of anger manage-
ment, communication, and problem-solving skills, with structured practice during sessions and in
homework, but less structured emphasis on partners’ use of cognitive-restructuring techniques to

12 JOURNAL OF MARITAL AND FAMILY THERAPY

challenge negative attributions. Given the short-term nature of the treatment, the relative empha-
sis on behavioral skills was intended to bring couples’ aggressive interactions under control
quickly and develop constructive skills for managing conflict. This approach is consistent with
Epstein and Baucom’s (2002) recommendation that therapists intervene first with a couple’s
destructive interaction pattern for coping with issues in their relationship before focusing on
underlying sources of distress. Although abusive behavior can be fueled by partners’ negative
attributions about each other, clinicians who treat partner violence typically focus initially on
containing aggression by means of behavioral interventions, even while they are identifying and
challenging cognitions that contribute to aggressive acts. The CBCT protocol in this study
emphasized behavioral over cognitive interventions. Perhaps with more extensive intervention
with attributions over a longer course of treatment, the CBCT condition would result in greater
attribution change than the systemic approaches.
The number of cases within the UT condition was not sufficiently large to allow an exami-
nation of possible differences among the various systemic approaches in obtained changes in
attributions or any of the other outcome measures. The present findings supported our expecta-
tion that several major systemic approaches address partners’ negative cognitions to some
extent, but it will be important to investigate possible differences in cognitive change among
models, given how important negative attributions are in aggressive relationships.
Across theoretical approaches, partners who exhibited greater reduction in negative attribu-
tions achieved more positive changes in other areas of relationship functioning, compared to
those who exhibited less attribution change. Both women and men whose negative attributions
decreased more had larger increases in relationship satisfaction and larger decreases in negative
communication, and men with larger decreases in negative attributions increased their positive
communication more. Although the study’s design does not identify whether attribution
changes preceded and played a causal role in the changes in other areas of functioning, the
findings underscore the importance of targeting partners’ negative attributions in the treatment
of relationship distress and abusive behavior. Future research could use a multiple-baseline
design with sequential introduction of cognitive and behavioral interventions and periodic
assessments of attributions and behavior, to examine the order in which changes occur and the
degree to which change in one domain influences change in another.
In extending LaTaillade et al.’s (2006) evaluation of cognitive-behavioral and other couple
therapy approaches to the treatment for aggression within a clinic population, this study indi-
cated that both CBCT and UT conditions were effective in increasing relationship satisfaction,
increasing negotiation, and decreasing psychologically abusive behavior. In contrast, there was
a significant decrease in observed negative communication only for women who received
CBCT, and no significant increase in observed positive communication in either CBCT or UT.
The lack of increase in positive communication may be due to the focus on decreasing negative
interaction during these relatively brief treatments. Because CBCT targets negative communica-
tion directly through skill practice during and between sessions, the greater decrease in women’s
negative communication in CBCT than in UT was expected. However, all other treatment ben-
efits did not differ based on treatment condition, suggesting that similar therapeutic benefits are
possible from different treatment orientations.
This finding is consistent with prior evidence suggesting that degrees of effectiveness for
established treatments for relationship distress tend to be comparable (Sprenkle, Davis, &
Lebow, 2009). However, Sprenkle et al. (2009) stress that a common factors approach to
therapy does not suggest that all treatments have equal effects, but rather that some treatments
are superior even after taking therapist and client personal characteristics into account. It is
premature to conclude that theoretical orientation is irrelevant in the treatment for partner
aggression, in that differences in outcomes may manifest over a treatment period longer than
the 10 sessions utilized in this study, and comparisons among the non-CBCT approaches may
reveal differences. A principle underlying the CBCT protocol tested in this research is that
treatments for partner abuse are more likely to be effective if they target empirically identified
risk factors, in this case negative attributions. Future research could address this assumption
more directly by varying degrees to which CBCT and alternative therapies target individuals’
cognitions that elicit or justify abusive acts. Nevertheless, this study contributes to the develop-

JOURNAL OF MARITAL AND FAMILY THERAPY 13

ment of a meta-model of change in couple therapy by providing evidence that cognitive change
occurs across models and is associated with constructive change in several areas of relationship
functioning.
Strengths of the clinical trial conducted in this study include sampling of couples from a
general clinic population rather than targeted recruitment of community couples for their prob-
lems with abusive behavior, random assignment to treatments, and use of multiple outcome
measures including self-reports, reports of partner behavior, and behavioral observation. Proce-
dures were used to ensure partners’ safety. First, extensive screening included individual inter-
views and questionnaires about partner violence, fears about participating in couple therapy,
and substance use. Second, couples were asked to sign a contract pledging to refrain from
aggressive forms of behavior. Third, at the beginning of each session, therapists inquired about
incidents of violence and evaluated the current level of safety. The findings demonstrate that
such safety procedures and use of treatments addressing violence risk factors minimize dangers
of treating abusive behavior with couple therapy and result in improved relational functioning.
These findings can only be generalized to couples who present voluntarily for therapy and
are likely to be motivated to improve their relationships. They cannot be generalized to couples
reporting severe levels of intimate partner violence, but couple therapy is not advisable for
those couples (Holtzworth-Munroe et al., 2002). Furthermore, the extent to which the couple
interventions would prevent the development of psychological and physical abuse among cou-
ples who report an absence of partner violence remains unclear.
This study’s focus on cognitive change in couple therapy was restricted to changes in
negative attributions. Other cognitions relevant to abuse (e.g., beliefs condoning violence as an
acceptable means to an end) also could be targeted and may be related to changes in behavior
and relationship satisfaction. With a larger sample, effects of therapy approaches within the
UT condition could be compared. A longer period of outcome assessment would help
determine whether treatment models require different lengths of time to produce effects. The
findings regarding less change in communication behavior should be viewed in light of the
smaller sample available for analyses of effects on communication, and the fact that the com-
munication sample measured a limited number of forms of behavior. Finally, this study exam-
ined effects of treatment ‘‘packages’’ without isolating components associated with change.
Dismantling designs could identify active ingredients in therapies related to positive outcomes
for abusive behavior.
In conclusion, after intensive screening, couples experiencing psychologically abusive
behavior and mild-to-moderate intimate partner violence can safely and effectively be treated
conjointly. The present findings offer additional support for the utilization of couple therapy,
regardless of theoretical orientation, as a means to intervene with this population. Across theo-
retical models, it is important to modify partners’ negative cognitions as well as their behavioral
patterns and skills when intervening to reduce abusive behavior.

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NOTE
1
The first author is a doctoral student who graduated from the accredited couple and fam-
ily therapy program and was a co-therapist for one of the cases included in the data set, the
second author is the director of the program and periodically provides clinical supervision of
student therapists, the third author is the director of the clinic and periodically provides clinical
supervision of student therapists, and the fourth author is a former program faculty member
and clinical supervisor.

16 JOURNAL OF MARITAL AND FAMILY THERAPY