The erosion of marriage has created enormous difficulties for children, parents, and society. Today, one child in three is born out of wedlock. Compared to children born within marriage, children born outside of marriage are overwhelmingly more likely to live in poverty, depend on welfare, and have behavior problems. They are also more likely to suffer depression and physical abuse, fail in school, abuse drugs, and end up in jail.
Marriage is beneficial for adults as well. Married adults are far more likely than single adults to report happiness in their lives. Compared to mothers who have never married, married mothers are half as likely to suffer from domestic violence.
Overall, more than 80 percent of long-term child poverty occurs among children reared in never-married or broken families. The welfare system exists primarily as a response to the collapse of marriage. Each year, the nation spends more than $200 billion on means-tested welfare aid for low-income families with children: 75 percent of this spending goes to single-parent families.
In response to the overwhelming evidence concerning the harmful consequences of the decline of marriage, the 1996 welfare reform law set a national goal to increase and strengthen two-parent families. To help meet that goal, President George W. Bush wants to set aside $300 million per year (or 2 percent of future federal funding in the Temporary Assistance to Needy Families, or TANF, program) for specific programs to strengthen marriage as part of the reauthorization of welfare reform. These programs would teach relationship skills to unmarried couples at the time of pregnancy with the goal of helping couples develop strong, healthy marriages. The programs would also provide marriage-skills training to low-income married couples to help those couples improve their relationships and avoid marital breakup.
Critics of the President's initiative seldom attack the concept of promoting healthy marriages directly. Instead, they claim that no evidence shows that the marriage education and enrichment programs envisioned in the President's initiative would work.
This charge is simply false. The evidence is overwhelming that programs that provide marriage-skills training help couples increase happiness, improve their relationships, and avoid negative behaviors that can lead to marital breakup. For example:
This scientific research demonstrates that marriage programs--whether they are called marital preparation, enhancement, counseling, or skills training--are effective. These studies make the case that marriages are not merely enabled to survive, but can also thrive when couples learn the skills to make their relationships work. Moreover, the research shows that the programs are effective in a variety of socioeconomic classes. Polls indicate that the overwhelming majority of low-income couples at risk of out-of-wedlock childbearing or marital breakup would like to participate in programs that would help them improve their relationships.
The collapse of marriage is a predominant factor behind high rates of child poverty, welfare dependence, and a host of other social problems. Two parents united in a healthy marriage represent, by far, the best environment for rearing children. However, the welfare system has punished marriage and rewarded single parenthood for a generation.
President Bush has proposed the first steps in reversing this trend. He wishes to bring fathers back into the home rather than pushing them out. The President's marriage initiative, incorporated in the House-passed welfare bill (H.R. 4737), represents a critical first step in moving beyond the current anti-marriage welfare system. The bill would provide skills to low-income couples to help them build and sustain healthy marriages. It would also foster experiments in reducing the anti-marriage penalties in welfare programs. If enacted, this legislation would begin the vital task of repairing the fabric of family in low-income communities.
The importance of marriage and the intact, two-parent family to the success of welfare reform cannot be overestimated. The family is the building block of society. As America's founders--particularly John Adams and John Witherspoon--put it, marriage is the bulwark of the social order and the "seedbed of virtue" upon which the Republic rests. It is the organism through which the very life of a nation is nurtured and passed on to future generations.
As social science research and government surveys document, the retreat from marriage in America since the 1960s has been accompanied by a rise in a number of serious social problems. Compared to children in two-parent intact families, children who are born out of wedlock or whose parents divorce are much more likely to experience poverty, abuse, and behavioral and emotional problems, to have lower academic achievement, and to use drugs more often. Compared to married mothers, single mothers are much more likely to be victims of domestic violence. On the other hand, when parents marry or remain married, the benefits to their children are substantial. Adolescents from such families have been found to have better health and fewer developmental problems, and are less likely to repeat a grade in school or be depressed.
While the social science literature makes this compelling case for marriage, welfare policy has consistently undermined the institution. Means-tested aid programs, such as TANF, food stamps, and public housing, encourage single parenthood by implicitly penalizing low-income mothers who marry employed men.
While the anti-marriage bias of the welfare system is widely recognized as a mistake, change has come slowly. The 1996 welfare reform law, which created the tanf program, established a national goal of increasing two-parent families--but state governments failed to respond to this directive. Out of more than $100 billion in tanf funds disbursed throughout the past six years, only about $20 million (a minuscule 0.02 percent) has been spent on marriage programs.
Because of this paucity of activity, President Bush has sought to create a new pilot program specifically dedicated to reducing child poverty and increasing child well-being by fostering healthy marriage. Funding for this program would be set at $300 million per year--roughly 2 percent of future tanf funds. The President's marriage proposal--involving voluntary programs in which no one would be forced to participate--has been incorporated into the House-passed welfare reform legislation, H.R. 4737.
Just as liberal groups passionately denounced the original welfare reform in 1996, they are critical of the President's new marriage initiative. The National Organization for Women has lined up against the idea of promoting marriage, declaring that such efforts "waste taxpayer dollars." Robert Kuttner of the American Prospect fears what he calls "shotgun welfare betrothals." The anti-marriage hysteria within some left-wing circles has been so strong that even The Washington Post has lamented "the left's marriage problem," stating that opposition to marriage by the feminist left is rooted in "reflexive hostility" and "tired ideology."
While much of the opposition to the President's marriage proposal is emotional and ideological, some criticism is couched in pragmatic terms. For example, critics assert that either marriages fail to form or fall apart in low-income communities primarily for economic reasons. According to this logic, the only way to strengthen marriage is to increase funding for job training and conventional welfare programs.
This reasoning is faulty. Aside from the simple fact that marriage continued to erode as the government spent hundreds of billions of dollars on such programs in the past, the basic premise that low-income marriages fail primarily for economic reasons is inaccurate. A recent survey in Oklahoma asked divorced welfare recipients about the reasons their marriages had failed. The three most common reasons were lack of commitment, too much conflict and arguing, and infidelity. These problems are precisely what the marriage-strengthening programs included in the President's plan are designed to address.
The most common pragmatic charge made by opponents of the President's marriage initiative is that there is no evidence that marriage-strengthening programs are effective. This charge is simply untrue. The social science evidence more than amply demonstrates that marriage programs of the sort outlined in H.R. 4737 can and do help couples develop enduring, healthy marriages.
Perhaps the most solid evidence comes from a meta-analysis of 20 different marriage programs conducted by Paul Giblin, Douglas H. Sprenkle, and Robert Sheehan. The 20 diverse programs in this meta-analysis covered a wide range of the types of programs that would be funded under the President's marriage initiative, including pre-marital, marriage enrichment, and family interventions. Using a sophisticated statistical procedure that integrated 85 studies of programs involving 3,886 couples, the researchers translated the studies' diverse findings into common expressions of program or treatment effectiveness called "effect size." The result: When measured against control groups that had not participated in the programs, the various marriage programs--involving couples that differed in age, income, and geographic location--yielded an average positive effect size of 0.44. This represents a substantial improvement in behavior, given that effect sizes typically range between -1 to +1. (See Appendix for detailed explanation of meta-analysis and effect size.)
An effect size of 0.44 means that the average couple participating in any one of the programs studied improved their behavior and relationship so that they were better off than more than two-thirds of the couples that did not participate in any program. Specifically, before the training began, the experimental and control groups were equally matched: The median couple that participated in the training scored better than half the couples in the control group and vice versa. After participating in the program, the average participant couple improved their relationship to the point where they performed better than 66 percent of the control couples who did not participate. This represents a substantial improvement in the couples' relationships. Some of the programs yielded effect sizes as high as 0.96, meaning that couples who took the program performed better than 83 percent of those who did not participate.
The goal of the President's marriage-promotion efforts is not simply to increase the number of married couples, but to help couples enter into and maintain healthy marriages. Thus, an important element of the plan is to provide marriage-skills training after a couple has married to help the couple sustain and improve their relationship. Similar skills training can be provided to non-married cohabiting parents, with the goal of improving their relationship and making successful marriage more likely.
Marital-skills training has been proven effective in improving relationship satisfaction and communication. According to one authority, "Outcome research has shown that marital intervention programs have been effective in reducing distress and dissolution in couple relationships, alleviating depression, and maintaining marital satisfaction during adjustments to parenthood." Such programs also "help women at risk for postpartum depression reduce the stress and attendant risks that may exacerbate the predisposition to such depression."
The Becoming a Family Project
One of the first couple-oriented, transition-to-parenting education programs is the Becoming a Family project. In one study of this program, couples participated in 24 weekly small-group meetings from the last three months of pregnancy through the first three months of parenthood. Declines in marital satisfaction were less severe in couples that participated when compared with couples that did not participate. At 18 months after childbirth, none of the participating couples had divorced, while 12.5 percent of the control group had separated or divorced. The study also found that expectant couples were very receptive to the program and evaluated it positively.
These results suggest that this program represents a huge opportunity to improve the relationships for low-income couples at risk of separating after the birth of a child. By keeping marriages together, programs such as Becoming a Family can greatly reduce the probability that children will be thrown into poverty and welfare dependence.
One of the oldest and best-researched skills-based training programs for married couples is Couple Communication (CC). While the program has been used in a variety of formats and settings, most research has examined the 12-hour, structured-skills training variant of the program.
Confirming an earlier meta-analysis, a 1999 meta-analysis of 16 studies found that the program yielded meaningful effects on all types of measures: Couples who took the training experienced moderate to large gains in communication skills, marital satisfaction, and other relationship qualities. The highest effect sizes were found in studies that measured marital communication. These studies showed substantial improvements in communication among couples taking the training when compared to behavior prior to the training. Mean effect sizes in communication were 1.06 immediately after training and 0.71 at follow-up evaluations up to one year later. This means that the average couple, immediately after training, enjoyed better communication skills than 85 percent of the couples prior to training; that percentage dropped slightly to 76 percent at the time of the follow-up evaluation. Effect sizes in self-reported measures of marital satisfaction were also strong: 0.74 immediately after training and 0.45 at one year follow-up.
In studies that evaluated CC couples against control groups, the program's effects were slightly smaller but still strong. For example, participating couples showed observable improvements in communication, with effects sizes of 0.95 immediately after training and 0.69 in follow-up evaluations up to one year later. This means that, up to one year after the program ended, participating couples communicated better than 75 percent of the couples that had never participated in the program.
Another effective skills-based program for married couples is Relationship Enhancement, which teaches practical skills that enable couples to resolve current and future problems on their own. Tapping into universal needs by teaching skills that are useful for couples regardless of ethnic background or religious beliefs, Relationship Enhancement is particularly suited for African-American couples and couples in cross-cultural situations. In Giblin's 1985 meta-analysis (cited earlier), this program yielded by far the largest effect size--0.96--among 20 marriage programs studied. Couples who took Relationship Enhancement training were better off than 83 percent of couples that took no training whatsoever.
Reflecting that success, Relationship Enhancement has been found to be effective with a wide variety of clinical and other special populations in preliminary empirical studies and case reports. It has been found to be effective in improving relationships and reducing symptoms and problems with psychiatric outpatients and their families; patients in community residential rehabilitation centers; alcoholics; co-dependents; spouse batterers; depressed clients; juvenile delinquents; drug addicts in rehabilitation; and those suffering from narcissistic personality disorder.
Among the various types of marriage programs, the most basic and perhaps most common form occurs before marriage. Unlike "intervention" programs or therapy that deals with troubled marriages, premarital programs focus on preventing marital distress by soliciting discussion of hidden assumptions about marriage and teaching couples communication and relationship skills before problems develop. Working primarily, although not exclusively, with engaged couples, these skills-based programs help prepare couples for the demands and stresses of married life.
Although clergy have traditionally provided this type of marital education, teachers, social workers, and counselors can also be effective. The assumption is that the earlier couples discuss issues and learn marriage skills, the fewer problems they will encounter.
The Prevention and Relationship Enhancement Program
The most extensively researched program of this type, the Prevention and Relationship Enhancement Program (PREP), was initially developed by Howard Markman and Scott Stanley of the University of Denver more than 20 years ago. prep teaches skills that are necessary for a good marriage: effective communication, teamwork, problem solving, and conflict management, as well as preservation and enhancement of love, commitment, and friendship.
A longitudinal study in Denver that evaluated the effectiveness of prep found that, compared to couples without the training, couples that participated in PREP:
These positive results speak volumes, as the lack of such patterns has been strongly correlated with marital distress, violence, and marital breakup. They also explain why couples enrolled in PREP faced a statistically significant lower chance of premarital breakup four to five years later. Such positive results are not limited to the United States and have been confirmed by studies in Austria and Germany.
Contributing to the success of premarital education programs like prep is the use of assessment questionnaires that help couples discover the extent to which they agree on issues of marriage, children, and life in general. Such testing helps to identify potential areas of conflict so that a couple becomes sensitive to their vulnerabilities and can initiate corrective action, including skills training. Some instruments are so sophisticated that they can predict, before a couple marries, whether the two will stay together after marriage. These programs may be particularly helpful to non-married expectant mothers, a majority of whom say they are interested in marrying the father-to-be and believe they have a very good chance of doing so.
Three major instruments--PREmarital Preparation And Relationship Enhancement (prepare); Facilitating Open Couple Communication, Understanding, and Study (foccus); and RELATionship Evaluation (RELATE)--have achieved robust scientific validity. According to Professor Thomas Holman of Brigham Young University:
Each of these assessment tools has solid evidence for validity, reliability, comprehensiveness, ease in administration and scoring, and practicality. Using these questionnaires as part of premarital counseling increases the couple's interest and investment in the process, provides a convenient and concise way to provide a couple with feedback on the strengths and weaknesses of their relationship, themselves as individuals, and their social context, and provides a way for couples to set goals for improvement before they marry. They are also all similar in that they assess about 90% of the premarital predictors of marital satisfaction and stability.
Prepare is a 195-item inventory that assesses relationship issues such as marital expectations, personality issues, communication, conflict resolution, financial management, sex, and parenting. According to how they answer the questions, couples are placed into four categories: vitalized, harmonious, traditional, and conflicted. The discussion that this assessment tool generates is a large part of its effectiveness. A 1996 study of 393 couples that examined the relationship between the four premarital types and their real-life outcomes after three years found that "conflicted" couples were the most likely to separate or divorce and that "vitalized" couples had the highest levels of satisfaction.
Interestingly, about 10 to 15 percent of couples that took prepare before their intended wedding decided not to marry. The scores for these couples were similar to those who did marry but later developed dissatisfied marriages. This means that PREPARE can be very effective in helping couples to make informed marital choices and avoid troubled marriages and relationships.
PREPARE also helps couples improve their relationships. A study conducted this year documents the effectiveness of premarital inventory questionnaires accompanied by feedback sessions in preventing marital distress. This approach yielded a 52 percent increase in the number of couples classified as "most satisfied" with their relationship. Among the remaining couples, more than half improved their assessment of their relationship. Even among the highest-risk couples, more than 80 percent moved up into a more positive category.
FOCCUS, an inventory similar to PREPARE but with a religious orientation, has demonstrated similar results. A study of 677 adults who completed foccus between 1987 and 1993 and were interviewed eight years later found that more than 66 percent agreed that the assessment instrument program had been valuable in their lives. Respondents in the early years of marriage were most likely to judge the training as helpful; among those in the first year of marriage, 88 percent agreed that foccus was valuable.
A premarital inventory built upon the experience of older questionnaires, relate, was developed by the Relationship Institute, a group of family professors, researchers, and educators. In contrast to prepare and foccus, this instrument solicits the respondent's perceptions of his partner, not just himself. It also has the benefit of providing direct feedback to the couple, not just to the professional. Studies have also documented the effectiveness of this tool in predicting marital satisfaction and stability.
Many other studies, too numerous to document here, provide additional evidence that marriage-centered programs are effective. Whether they offer marital-skills training, counseling, or intervention for distressed marriages, such efforts have been found to increase the chances of marital success and happiness.
For example, in a study of a two-session marriage intervention program called Marriage Checkup, the use of a marital assessment questionnaire and "motivational interviewing" of couples recruited by a newspaper advertisement significantly improved marital satisfaction; gains were maintained at a one-month follow-up. In another study of 137 couples (62 percent of whom were maritally distressed) participating in a four-month workshop called Practical Application of Intimate Relationship Skills (pairs), couples reported significant increases in both intimacy and overall marital adjustment. While both men and women reported improvements, gains for women were more immediate and dramatic.
Studies also document the effectiveness of more intensive forms of marital invention: counseling and therapy. An extensive review of the literature on the effectiveness of marital counseling in preventing marital separation and divorce found dozens of studies demonstrating that counseling was effective in reducing conflict and increasing marital satisfaction. This review combined two meta-analyses to find that 90 percent of distressed couples that took a full program of therapy were still together 18 to 24 months later, compared with 61 percent of those who took only a partial program.
Three of the paramount goals of welfare reform are reducing child poverty, reducing welfare dependence, and improving child well-being. Efforts to strengthen marriage can and must play a critical role in meeting each of these goals.
A large share of current spending in the welfare and social service industries represents efforts to deal with social and economic problems that result from the collapse of marriage. Both inefficient and unsuccessful, this approach focuses exclusively on social and economic symptoms, not on the root cause. In contrast, President Bush's initiative deals with the underlying causes of child poverty, welfare dependence, and dysfunctional behaviors by strengthening marriage itself. His annual $300 million pilot marriage-promotion programs represent only one penny for every five dollars that government currently spends subsidizing single-parent families.
Opponents of the President's proposal have suggested that there is no evidence that the programs that would be funded by the initiative will prove successful, but at least 29 journal articles covering well over 100 separate evaluations show that marriage-strengthening programs are effective in reducing strife, improving communication, increasing parenting skills, enhancing marital happiness, and reducing divorce and separation. In addition, the President's initiative calls for ongoing evaluations that will help to improve the effectiveness of the programs that will be funded.
Marriage is good for children, adults, and society at large. Children born and reared in married families are much less likely to live in poverty or to become dependent on welfare. Similarly, children raised in intact two-parent families do far better with regard to virtually every measure of child well-being, from depression and health to school failure and crime. The growth of many other social problems is tightly linked to marital decline.
Polls indicate that the vast majority of low-income parents are interested in receiving training in improving relationships. Individuals who have received welfare aid are actually more interested in participating in skills training than those who have never received aid.
Programs to increase the ability of couples to enter into healthy marriages and to help currently married couples to sustain and improve the quality of their relationships can and must play a critical role in welfare reform. Effective programs can and should be provided to low-income couples that need and want this assistance. While the President's $300 million marriage initiative cannot by itself restore a culture of marriage, this critical component of welfare reform represents a necessary first step.
Patrick F. Fagan is William H. G. Fitzgerald Research Fellow in Family and Cultural Issues, Robert W. Patterson is a domestic policy consultant, and Robert E. Rector is a Senior Research Fellow at The Heritage Foundation.
Because of small sample sizes, many studies in the social sciences do not yield statistically significant differences even though a program or treatment has good effects. A meta-analysis, therefore, pools together many such studies to compensate for the small size of separate samples. Differences in scales and measures of outcomes in separate studies are overcome by measuring the change achieved by a program in terms of the standard deviation of each outcome measure; that change is called effect size.
The basic formula for calculating any study's effect size is to subtract the mean performance score of the control group (which did not participate in the program) from the mean performance score of the treatment group that did participate in the program and then divide by the standard deviation of the control group. Meta-analysis averages the effect sizes from multiple separate studies. By combining studies, meta-analysis is able to provide much greater accuracy and reliability than can be achieved in a single study with a small sample.
Understanding meta-analysis requires translating effect size into practical terms. In the case of marriage-strengthening programs, effect size measures the performance of the average or median couple participating in the marriage program relative to that of the couples in the control group that did not participate. If a marriage program has no impact, the effect size will be zero: The performance score of the median couple that participated in the program will be the same as the median couple that did not participate. The experimental and control groups will be equally matched: The median couple in the experimental group will score better than half the couples in the control group and vice versa.
If a program has an impact, the performance of the treatment couples will improve relative to the control couples. An effect size of 0.5 means that the median couple in the treatment group has a better performance score than 69 percent of the couples in the control group. An effect size of 1.0 means that the median couple in the treatment group has a better performance score than 84 percent of the couples in the control group. Table 1 shows the performance of the median treatment couple relative to control couples for various effect sizes.
Accordino, M. P., and Guerney Jr., B. G. "The Empirical Validation of Relationship Enhancement Couple and Family Therapy," in Humanistic Psychotherapies: Handbook of Research and Practice. Ed. D. J. Cain and J. Seeman. Washington, D.C.: American Psychological Association, 2001, pp. 403-442.
Brooks, L. W. An Investigation of Relationship Enhancement Therapy in a Group Format with Rural, Southern Couples. Unpublished doctoral dissertation, Florida State University School of Social Work, 1997.
Falst-Stewart, William, et al. "Behavioral Couples Therapy for Male Substance-Abusing Patients: Effects on Relationship Adjustment and Drug-Using Behavior." Journal of Consulting and Clinical Psychology 64 (1996), pp. 959ff.
Hahlweg, K., et al. "Effectiveness of Behavioral Marital Therapy: Empirical Studies of Behavioral Techniques in Preventing and Alleviating Marital Distress." Journal of Consulting and Clinical Psychology 56 (1988), pp. 440-477.
Halford, K., "Can Skills Training Prevent Relationship Problems in At-Risk Couples? Four-Year Effects of a Behavioral Relationship Education Program." Journal of Family Psychology 15 (2001), pp. 750-768.
O'Farrell, Timothy J., et al. "Verbal Aggression Among Male Alcoholic Patients and Their Wives in the Year Before and Two Years After Alcoholism Treatment." Journal of Family Violence 15 (2000), pp. 295ff.
9. That welfare is biased against marriage is widely accepted, but relatively few understand how this bias operates. Many erroneously believe that welfare programs have eligibility criteria that directly exclude married couples. This is not true. Nevertheless, welfare programs penalize marriage and reward single parenthood because of the inherent design of all means-tested programs. In a means-tested program, such as food stamps or TANF, the benefits are reduced as nonwelfare income rises. Thus, under any means-tested system, a mother receives greater benefits if she remains single than she would if she were married to a working husband. Welfare not only serves as a substitute for a husband, but actually penalizes marriage because a low-income couple will experience a significant drop in combined income if they marry. For example, the typical single mother on TANF receives a combined welfare package of various means-tested aid benefits worth about $14,000 per year. Suppose this typical single mother receives welfare benefits worth $14,000 per year while the father of her children has a low-wage job paying $15,000 per year. If the mother and father remain unmarried, they will have a combined income of $29,000 ($14,000 from welfare and $15,000 from earnings). However, if the couple marries, the father's earnings will be counted against the mother's welfare eligibility. Welfare benefits will be eliminated or cut dramatically; the couple's combined income will fall substantially. Thus, means-tested welfare programs do not penalize marriage per se, but instead implicitly penalize marriage to an employed man with earnings. The practical effect is to significantly discourage marriage among low-income couples.
10. National Organization for Women Legal Defense Fund, "Marriage and Family Initiatives: Are They Effective?" www.nowledf.org (accessed April 13, 2002).
15. C. P. Cowan and P. A. Cowan, When Partners Become Parents (New York: Basic Books, 1992) and "Interventions to Ease the Transition to Parenthood: Why They Are Needed and What They Can Do," Family Relations, Vol. 44 (1995), pp. 412-423.
17. See www.couplecommunication.com.
20. See M. P. Accordino and B. G. Guerney Jr., "The Empirical Validation of Relationship Enhancement Couple and Family Therapy," in Humanistic Psychotherapies: Handbook of Research and Practice, ed. D. J. Cain and J. Seeman (Washington, D.C.: American Psychological Association, 2001), pp. 403-442.
21. See www.prepinc.com.
22. See H. J. Markman et al., "Prevention of Marital Distress: A Longitudinal Investigation," Journal of Consulting and Clinical Psychology, Vol. 56 (1988), pp. 210-217, and "Preventing Marital Distress Through Communication and Conflict Management Training: A Four and Five Year Follow-up," Journal of Consulting and Clinical Psychology, Vol. 62 (1993), pp. 1-8.
24. See B. Silliman et al., "Preventive Interventions for Couples," in Family Psychology: Science-Based Interventions, ed. H. Liddle et al. (Washington, D.C.: APA Publications, 2001), pp. 123-146; K. Hahlweg et al., "Prevention of Marital Distress: Results of a German Prospective Longitudinal Study," Journal of Family Psychology, Vol. 12 (1998), pp. 543-556; and K. Halford, "Can Skills Training Prevent Relationship Problems in At-Risk Couples? Four-Year Effects of a Behavioral Relationship Education Program," Journal of Family Psychology, Vol. 15 (2001), pp. 750-768.
29. See www.foccusinc.com.
31. See www.relatesurvey.byu.edu.
34. See www.pairs.com.
38. K. Hahlweg et al., "Effectiveness of Behavioral Marital Therapy: Empirical Studies of Behavioral Techniques in Preventing
and Alleviating Marital Distress," Journal of Consulting and Clinical Psychology, Vol. 56 (1988), pp. 440-477.
40. Timothy J. O'Farrell et al., "Verbal Aggression Among Male Alcoholic Patients and Their Wives in the Year Before and Two Years After Alcoholism Treatment," Journal of Family Violence, Vol. 15 (2000), pp. 295ff.
41. William Falst-Stewart et al., "Behavioral Couples Therapy for Male Substance-Abusing Patients: Effects on Relationship Adjustment and Drug-Using Behavior," Journal of Consulting and Clinical Psychology, Vol. 64 (1996), pp. 959ff.
42. William Falst-Stewart et al., "Behavioral Couples Therapy for Male Methadone Maintenance Patients: Effects on Drug-Using Behavior and Relationship Adjustment," Behavior Therapy, Vol. 32 (2001), pp. 391ff.