Friday, May 13, 2011

Does it work? Does Relationship and Marriage Education Work?

I have long been a believer that solid forms of marriage and relationship education (MRE) can help individuals and couples to have stronger, happier relationships. By education, I mean strategies that teach skills, strategies, and attitudes associated with success in relationships; I do not mean therapy, though therapy can be useful if done well. I started working with my colleague, Howard Markman, in 1977 when I was a junior at Bowling Green State University and he was a young assistant professor. His passion then, now shared by me and all our colleagues, was to build prevention oriented, relationship education strategies to help couples prevent major problems in marriage before the problems could get a serious foothold. His particular vision was to make such programs as empirically based as possible. Over the years, we and our colleagues have developed one of the better known approaches, called PREP (The Prevention and Relationship Education Program). [By the way, we recently changed the word “enhancement” to “education” in the acronym, to reflect the terms favored in the field at this time.]

By “empirically based,” we mean something specific. First, we mean basing the content of such programs on sound science about how relationships work, how they fail, what is risky, and what is protective. Empirically based programs utilize the scientific knowledge that is out there to inform the strategies. Second, empirically based programs are tested in outcome studies. Empirically based curricula should be tested and found to be helpful, or, if not directly tested, at least include some of the types of strategies used in programs that have been tested. Third, empirically based programs are regularly refined. By this we mean that scientifically based programs are always changing in some aspects based on new knowledge that is being generated in the field. New studies may suggest an idea is outdated, or may suggest a great new way to get a complicated point across to people, or may show that some type of strategy is more effective than another. Like many other things that stay cutting edge these days, empirically based programs of relationship education stay up on what is going on. These points are foundational to the work we do on PREP and all the curricula we have developed over the years.

There are two primary types of educational models are designed to help achieve success in relationships—especially marriage: Services designed for existing couples and services designed for individuals whether or not they are currently in a relationship. The field has focused the most energy, for decades, on couples. Many studies and approaches focus on couples who are planning marriage or couples who are already married and want to tune up their relationship. There are many studies—outcome studies—testing the effectiveness of MRE with couples. The more recent, rapidly growing focus is on relationship education for individuals. The difference between individual focused models and couple focused ones is very important. Most couple focused approaches assume the work is with existing, committed couples, who want their relationships to work.

The stronger individually focused models tend to be designed to help individuals realize their own aspirations for success in love and marriage, not only by teaching skills but also by helping participants recognize healthy and unhealthy relationship patterns, and to consider carefully if a particular partner is a good choice for them (and their child, if they have one or more). Even when there is an existing relationship, individually oriented models do not assume that it’s healthy or that it should continue. A lot of the effort in individually oriented programs is focused on getting people to go slower, make better choices, and to be thinking clearly about what will get them closer to their own goals for happy, healthy and lasting love; in other words, to be deciding rather than sliding when it comes to key turning points. There are growing uses of this approach with individuals such as high school students, college students, single parents, adults receiving government supports (like Temporary Assistance to Needy Families), military service personnel, and so forth. You might wonder why some government or private systems would care about the love lives of individuals. The answer to this is really pretty simple, and it’s summed up best by a colleague of mine named Marline Pearson. In extensive work with teens and those in young adulthood, her battle cry has been, “Your love life is not neutral.” By this, she simply means that what people do in their love lives can have a huge impact on whether or not (or when) they will achieve other important life aspirations (educational, vocational, familial, etc.). I’ll write more about this in a future post.

Do these educational approaches to helping people build lasting love work? I believe there is a lot of evidence that they do. Do they work as well as they could? No. See point three above under the notion of what an empirically based, best practices model does—it regularly gets improved as more is learned. That is essential because many of us in this field want to learn how to continually improve what we do. There is always more to learn. Back to the point about if such strategies work. Here is what I know:

• A large number of studies show that MRE for couples works. Since it’s a newer field, there are fewer studies, but promising none-the-less, showing that individual oriented relationship education works.

• There are now a number of important, meta-analytic studies showing that MRE works, particularly when it comes to helping couples communicate and manage conflict better. There is also evidence that MRE helps couples maintain overall relationship quality (such has marital happiness). Meta-analytic studies are very valuable because they are studies of the effects of many other studies all included in one large analysis. I will include some citations for such studies at the end of this post.

• Studies in this field generally show that those who need help the most are most likely to get the greatest benefit from such services. This is not always true, but, in general, when studies examine higher versus lower risk couples or individuals, those at greater risk often benefit the most. However, the benefits for higher risk couples may be shorter-lived, suggesting the need to provide occasional booster shots (to augment the original inoculation) to help couples stay on track. Higher risk can mean many things, such as being from a family wherein your parents divorced.

• There is plenty of evidence that MRE services are much more available to middle income and up couples. This has been changing in the past decade, mostly related to various government efforts, but generally, like in any other area, effective services are the least available to those who are economically disadvantaged. For a great example of recent, positive evidence that such efforts can be successful, see the link (here) that I posted in an earlier entry on this blog.

• A few studies show that MRE can reduce the odds of divorce or break-up. This has been harder to show than changes on dimensions such as communication quality largely because few studies track couples long enough for break-up and divorce to be evaluated. And tracking is crucial here. If you cannot track most of your original sample (people move, and such), you have less opportunity to meaningfully test for these possible benefits.

An ongoing study of ours provides a good example of evidence of MRE helping couples reduce the odds of divorce. We are currently conducting a pretty large study of our program, PREP, as used by chaplains in the US Army. Chaplains in all branches of the services have used PREP, as well as other approaches, to help people in their marriages for many years. PREP has been used extensively. In this particularly study, funded by NIH, we randomly assigned couples to receive either PREP or serve in a control group that did not receive PREP (at least not at the same time. Some couples in the control group no doubt eventually have received it if they sought to do so.) There are two parts of the sample in this project of ours. (The largest wave began a few years ago with the smaller wave following about a year behind.) The initial wave of couples was much larger than the second wave, and tended to be couples exposed to high stress related to ongoing war efforts. With the initial, larger wave, we found that those couples receiving PREP had 1/3 the divorce rate (2%) one year later compared to the control group (6%). We did not find this difference in the smaller, second wave, however. When we average the two groups together, we find that the PREP couples have an overall divorce rate at the one year point that is 50% of that in the control group. This effect may well weaken over time—many preventive effects do, which argues for providing ongoing training and supports to couples who are undergoing numerous challenges. At any rate, this was one of the most encouraging findings in the MRE field to date because it is based on a large sample that we continue to follow in a study using the most rigorous scientific procedures for evaluating program outcomes. (for more information, click here)

When it comes to examining the evidence about the effectiveness of MRE, there are both optimists and pessimists. I believe that the evidence favors the optimists; however, I think pessimists can raise legitimate concerns about how to increase effectiveness. If you want to know more about studies on the benefits of MRE, you could find any or all of the following. There are many other important studies but these ones would get you on the right track. (I am not allowed to provide the actual papers to you because of copyrights, but if you are really curious and have access to an academic library, or you search online, you would be able to find the abstracts or whole papers in one way or another.)

Blanchard, V. L., Hawkins, A. J., Baldwin, S. A., & Fawcett, E. B. (2009). Investigating the effects of marriage and relationship education on couples’ communication skills: A meta-analytic study. Journal of Family Psychology, 23, 203-214.

Carroll, J. S., & Doherty, W. J. (2003). Evaluating the effectiveness of premarital prevention programs: A meta-analytic review of outcome research. Family Relations, 52, 105-118.

Hawkins, A. J., Blanchard, V. L., Baldwin, S. A., & Fawcett, E. B. (2008). Does marriage and relationship education work? A meta-analytic study. Journal of Consulting and Clinical Psychology, 76, 723 -734.

Hawkins, A. J., & Fackrell, T. A. (2010). Does relationship and marriage education for lower-income couples work? A meta-analytic study of emerging research. Journal of Couple & Relationship Therapy, 9, 181–191.

Also useful:

Halford, W. K., Markman, H. J., & Stanley, S. M. (2008). Strengthening couple relationships with education: Social policy and public health perspectives. Journal of Family Psychology, 22, 497 - 505.

If you care about this area and whether or not MRE is effective, it is up to you to read what you can and form your own conclusion. As should be obvious, as a founder and developer of a major model of education used in this field (PREP), I have a financial interest in such efforts (in the spirit of full disclosure). However, I can tell you that my interest in actually helping people trumps all other interests here. Fortunately, many of the most important studies in this field—including the meta-analytic studies—were not conducted by Howard Markman or myself or our team. Of course, other studies have been conducted by us. There. That’s a brief (but long blog entry!) overview of the evidence suggesting MRE works. You will decide for yourself if such efforts may be useful to you personally or to others.

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