Structured assessment tools and scientific measurements of any kind are often overlooked in the psychotherapist’s office. Dr. Amen, in his book about treating ADHD (2013) says that he finds it bizarre that in every other medical discipline except psychotherapy, tests and measures are mandatory tools to understand the problem and to guide the treatment. This is why Dr. Amen has based his ADHD treatments on SPEC scans; to treat the brain, he looks at the brain before trying to help.
However, a therapist does not necessarily need to have access to expensive medical equipment. There is an abundance of reliable assessment tools available to gather information in an easy and structured way. That being said, there might be some bias and resistance towards using standardized tools to assess individuals, couples and families, since psychotherapy is such an individual process, that happens within a conversation.
Sasha Raskin with Drs. John and Julie Gottman
An assessment tool such a questionnaire might feel impersonal to a therapist or maybe feel like they are wasting their clients’ time when they could be doing therapy instead. In their couples therapy training, Julie and John Gottman talk about the approach that some couples therapists might have towards assessment:
We are aware of the fact that many clinicians doing couple therapy do not do a formal assessment of the relationship before beginning treatment. Many clinicians feel that they are cheating the couple when they start with an assessment instead of immediate treatment. They see two people in great distress who want help immediately, and they want to give them that help. We understand how clinicians feel about wanting to get started helping right away. (Gottman & Gottman, 2017, p. 2-1)
However, the main goal behind therapy is to help clients with their problems, and various types of assessment can be great tools to gather information effectively to be able understand the client better, as well as allow the clients to make more sense of what is going on for them. Assessment can help with creating more defined goals for therapy, as well as helping in monitoring the progress in the therapy.
Not all therapy created equal, and not all therapy modalities fit all clients. It is essential to make sure that the therapist is helping the clients to create change for the better, and that the chosen therapy method is helpful for them. These days evidence-based therapies is a frequent buzz word. It feels reassuring both for therapists and clients that the specific type of therapy they will work with is scientifically proven to be helpful. However, it is not enough for therapy to be helpful to be successful. What matters is how helpful it is.
Drs. Julie and John Gottman, write in their latest book about the problem with settling for evidence-based therapy that does show improvement, but not enough to feel better:
These so-called evidence-based small-effect treatments just don’t so much to help our clients. The American Psychological Association may have given them their seal of approval, but that certification is small consolation to our everyday clients, who are still ailing after therapy. This average effect size of half a standard deviation would still leave many couples very, very unhappy. (Gottman & Gottman, 2018, p. xii)
In summary, it is not enough for therapists to be helpful. They should be able to help at least to a point where both the therapist and the clients can see real progress, relief, change, and healing. To do so, therapists should embrace proven tools that can help them to be effective in what they are doing and gather all the needed information to help them maximize their efforts to work on the specific issues that need to be worked on. Structured assessment tools can be precisely the help that therapists need, bridging meticulous science with the less structured talk therapy.
The oral history interview is a part of the Gottman couples therapy method. It was created to provide clinicians with a tool which explores the history and the philosophy of the couple’s relationship:
The oral history interview is a semistructured interview conducted in the couple's home, in which the interviewer asks a set of open-ended questions. The interviewer asks about the history of the couple's relationship; how they met, courted, and decided to get married; about the good times and the bad times in their marriage, about their philosophy of what makes a marriage work; and how their marriage has changed over the years (see appendix.) (Buehlman, Gottman, & Katz, 1992, P. 298).
The oral history interview tool was developed by Lowell Krorkoff and John Gottman, and it makes use of the interviewing techniques of Studs Terkel (Terkel, 1980). It took about a year to develop. What started with a lengthy unstructured interview that lasted many hours, was narrowed down to a semi-structured interview that takes an hour-hour and half to administer completely. However, in the Gottman couples therapy training, the instructions are to ask only the most important and relevant questions, which can take around 20 minutes. Questions about the transition to parenthood, for example, might not even be relevant to that specific couple. In that way, when used in therapy, the interview questions provide a compelling way of gathering information, while still allowing the therapist the freedom to focus on whatever feels most vital for them.
There are eight dimensions in the oral history interview that are coded using the Buehlman (1991) coding system: Love maps (cognitive room), fondness and admiration system, disappointment and negativity, we-ness, glorifying the struggle, chaos, stereotypic roles (tradionality), and conflict avoiding versus couples.These dimensions can predict the future course of the relationship as well as assist in setting goals for the therapy.
Love maps (cognitive room). This dimension evaluates how much cognitive space each partners allows for the relationship and their partner’s world. In other words, how much details does each partner know and remember about the other, and about their shared life?
Fondness and admiration system. This dimension tracks the amount of admiration and fondness expressed towards and about the other partner during the interview.
Disappointment and negativity. This dimension traces the amount of direct and undirect hostility and disappointment that was expressed during the interview by any of the partners. This was found to be the biggest predicting factor of later divorce.
How much did the partners talk about themselves and each other as separate individual, versus to referring to themselves as a unit, using words like “we” and “us”?
Glorifying the struggle. This dimension tracks the couple’s believes about their efficacy in handling difficult conversations, arguments, and fights, and their abilities to overcome obstacles together.
Chaos. How much does the couple feel that their lives are in control, or chaotic and out of control?
Stereotypic roles (traditionality). How much do the partners differ from each other in the way the see gender roles, such as emotional responsiveness, and roles as spouses and parents?
Conflict avoiding versus discussing couples. Does the couple tend to avoid engaging in and discussing conflict? How much does the couple share details about their conflicts during the interview?
The first study that tested this coding system in couples was done by Buehlman in 1992:
Using the Oral History Interview, Buehlman and her associates (1992) were able to predict, with 94% accuracy, those couples who would divorce or stay married in a longitudinal study of 56 married couples. The couple's perceived marital bond with marital stability. Couples in which spouses were more critical of their partners, disillusioned about the marriage, and believed the challenges of the marriage were outside their control were more likely to have divorced by the 3-year follow-up. Hence, how a couple told the story of their relationship could predict their likelihood of marital stability or divorce. (Carrère, Buehlman, Gottman, Coan & Ruckstuhl, 2000, p. 44).
Even though the questions in the interview are open ended, there is a high internal reliability: “Overall reliability for the oral history coding system was 75% agreement between coders. Intercorrelations for individual dimensions ranged between .71 and .91.” (Gottman, Buehlman & Katz, 1992, p. 299).
The initial that used the oral history interview along physical measurements of the couple and years follow-up was intended to use the data to predict rates of divorce.There were significant correlations with marital satisfaction at both time points and most of the oral history variables.
Gottman, Buehlman & Katz(1992) summarize the findings:
First, we found that there was evidence in the oral history interview for one dimension or component of couples who were either low or high in (a) the fondness the husband expressed toward his wife, (b) we-ness expressed by both husband and wife, (c) expressed negativity and disappointment in their marriage, and (d) describing their lives as chaotic. Second, we found that in the divorced couples, the husband is low in fondness, low in we-ness, and in expansiveness, while also being high in negativity and marital disappointment. wife we-ness and wife marital disappointment were the only wife dimensions that fell into Factor 1. The other two variables in this factor are how chaotic a couple reports their lives have been and if they "glorify the struggle" or not.The variables that made up this dimension were able to predict divorce and months separated with quite a bit of accuracy. (p.308).
There are some limitations to the research that was done on the oral history interview. The sample population of the 56 couples that the interview was tested on initially was just married couples and was biased in the direction of higher marital satisfaction. However, the range of marital satisfaction was large. All families had a target child in the 4- to 5-year-old age range. These two populations do not represent all couples that come to therapy, for example highly distressed or without children, which is a concern for the validity of the test, at least in its’ ability to predict divorce across all populations. It is important to remember, however, that what started as research tool to predict divorce rates, was later incorporated into couples therapy as a useful tool for information gathering.
Another limitation of the research about the oral history interview is that it was very much caught up in the heteronormative view.It examined only heterosexual, married couples, who self identified as make and women. By choosing to limit the population and not including in the research the whole LGBTQIPAA population twice, both in the 1992 and the 2000 research, and limiting the population just to married couples, Gottman and his fellow researches inexplicitly take a stance on what are “normal” romantic relationship:
Thus, heteronormative assumptions create a society where only heterosexual relationships are visible. Furthermore, heteronormative assumptions lead well-intentioned individuals to ignore the needs and realities of LGB individuals and relationships. For example, a common heteronormative assumption that heterosexual therapists may make is that every client who seeks therapy is in a heterosexual relationship or of a heterosexual sexual orientation. (McGeorge & Carlson, 2011, p. 15).
The second problem with is that these populations might have different or additional challenges and strengths than just heterosexual sys-gendered married couples. That , the author does not see any reason why these questions can not in couples therapy with any population.
Despite the limitations of the research about it, the oral history interview is a powerful tool for marital and family assessment and treatment.However, the author can also see how sharing the depth of the relationship with the therapist while the family members being witnesses can be a bonding, eye opening and perhaps a healing experience.Further research on the use of this tool with families.
The oral interview assessment tool was tested again with 95 newly couples (Carrère, Buehlman, Gottman, Coan & Ruckstuhl, 2000). The findings once again provided great information in regards to the success of the marriage in the future:
A principal components analysis of the interview with the couples (Time 1) identified a latent variable, perceived marital bond, that was significant in predicting which couples would remain married or divorce within the first years of their marriage. A discriminant function analysis of the newlywed oral history data predicted, with 87.4% accuracy, those couples whose marriages remained intact or broke up at the Time 2 data collection point. The oral history data predicted with 81% accuracy those couples who married or divorced at the Time 3 data collection point. (p. 42).
The strength of this tool is that it allows to step out outside of the immediacy of the current problems that the couple is experiencing, and the personal histories of the individuals in the couple, into the complexity and insight of the relationship’s history.Virginia Satir (1964) talked already half a century ago about the need to explore the family’s and couple’s history, and not just the content, but the way the clients responded to the questions. Another benefit of the is that it adds more structure to the first therapy while gathering information in ways about the main areas of the relationship. Another important point is that even though there is no research about that, the author believes that the tool can with non-monogamous relationships and non traditional romantic structures such as polyamory; the questions apply to relationships that consist of more than two people as well.
Even though the tool on somewhat couples, the is as helpful with relatively couples who experience some issues as well as couples who are perhaps on the brink of divorce. Gottman & Gottman (2017) indicate, , that couples therapy in general, and this tool being a part of is contraindicated when the there is an affair that is happening in the present or domestic violence.
To conclude, the oral history interview is just one of many research-based tools that therapists can use in their practice.The practice of therapy is not easy for the clients, and it is not easy for the therapists.Therapy has the potential to become even more complicated when there are more people in the room, who might also be in an escalated cycle, such as a couple that considers to break up:
When teach courses on couple therapy to psychoanalytically oriented clinicians, the students listen patiently to presentation on the complexities of internalized objects and mutual projections, but then almost universally respond with, “yes, but what do we DO with the couples we see?” This desire for specific and practical ways to manage the heated action that can occur in the conjoint treatment of partners speaks to what can be unsettling for even the most sophisticated psychoanalyst who is learning the practice of therapy with couples.(Greenspun, 2013, p. 356).
To be able to do so, the therapist first needs to understand their world. Using tested assessment tools such as the oral history interview is extremely helpful in organizing the most information both for the therapist and the clients. reach point B, must also be very clear on what point A is.
Sasha Raskin, a therapist in Boulder, provides individual counseling ,family therapy, and couples therapy / counseling in Boulder, Colorado, and worldwide via video and phone calls, drawing from over ten years of clinical experience. Schedule your free 20-minute phone consultation with Sasha Raskin
References
Amen, D. G. (2013). Healing ADD from the inside out: The breakthrough program that allows you to see and heal the seven types of attention deficit disorder. New York: Berkley Books.
Buehlman, K. T., Gottman, J. M., & Katz, L. F. (1992). How a couple views their past predicts their future: Predicting divorce from an oral history interview. Journal of Family Psychology,5(3-4), 295-318. doi:10.1037//0893-3200.5.3-4.295
Carrère, S., Buehlman, K. T., Gottman, J. M., Coan, J. A., & Ruckstuhl, L. (2000). Predicting marital stability and divorce in newlywed couples. Journal Of Family Psychology, 14(1), 42-58. doi:10.1037/0893-3200.14.1.42
Gottman, J & Gottman J. S. (2017). Level 1 clinical training: Gottman method couples therapy. The Gottman Institute, Inc.
Gottman, J. M., & Gottman, J. S. (2018). The science of couples and family therapy: Behind the scenes at the love lab. New York: W.W Norton & Company.
Greenspun, W. (2013). Review of The science of trust: Emotional attunement for couples. Psychoanalytic Psychology, 30(2), 356-362. doi:10.1037/a0032057
McGeorge, C., & Carlson, T. S. (2011). Deconstructing heterosexism: Becoming an LGB affirmative heterosexual couple and family therapist. Journal Of Marital And Family Therapy, 37(1), 14-26. doi:10.1111/j.1752-0606.2009.00149.x
Satir, V. (1964). Conjoint family therapy. Palo Alto, CA: Science and Behavior Books.
Terkel, S. (1980). American dreams lost and found. New York: Baiiantine.
APPENDIX
Oral History Interview Questions
This interview is based on the work of Studs Terkel. Terkel was interested in creating radio programs, so he invented an interviewing style that is very different from a clinical interview. He avoided the usual vocal backchannels ("urn hmrn", etc.) that clinical interviewers and therapists employ because these are annoying on a radio show. At the end of the subjects' responses, Terkel would gesture and respond with great energy and emotion and then ask another question and be quiet. He could then splice himself out of the tapes and have a long segment of just the subject talking. This is a semistructured interview, which means that you will memorize the questions. However, the subjects may answer Question 10 as they are answering Question 2, and that is OK in a semistructured interview. The important thing is to get answers to all the questions, but the order is not important. You will go with the natural course of conversation, and try to get the subjects to be as expansive and involved as possible.
A bad interviewer merely gets answers to the questions, but a good interviewer makes sure to get into the subjective world of the people being interviewed. For example, suppose that a couple describe a period in their relationship when he went to college but she stayed in high school one more year to finish. She says that she visited him a few times during this year. A good interviewer wonders about the inner experience of this period. Was the situation one in which he was embarrassed by her visits, viewing her as a kid or a yokel, and she felt the rejection? If so, how did they cope with these feelings? Or was this a situation in which he felt great showing her the world of college and she was proud and excited? We want to know about these inner experiences.
We-ness. You will find some couples who emphasize we-ness in these interviews, whereas some couples do not. Sometimes one person will be talking about the "we" while the other is emphasizing separateness and difference.
Glorifying the struggle. Some couples will express the philosophy that marriage is hard, that it is a struggle, but that it is worth it.
Gender differences. See if you can identify differences between spouses that relate to gender differences in emotional expression, responsiveness, and role.
Conflict-Avoiding versus Conflict-Engaging Couples. Some couples minimize the emotional side of their marital interaction, either positive or negative affect. They tend to avoid disagreements. They tend to speak about the events of the day in terms of errands rather than feelings. Self-disclosure is minimized. Their roles tend to be fairly stereotyped and prescribed by cultural norms.
Part I: History of the Relationship (about 45 minutes)
Question 1. Why don't we start from the beginning... . Tell me how the two of you met and got together. Do you remember the time you met for the first time? Tell me about it. Was there anything about (spouse's name) that made him/her stand out. What were your first impressions of each other?
Question 2. When you think back to the time you were dating, before you got married, what do you remember? What stands out?
How long did you know each other before you got married? What do you remember of this period? What were some of the highlights? Some of the tensions? What types of things did you do together?
Question 3. Tell me about how you decided to get married. Of all the people in the world, what led you to decide that this was the person you wanted to marry? Was it an easy decision? Was it a difficult decision? (Were they ever in love?)
Question 4. Do you remember your wedding? Tell me about your wedding. Did you have a honeymoon? What do you remember about it?
Question 5. When you think back to the first year you were married, what do you remember? Were there any adjustments to being married? What about the transition to being parents? Tell me about this period of your marriage. What was it like for the two of you?
Question 6. Looking back over the years, what moments stand out as the really good times in your marriage? What were the really happy times? (What is a good time like for this couple?)
Question 7. Many of the couples we've talked to say that their relationships go through periods of ups and downs. Would you say that this is true of your marriage?
Question 8. Looking back over the years, what moments stand out as the really hard times in your marriage? Why do you think you stayed together? How did you get through these difficult times?
Question 9. How would you say your marriage is different from when you first got married?
Part II: The Philosophy of Marriage
Question 10. We're interested in your ideas about what makes a marriage work. Why do you think some marriages work while others don't? Think of a couple you know that has a particularly good marriage and one that you know who has a particularly bad marriage. [Let them decide together who these couples are.] What is different about these two marriages? How would you compare your own marriage to each of these couples?
Question 11. Tell me about your parents' marriages. [Ask of each spouse.] What was (is) their marriage like? Would you say it's very similar or different from your own marriage?
Sasha Raskin, MA, is an international #1 bestselling co-author , the founder and CEO of Go New , a transformational education program, a life, and business coach and a psychotherapist in Boulder, CO. He is working on a P.h.D in Counseling Education and Supervision and is an adjunct faculty at the Contemplative Counseling master’s program at Naropa University, from which he also graduated. Sasha has been in the mental health field for more than 10 years, worked with youth at risk, recovery, mental health hospitals, and coached individuals, couples, families, startups, and groups. He has created mindfulness stress reduction and music therapy programs within different organizations. Whether it’s in person or via phone/video calls, Sasha uses cutting-edge, research-based techniques to help his clients around the world to thrive.
As a coach Sasha Raskin provides individual and group coaching in Boulder, Colorado, and worldwide via video and phone calls, drawing from over ten years of experience. His services include: life coaching, business coaching, career coaching, ADD / ADHD coaching, leadership coaching, and executive coaching. Schedule your free 20-minute coaching phone consultation with Sasha Raskin
As a counselor in Boulder, CO, Sasha provides individual counseling in Boulder, CO , family therapy in Boulder, CO, and couples therapy in Boulder, CO, marriage counseling in Boulder, Colorado, and couples intensives / couples retreats, drawing from over ten years of clinical experience. Schedule your free 20-minute psychotherapy phone consultation with Sasha Raskin