Health News

Studies Offer Insights into Value, Principles of Evidence-Based Relationship Skills Training


Virginia Satir, known as the “Mother of Family Therapy,” and Dr. Marty Sullivan, a pioneer of Duke University’s Integrative Medicine program, were among the earliest innovators in their fields to integrate relationship skills training into modern approaches to promoting health and wellness. Findings from a five-year federally funded study provide significant evidence validating the models they embraced.

Relationship education helps people see what’s often below the surface and improve skills for communication, emotional understanding, and constructive conflict resolution.

It’s been nearly 30 years since the late Virginia Satir, known as the “Mother of Family Therapy,” actively encouraged psychotherapists to shift their focus from therapy to education as their primary strategy for helping relationships.

Virignia Satir and Dr. Marty Sullivan: Early Innovators
Early proponents of relationship education: Virginia Satir and Dr. Marty Sullivan.

More than 15 years ago, Dr. Marty Sullivan of Duke University’s Integrative Medicine Program began integrating relationship skills training into a holistic approach to promoting health and wellness.

Findings from a five-year study funded by the U.S. Department of Health and Human Services, Administration for Children and Families, provides significant evidence validating their pioneering examples.

New Paradigm for Marriage, Family, Health and Wellness

Satir recognized increasing rates of marital and family breakdown from the sixties onward as a consequence of transitioning gender roles as couples struggled to create and sustain marriages based on a paradigm that didn’t exist prior to the freedoms and rights women gained throughout the twentieth century. With that transition, the basis of marriage evolved in many Western societies, including the United States, from providing “security, stability and raising children” to meeting each other’s needs for “love and intimacy.”

Understanding this shift is key to considering both the value of relationship education and differences between evidence-based skills training and traditional marriage therapy or counseling. It’s also helpful for reflecting on the origins of homelessness, addictions, increasing rates of poverty, and factors that can lead to violence against the self or others.

A Holistic Approach to Health and Happiness

In the late nineties, Dr. Marty Sullivan, whose early work integrating PAIRS relationship education skills into a holistic approach to helping patients recover from heart disease influenced creation of Duke University’s renowned Integrative Medicine program, said:

“What does coronary artery disease have to do with relationship skills? I think it has a lot to do with that because when we look at the risk factors for coronary artery disease and the psychosocial risk factors, many studies have shown that they are very strong. I think that it is no accident that we have an epidemic in this country of divorce and dissatisfaction in marital relationships and also an epidemic in coronary artery disease.”

In a plenary address to a 1997 conference of policy-makers and practitioners in Washington, D.C., Dr. Sullivan cited Mother Teresa as a motivating influence:

“There was an interesting interview with Mother Theresa when she was traveling in Europe. Someone asked her, ‘What is the worst disease that you have seen?’ They were thinking that this woman had been to India and she was going to talk about Cholera, or leprosy, or AIDS. She thought for a moment and she looked at the press and said, ‘loneliness and isolation in the West.’”

Underlying Impact on Key National Challenges

While the primary target of relationship skills training is typically couples and parents, tools for improving interpersonal communication, emotional understanding, and healthy conflict resolution can have a lasting impact on children influenced by their parents’ actions and example, people overcoming traumatic experiences, relationships among co-workers, and service to clients and customers within public and private businesses and organizations.

Relationship education helps people see what’s often below the surface and improve skills for communication, emotional understanding, and constructive conflict resolution.

Many of the national challenges facing the United States are rooted in relationship breakdown. There are few examples of horrific acts of violence being committed by people who have not experienced the breakdown of vital relationships. That’s true for the 20-year-old who killed himself, 20 children, and six adults at Sandy Hook Elementary School. It’s a factor in a high percentage of suicides of active-duty military.

It’s also rare that men and women who become homeless, fall into poverty, or find their lives hijacked by addictions do not first experience the breakdown or loss of relationships that could have helped prevent the spiral of hopelessness, despair, and isolation.

Dr. Sullivan and Satir were among the earliest innovators in their fields to embrace integration of relationship skills training and principles into modern approaches to promoting health and wellness.

Seven Principles of Relationship Skills Training

1. It’s Your Ship, You’re the Captain

Relationship education is about helping people find strategies and solutions that fit for their unique circumstances, values and relationship goals. That includes respecting their own personal responsibility for their success and the decisions they make for their lives. Evidence-based skills training provides techniques that are easy to understand and use to surface greater awareness of what lies beneath the tip of the iceberg, navigate typical relationship challenges, and overcome differences that are a natural part of any close relationship.

2. One Mouth, Two Ears

Relationship education provides safe, time-limited structures for conversations that matter, which are often much more about listening than talking. Learning to actively listen with empathy and respect to another person’s perspective and experience –without judgment, defensiveness, blame, or an effort to quickly try to “fix” the issue or the person — makes it safer for intimates to develop greater awareness of themselves and each other.

3. Riding the Waves

Relationship education teaches practical, usable skills for better understanding and safely expressing the full range of emotions, including anger, sadness and fear. Upsetting feelings held in eventually either implode or explode. Confiding painful feelings to a significant other leaves more room to experience feelings of love, pleasure and happiness. Just as the most powerful waves lose their energy when they break against the shore, the same is generally true of emotions.

4. It’s Rarely the Problem that’s the Problem

Relationship education enables distressed couples — with good will towards each other, openness to learning, and a desire for the relationship to succeed — to deal with differences and problems in ways that often lead to greater closeness, understanding, acceptance and commitment. The issues that surface are typically symptoms of communication breakdowns, hidden assumptions and expectations, behaviors that come from holding in upsetting feelings, or lack of skills for constructive conflict resolution.

5. Love is a Feeling

Relationship education helps people develop their emotional intelligence, including understanding that feelings of love come from the anticipation of pleasure in our interactions with others. If instead of anticipating pleasure, we expect pain, feelings of love are unlikely to survive, let alone thrive. What’s a pleasure changes during different stages and passages of life. Sustaining feelings of love requires learning what it takes in today’s circumstances to stay a pleasure in each other’s lives. And doing it.

6. Marriage is a Contract

Relationship education recognizes that although nearly all traditional marriage vows include the promise to “love ‘till death do us part,” the marriage contract itself cannot be dependent on “feelings” of love, which naturally wax and wane. That doesn’t mean commitment or obligations wax and wane. Emotions are affected by many factors, often unrelated to issues inside our closest relationships. Marriage is the glue that’s meant to hold couples and families together during periods of growth, change and challenge that are natural part of life.

7. Relationships are Work

Relationship education is built on the understanding that what happens in our closest relationships impacts quality of life, fulfillment, happiness, and the ability to pursue cherished dreams and aspirations. Relationships take regular attention. Without intentionally nurturing relationships, it’s easy to become strangers, for relationships to wither and become vulnerable. Beyond staying a pleasure in each other’s lives, the work of an intimate relationship is to consistently meet each other’s needs for bonding (emotional and physical closeness). Relationship education provides a road map and usable skills for sustaining healthy relationships that are an ongoing source of love, pleasure, happiness, and fulfillment for both partners.

Significant, multi-year research has shown that evidence-based skills training leads to greater marital satisfaction, happiness, and stronger families for the far majority of participants. For singles, relationship skills training can reduce symptoms of distress and anxiety that often lead to isolation, create new possibilities for connection, and improve emotional and physical well-being.

Seth Eisenberg is President/CEO of the nonprofit PAIRS Foundation in Hollywood, Florida, an industry leader in marriage and relationship education.


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