Accurate Expression and Validation 2010

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH
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Accurate Expression and Validating Responses: A Transactional Model for Understanding Individual and Relationship Distress
Alan E. Fruzzetti and John M. Worrall
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Individual psychological problems and relationship distress or dysfunction are often intertwined, and the clinical importance of relationship distress in the diagnosis and treatment of individual psychological distress is well established (e.g., Fruzzetti, 1996; Gotlib & Beach, 1995). Data from the National Survey of Midlife Development in the United States (MIDUS) collected in 1995 showed marital satisfaction to be the strongest predictor of life satisfaction, surpassing health, work, children, and sexuality (Fleeson, 2004). Individuals are much more likely to be depressed or have other severe psychological problems if they are in a distressed relationship (e.g., Fruzzetti, 1996). For example, OLeary, Christian, and Mendell (1994) found that individuals in distressed relationships are ten times more likely to meet Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000) criteria for depression are than individuals in nondistressed relationships. A study of more than 2,500 married and cohabiting adults found relationship discord to be incrementally related to impairment and psychological distress over and above the effects of psychiatric disorders (Whisman & Uebelacker, 2006, p. 369). And, in another study involving 1,675 married individuals, marital dissatisfaction signicantly predicted alcohol use disorders (Whisman, Uebelacker, & Bruce, 2006). Similarly, individual distress and psychopathology (e.g., depression, anxiety, substance abuse disorders, and borderline personality disorder) have been shown to negatively affect relationship quality (Hoffman, Fruzzetti, & Buteau, 2007). Couples therapy is often effective in the treatment of individual psychopathology, as well as in alleviating relationship distress and dysfunction. For example, behavioral couples therapy was shown to be more effective than
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SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS
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individual cognitive therapy at alleviating relationship distress and at least as effective as cognitive therapy for depression in women who were in distressed relationships (Jacobson, Dobson, Fruzzetti, et al., 1991; Jacobson, Fruzzetti, Dobson, et al., 1993; OLeary & Beach, 1990). Similarly, a pilot study found emotion-focused therapy (EFT) for couples to be as effective as pharmacotherapy in the treatment of major depressive disorder in the female partner, and also some evidence that the females receiving EFT showed greater improvements after concluding treatment than did those who had received pharmacotherapy (Dessaulles, Johnson, & Denton, 2003). One of the conclusions from the Treatment of Depression Collaborative Research Program, a large multicenter trial that compared treatments for depression, was that marital therapy may be indicated as a primary or maintenance treatment for preventing relapse and recurrence of depression (Whisman, 2001b, p. 129). Couple interventions, where at least one partner experiences problems associated with chronic emotion dysregulation (e.g., borderline personality disorder), have been shown to be effective. For example, Kirby and Baucom (2007) found signicant treatment effects, including a reduction in depressive symptoms and emotion dysregulation in the partner with emotion dysregulation difculties, and an increase in their partners relationship satisfaction. Also, family interventions have been shown to be useful supplements to individual interventions in the treatment of individuals with severe psychopathology (e.g., Fruzzetti, 1996). Despite the overwhelming evidence linking individual distress and psychopathology to relationship distress and dysfunction, exactly how these processes are linked is not clear. For example, although ineffective communication, ineffective problem solving, poor distress tolerance skills, low warmth, physical abuse and aggression, nonegalitarian relationship functioning, and negative affect have all been shown to be associated with individual distress, the actual mechanisms that explain, rather than simply describe, the relation between individual and relationship distress have not been identied (e.g., Fruzzetti & Iverson, 2006). Researchers generally have focused less on specic partner interactions that mediate the relation between relationship dysfunction and individual psychopathology, and more on describing generic processes, and it is clear that we need a better understanding of the specic factors that moderate and mediate this relation (Whisman, 2001a). However, there have been some hopeful recent developments in which more detailed transactional perspectives have been proposed. For example, stress generation describes a bidirectional relationship in which an individuals characteristics and behaviors inuence rates of stressful events and rates of depression (Hammen, 2006). Similarly, excessive reassurance seeking
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Accurate Expression and Validating Responses
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has been shown to be related to depressive symptoms (Joiner, Metalksky, Katz, & Beach, 1999). However, models are needed to explicate more fully how individual psychological distress creates relationship distress, and how relationship distress creates individual psychopathology, moment to moment over time. Focusing on understanding the details of the underlying transactions that constantly occur within couple relationships (even prior to any reported individual or relationship distress) will help inform the development of new and better intervention and prevention programs. This chapter presents a transactional model for understanding more specically the linkages between individual and relationship distress within couple interactions (c.f. Fruzzetti & Iverson, 2006; Fruzzetti, Shenk, & Hoffman, 2005). It will describe how specic patterns of ineffective communication can develop over time, and how individual distress and relationship distress are linked. We will rst establish some groundwork for the model by explicating the hypothesized role of emotion in relationships, and then discuss the key components of the model. Examples of healthy and unhealthy couple interactions will be used to illustrate the various principles involved. We will conclude with a brief discussion about the treatment implications of the model and suggest some directions for future research.
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A TRANSACTIONAL MODEL: PRINCIPLES AND THEORY

Background and Relation to Models of Social Support Processes
Social support may be dened as information leading one to believe that he or she is cared for, loved, esteemed, and a member of a network of mutual obligations (Cobb, 1976, p. 300). There are different hypothesized roles of support in intimate relationships. Cutrona, Pierce, Sarason, and Sarason (1996) argue that its most important role is in improving the quality of a relationship. Gable, Reis, Impett, and Asher (2004) discuss the role of enthusiastic responses to a partners communication of personal positive events in enhancing relationship well-being. Other roles of support include helping a person to deal with negative life events (Cohen & Wills, 1985), or to create a sense of predictability, stability, clear role expectations, and a sense of belonging and purpose (Cutrona et al., 1996, p. 74). Having an intimate partner does not imply, much less ensure, that a person will receive effective support (e.g., Coyne & Bolger, 1990). Gleason, Iida, Shrout, and Bolger (2008), in a diary study of couples over 31 days leading up to a major stressor, found that support in dyadic relationships may increase distress (based on measures including anger, anxiety, and depressed mood) in recipients. They note that support can be ineffective and even
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detrimental. Although receiving support may increase relationship closeness, it may make a person feel worse in other domains (e.g., mood). They found large, unexplained differences among individuals in how they react to support. In two daily diary studies, Iida, Seidman, Shrout, Fujita, and Bolger (2008) found support provision in intimate dyads to involve characteristics of providers, recipients, and their relationships. In summary, despite considerable research, there is no agreement about the underlying mechanisms associated with effective support in intimate dyads. This chapter presents a model to try to begin to identify specic partner behaviors associated with effective support that are relevant to both successful individual and relationship functioning.
Denitions
The terms accurate expression, emotion dysregulation, validation, and invalidation all refer to key components in the transactional model that follows. Accurate expression refers to a description of a persons emotions, thoughts, and wants/desires, without interpretation or judgment. If a person is feeling sad, for example in response to a partners absence, accurate expression might involve the person noticing that she or he is sad and communicating this to his or her partner (Fruzzetti, 2006). Note that, in contrast, inaccurate expression in this situation might involve the person expressing anger toward the partner (anger in this example would likely be a secondary emotional response, described in detail later) rather than sadness or disappointment. Emotion dysregulation may be dened as a level of emotional arousal that is high enough to interrupt effective self-management: The individual focuses, increasingly, on reducing painful emotional arousal. Thus, emotion dysregulation interferes with a persons ability to pursue longer-term goals and maintain self-control (Fruzzetti, Crook, Lee, Murphy, & Worrall, 2009). Although there are many denitions of the term validation, it has a quite specic meaning here. Validating responses communicate ones understanding and acceptance of anothers feelings, thoughts, desires, actions, and/or experience (Fruzzetti & Fantozzi, 2008). In contrast, invalidating responses communicate a failure to understand, and accept as legitimate, the others experience or actions. In other words, invalidating responses convey that the others experiences or actions are illegitimate, invalid, incomprehensible, or otherwise wrong. Invalidating responses typically maintain or increase negative emotional arousal in the other person, whereas validating responses facilitate reductions in negative arousal (Shenk & Fruzzetti, 2009). Accurate expression and validating responses are linked in important ways, just as inaccurate expression and invalidation are linked. Figure 5.1 shows that it is much easier to validate another when the
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Partner A expresses an emotion or other experience accurately
Query: Please check & confirm whether removing of the line "Accurate Expression and Validating Responses: A Transactional Model 1" from the fig, is ok?
Partner B validates Partner A
Partner As arousal decreases
A is more attentive, better able to further express accurately, and to listen to and validate Partner B
Figure 5.1 Accurate expression and validating responses: A transactional model 1.
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person expresses him- or herself accurately. Validating helps keep arousal low, which in turn helps the individual stay oriented to goals and cognitively clear, which makes accurate expression (and the partners ability to listen, understand and validate) more likely. This transaction (accurate expression validating response) continues over time, mediated by low or modest emotional arousal. In contrast to accurate expression, inaccurate expression is much easier to invalidate, which further heightens the persons emotional arousal, causing confusion and increasing the urge to escape the situation (get out of it, regardless of longer-term impact), which typically keeps the focus away from the persons initial descriptive experience (Fig. 5.2). This transaction (inaccurate expression invalidating responses) continues over time, mediated by high negative emotional arousal. This high negative emotional arousal, of course, is the essential link between distressed individuals and distressed relationships. That is, high negative emotional arousal is the common pathway to both individual distress and relationship distress. When an individual has chronically high negative emotional arousal, he or she is more vulnerable to chronic individual distress, emotion dysregulation, and
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Emotional Vulnerability: A) Sensitivity, reactivity B) Sleep, food, stress, etc
Heightened Emotional Arousal (primary emotional response to the situation)
Inaccurate Expression (secondary emotions, plus demanding, attacking, etc.)
Misunderstanding and Invalidation
Figure 5.2 Unhealthy transaction (leads to escalating cycle of inaccurate expression and invalidation, co-occurring with high negative emotional arousal or dysregulation).
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psychological disorders (e.g., depression substance, use, anxiety). Both the precipitants of that arousal, and how the person manages the arousal, affect the development of psychological disorder. In addition, when a person is highly negatively emotionally aroused, or sometimes even emotionally dysregulated, he or she is (a) more likely to say and do hurtful things, (b) less likely to listen empathically and respond to a partner in a validating way, and (c) less likely to receive support and validation in a constructive (helpful) way (Fruzzetti et al., 2009). Thus, elevated negative emotion and emotion dysregulation create a dysfunctional cycle that can quickly lead to a distressed relationship, as well as to individual distress and psychopathology. As noted, we prefer the term transaction to describe these processes, for a variety of reasons (cf. Fruzzetti et al., 2005). Most importantly, the term captures the reciprocal and ongoing nature of what happens between partners, both in a given situation (conversation or exchange) and over time, as these shorter exchanges develop into patterns. With each cycle, what one person does affects the other, back and forth, resulting in either a moderating pattern (healthier) or an exacerbating pattern (less healthy). The factors are constantly changing, inuencing each other over time.
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Emotion in Relationships
An emotion may be conceptualized as a process and a multisystemic response involving neurobiology, cognition, and behavior, most often occurring in a largely social context (Fruzzetti et al., 2009). Of course, emotional responses may be triggered by internal events (e.g., thoughts, memories, somatic events) or external events (other people, events, etc.). There are two kinds of emotions, primary and secondary. A primary emotion is a universal and adaptive (healthy) emotional response to a situation or stimulus (Greenberg & Safran, 1989). Alternatively, a secondary emotion is a learned emotional reaction, perhaps to the primary emotion itself or to the situation or stimulus, sometimes mediated by particular kinds of thinking (e.g., judgments). Although secondary emotions may be adaptive in a narrow situation, they are less broadly adaptive. For example, one partner who is looking forward to the other one coming home may be disappointed that the other one is late (disappointment is the primary emotion here). However, he or she may express annoyance or anger (a secondary emotion in this situation) upon the partners arrival, which is both less accurate (not describing the disappointment) and likely to be less effective in achieving relationship goals because anger is likely to create more distancethe opposite of what the partner was wanting (close time together). Emotions play a central role in intimate relationships, and negative emotion is a core feature of relationship distress. Individuals cognitive, physiological, and overt behavioral repertoires (and hence their transactions with the partner) are mediated by the extent to which they are able to stay emotionally regulated (e.g., Fruzzetti & Iverson, 2004; Fruzzetti et al., 2005). In addition, having difculties regulating emotion increases the likelihood of developing a variety of forms of individual psychopathology (e.g., depression, anxiety, borderline personality disorder; Ehring, Fischer, Schnlle, Bsterling, & Tuschen-Cafer, 2008; Fruzzetti et al., 2005).
Emotion Regulation and Dysregulation

Thompson (1994) maintains that emotion regulation consists of the extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish ones goals. Gross (1998) describes a process model of emotion regulation in which emotion may be regulated at ve points in the emotion generative process: (a) selection of the situation, (b) modication of the situation, (c) deployment of attention, (d) change of cognitions, and (e) modulation of responses (p. 271). This process of regulating emotions as an individual is central to partners transacting in a healthy way. If one partner becomes emotionally dysregulated, he or she becomes focused on escaping
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the aversive experience of painfully high negative emotion, without much regard for the longer-term costs associated with escape. This often takes the form of expressing hostility and destructive criticism, but could take other forms that are destructive (such as demanding, judging, interpreting, etc.). These are not examples of accurate expression, which instead would be more descriptive of primary emotions, and include heart-felt wants and desires (those experienced under low or moderate levels of arousal), consistent beliefs or opinions, and so on. Moreover, in states of high emotional arousal people simply cannot optimally solve problems, communicate, or perform complex tasks like those needed to negotiate in a difcult interpersonal situation. Emotion regulation skills and abilities enhance effective functioning both in the short and long term. In particular, they help the individual manage social interactions effectively and pursue both short- and long-term goals simultaneously (Thompson, 1994). Thus, the core problem for many distressed couples may be dysregulated emotion, either across situations in general or at least in relationship situations (Fruzzetti, 2006; Fruzzetti & Fantozzi, 2008). High emotional arousal overwhelms a persons thinking and reasoning abilities. Otherwise normal individuals (i.e., even without severe individual psychopathology) may learn to react strongly and quickly with high negative emotion in the context of a signicantly distressed relationship (negative escalation; cf. Weiss & Heyman, 1990). The more emotional arousal increases, the less likely it is that a person will be able to think logically or problem-solve effectively. Following an emotional event, if a persons emotional arousal is high enough, inaccurate expression of the emotion (especially expression of a secondary emotion instead of the primary) is likely to follow. The individual may, for example, express anger when the more authentic emotion is sadness, fear, or hurt. Many factors may be associated with dysregulated emotion. However, interpretations, assumptions, and, in particular, judgments (right/ wrong or good/bad interpretations, about oneself or another), exacerbate emotional arousal and contribute to inaccurate expression. Importantly, one partners response to the other partners inaccurate expression may further reinforce it by giving desired (albeit negative) attention to the person when he or she expresses a secondary emotion (or other less descriptive and less accurate expression). Giving extra attention to or trying to soothe a partner may positively and/or negatively reinforce that partners expression of anger, increasing the likelihood of similar patterns of behavior in the future. And, even if the partner does not soothe, but rather reciprocates with additional inaccurate and negative expression him- or herself, this may elicit further arousal and inaccurate expression. Thus, one
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persons inaccurate expression can easily lead to the others. It is difcult for one partner to provide appropriate, useful, or meaningful support when the other partner is not expressing accurately what she or he thinks, feels, or wants.
Vulnerabilities to Negative Emotional Arousal and Dysregulation

The greater a persons vulnerabilities to negative emotional arousal, the higher his or her emotional arousal is likely to be immediately after a given emotional event and prior to expressing anything publically or anyone else responding to him or her. In addition to the event itself, four other factors contribute to higher levels of negative emotional arousal in a specic situation: (1) the persons emotional temperament, (2) the persons current biological disposition, (3) immediate prior events, and (4) the judgments or appraisals the person makes (or does not make) about the event, the other person (in an interpersonal situation or event), or about him- or herself, just as the event occurs or unfolds. Let us explore how each of these factors functions (see Fig. 5.3). Negative Events. The negative events noted in Figure 5.3 are typically small daily events, things that happen throughout the course of the day. This might include perceiving a look of disapproval on a colleagues face at work, or a partner not arriving home from work on time as expected. Of course, the event could be less routine (a relationship breakup, loss of job, car accident, etc.), but most events are more mundane. For purposes of this model, however, events between partners or otherwise directly relevant to their relationship are the most important daily events. Indeed, for partners in a couple, many relationship events occur throughout the course of a day. The negative quality of an event is determined to some extent by its objective qualities (e.g., being blamed or judged is almost always a negative event), but also by context and emotional impact. And, context includes both direct relationship factors (e.g., recent conversations or interactions) and individual vulnerabilities. For purposes of this model, negative events are both those that are negative in quality and those that are simply less positive than desired. For example, when one partner is doing something and the other partner rolls his or her eyes and sighs deeply in an exasperated way, it is clearly experienced as a negative event. In addition, if one partner is looking forward to seeing the other at the end of the work day, really wanting to be together, and is met with a tepid response upon reuniting (partial smile, gentle but not enthusiastic hello), the differential between what is desired (a very positive response) and what is received (a modest, more neutral or mildly
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Emotional Vulnerability: A) Sensitivity, reactivity B) Sleep, food, stress, etc
History of Conflict and Misunderstanding
Negative Relationship Event or Trigger
Heightened Emotional Arousal (primary emotional response to the situation)
Judgments and/or Learned/Repetitive Patterns
Inaccurate Expression (secondary emotions, plus demanding, attacking, etc)
Misunderstanding and Invalidation
Figure 5.3 Transaction between individual emotion dysregulation and partner invalidating responses; individual and couple distress results.
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positive response) is also negative in this model. That is, we expect that disappointment (in the class of negative emotions) will naturally follow as a primary emotion. Emotional Temperament. Certain temperamental factors make people more or less vulnerable to emotion dysregulation (Fruzzetti et al., 2005; Linehan, 1993a). Some individuals may be particularly sensitive in general or sensitive only to certain kinds of emotional stimuli. Importantly, in close relationships that have been distressed over time, one or both partners may develop extreme vulnerabilities to negative arousal, mostly in situations
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with each other (and not in other situations). Thus, we may consider emotional temperament a marker that is stable in the short term, but not necessarily stable in the long term. We may consider three different types of temperamental vulnerability: sensitivity, reactivity, and length of time it takes to return to emotional baseline. Sensitivity refers to how big the emotional cue or stimulus needs to be for the person to notice or perceive it. Higher sensitivity means the person is more acutely aware of emotional cues. Of course, some individuals may be relatively insensitive and may tend to miss important stimuli, in particular in interpersonal situations. This may contribute to missed opportunities for giving or receiving support, for problem prevention and problem solving, or for closeness. In couples, when partners mismatch on sensitivity (one being keenly sensitive, the other more detached from emotion cues), conict is likely. Reactivity denes how much a person responds emotionally after perceiving an emotional cue, and is relatively independent of sensitivity (Fruzzetti et al., 2005). That is, a more reactive partner may notice a certain emotional cue and have a very big, negative response, whereas a less reactive partner may notice a similar cue but not react to it much at all. It is possible that when one partners arousal matches the arousal of the other partner (especially at low to moderate levels), it is easier for the couple to maintain effective communication. If one partners reactivity is substantially lower or higher than that of the other, the potential for misunderstanding is increased. For example, low reactivity may result in a lack of response to an emotional cue (e.g., an upset expression on a partners face). This has the potential to be misinterpreted by the other partner (e.g., he doesnt care about me). Conversely, an emotionally reactive person may become highly negative when under stress (e.g., Fruzzetti & Iverson, 2006). This can result in amplied discomfort when negative life situations arise, including disagreements or conict with a partner (Gardner, Busby, & Brimhall, 2007). Some individuals, after becoming emotionally activated, take a relatively long time to return to their normal (baseline) level of emotional arousal, and others return to baseline rather quickly. A slow return to baseline means that the individual tends to stay at higher levels of emotional arousal longer. Events that would otherwise result in a moderate reaction are likely to seem to trigger more extreme responses if an individuals emotional arousal is already high (the modest stimulus, plus still elevated arousal from a long time prior, results in high negative arousal or even dysregulation). Thus, slow return to baseline also creates more opportunities for misunderstanding. These vulnerabilities are not mutually exclusive, nor do they necessarily covary greatly. An individual may be very sensitive, highly reactive, and also
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have a slow return to baseline. But, a person may also have none of these vulnerabilities, or any combination of one or two of them. Various combinations may make couples more resilient to aversive conict (e.g., if neither is particularly sensitive or reactive), or more prone to aversive conict (e.g., if one partner is very sensitive and the other is highly reactive). Consequently, the matching or mismatching of temperamental factors can contribute to a variety of couple interaction patterns (Fruzzetti & Jacobson, 1990), and of course any partner with high vulnerabilities to negative arousal and dysregulation is more at risk for developing signicant psychological distress associated with a variety of disorders (Fruzzetti et al., 2005). Current Biological Disposition. Other vulnerabilities are more transient, and may be environmental or situational. Examples of transient vulnerabilities that apply to almost everyone at one time or another include being tired (insufcient sleep or poor quality of sleep), having a physical illness, not eating properly, not getting enough exercise, and the use of mood altering-drugs such as alcohol, caffeine, or prescription or street drugs. Other transient vulnerabilities that affect arousal and contribute to emotional distress and dysregulation in the short term include employmentrelated stressors (or lack of employment and its associated nancial stressors), health-related stressors, social stressors, and stressors related to children and family. Importantly, a healthy relationship may represent an important resource to help an individual deal with stressors. However, a distressed or dysfunctional relationship may itself be a major stressor in a persons life. When this occurs, the person also loses a key support structure (a healthy relationship) to help them cope with other stressors. Immediate Prior Events. Temperamental factors and current biological disposition contribute to negative emotional reactions due to any negative event. In addition, very recent prior events interact with these factors to create an emotional baseline just prior to the next event. Thus, a partner who just had a disagreement with a co-worker will enter into a couple situation or event with higher negative arousal than a partner who just had a fun time exercising. Prior events also interact with temperamental factors and current biological dispositions to create more or less aversive arousal. Judgments And Appraisals. Of course, how we think about events also has an impact on our arousal. Of particular interest in this model are judgments, which are a particular type of appraisal, classifying something (an action of the partner or oneself) as good/bad or right/wrong. Judgments have a signicant and immediate impact on emotional arousal (Fruzzetti et al., 2009).
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Typically, if a person is judgmental toward his or her partner, anger will result (and the primary emotion will be lost, at least temporarily). Conversely, if a person is judgmental toward oneself, guilt or shame follows. And, people tend to become increasingly judgmental in states of high negative emotional arousal. The alternative to judgments and appraisals (including positive ones) is mindful description. Mindfulness, or nonjudgmental awareness, has signicant implications for healthy relationships. Mindfulness in the context of a couple relationship involves awareness of the other person, engaging in interactions without judgments, letting go of judgments quickly when they do occur, staying present (focused on the current moment or activity), being aware of and allowing primary emotions (experiencing primary emotions without suppression or escape), enjoying being together in daily activities, and reminding oneself of long-term goals as context (e.g., I love my partner and my partner loves me; Fruzzetti, 2006; Fruzzetti & Iverson, 2004).
Accurate Expression of Emotions, Thoughts, and Wants

Accurate expression refers to a partners abilities to observe and be aware of his or her emotions (especially primary emotions), thoughts, and wants and desires, and to describe them as they are, without interpretation or judgment. Accurate expression typically includes the description of primary emotions, whereas inaccurate expression involves expression of secondary emotions or a distortion of the importance of a topic and ones feelings about it (e.g., anniversaries arent important, I dont care that he forgot my anniversary when the partner is genuinely disappointed; Fruzzetti & Fantozzi, 2008). As noted, primary emotions are universal responses to a situation, whereas secondary emotions are responses to the primary emotion mediated by appraisals and judgments, or are conditioned over time (Fruzzetti & Fantozzi, 2008). Fear, sadness, surprise, disgust, and joy are all examples of emotions that are typically experienced as primary emotions. Although anger is often a secondary emotion, in particular in close relationships, it can also be a primary emotion. Anger is normative and justied (a primary emotion) in situations of signicant injustice, and when a person experiences a lot of pain and distress. Thus, in close relationships, anger often is expressed when a person primarily feels hurt. This is paradoxical, of course, because the hurt partner typically is hurt because of distance in the relationship and truly wants more closeness. Yet, by expressing anger, further distance is more likely to follow, rather than increased closeness. These particular six emotions correspond to identiable facial expressions in humans (one of the key roles of emotions in humans is to help in communication; Ekman, Friesen, & Ellsworth, 1972). Secondary emotions
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are generally reactions to underlying emotional processes, not a persons direct response to the event or situation. According to Greenberg and Safran (1989) dysfunctional and maladaptive emotions are usually secondary emotions that block the experience and expression of primary emotions. Anger and shame are commonly experienced as secondary emotions, although other emotions also could become secondary emotions. Anger is particularly problematic in close relationships because, even when justied, it is typically corrosive. Anger is usually associated with an urge to attack (at least verbally), which is experienced by the receiving partner as a threat. At this point, both partners fail to appreciate the other (likely more) primary emotions the rst partner missed (disappointment, hurt, etc.). This inaccurate expression of anger may be complete (anger may be entirely secondary) or partial (it may be justied, but one or more additional emotions are neither identied nor expressed because anger expression dominates). In negotiation or conict situations, fear (that the partner will not get desired outcomes) and disappointment (he or she has not been getting what has been desired) are primary emotions that are likely to be missed through the inaccurate expression of anger. Of course, it is difcult for the other partner to respond to the sadness or fear in the face of criticism and attack (expression of anger). Thus, support and other validating responses are unlikely to be provided. Multiple forms of inaccurate expression can easily be misunderstood, thus eliciting negative and invalidating responses that exacerbate already high (and often rising) negative emotional arousal. In contrast, accurate expression is much easier to understand, which helps to facilitate selfvalidation and validating responses from others, and in turn, to reduce negative emotional arousal and to regulate emotion adaptively. If a partner experiences and is able to express accurately his or her primary emotion (e.g., sadness), to allow and accept the emotion, and to understand that it makes sense in the context of the situation or relationship history, this alone is likely to help him or her to stay emotionally regulated and to express the experience accurately to his or her partner. In contrast, inaccurate expression is a key part of ineffective communication. For example, someone may react to a feeling of sadness or hurt by expressing anger toward his or her partner. The feeling of anger may be easier to tolerate than feelings of sadness or hurt (or, the partneror othersmay have responded to sadness in a punishing way in the past). Over time, the anger reaction to sadness may become automatic. The person may not be aware that the anger is a response to another, more authentic, emotion. His or her partner may only be aware of and respond to the anger, thus setting the stage for a dysfunctional pattern of interaction to develop,
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with its associated relationship and individual distress. Alternatively, she or he may self-silence by not communicating private experiences to his or her partner (e.g., by pretending nothing is wrong when feeling sadness or hurt). Thus, avoidance is one way to express experiences inaccurately, which also leads to unhealthy patterns of interaction and an increase in the risk for individual psychological problems and conicted, dysfunctional relationships (Fruzzetti, 2006; Fruzzetti & Jacobson, 1990; Whiffen, Foot, & Thompson, 2007).
Validating Responses
There is something very basic about feeling understood and accepted, which is communicated via validating responses. In close relationships we thrive on acceptance and validation from our partner or spouse. Healthy relationships thrive on heavy doses of validation and little invalidation (Fruzzetti & Iverson, 2006). For example, Iverson, McLaughlin and Fruzzetti (2009) demonstrated that couples with a depressed partner showed signicantly more invalidating responses, and fewer validating ones, than matched couples without a depressed partner. And, in a study involving distressed couples seeking treatment, a brief couple intervention (six sessions) that focused on increasing accurate expression and validating responses (and decreasing invalidating ones) led to signicantly increased validating and decreased invalidating responses.These changes were highly associated with decreased levels of both individual and relationship distress at both post-treatment and at follow-up (Fruzzetti & Mosco, 2009). There are a lot of different ways to validate what someone feels, thinks, does, or wants. Validation may involve acknowledging and legitimizing the facts, the situation, or another persons feelings, opinions, and responses. It requires respecting the other persons emotions and reactions, and wants and desires, in addition to focusing on logic and reason (Linehan, 1997). In the context of an intimate relationship, it is likely to involve communicating that the relationship is important and that the other person is important (Fruzzetti, 2006). More specically, validation may be categorized into several different levels or types: (a) nonjudgmental (mindful) listening and observing, paying attention; (b) accurate reection (verbal and nonverbal), which involves nonjudgmentally acknowledging the others feelings, thoughts, and/or wants and desires; (c) asking about the others perspective or experience to seek clarication, or articulating their unverbalized emotions, thoughts, or wants and desires; (d) validating based on a persons history or relationship history that their emotions, thoughts, and/or wants and desires make sense (understanding his or her experience in a larger context); (e) normalizing the others experience, communicating that it makes
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perfect sense (e.g., of course anyone in this situation would feel that way); (f) treating the other as an equal, not as fragile, even if current circumstances make the person vulnerable; and (g) self-disclosing ones own vulnerability to match the others vulnerability (e.g., if one partner says I love you, the other partner says, I love you, too, or, if one says I am so unhappy we have been ghting about this I really want to make things better the other says, me, too in a soft or even sad way; Fruzzetti, 2006; Fruzzetti & Iverson, 2006). Validation can be nonverbal as well as verbal. This may take the form of nurturance and support that reects an understanding of the others experience and desires. This includes being responsive to the others needs and experiences, which clearly reects understanding and acceptance (e.g., by helping with a partners chores when it is clear he or she has had a tiring day at work; treating him or her as you would like to be treated in a similar situation), and by one partner showing that he or she takes the other partner seriously (e.g., by joining in activities that are important or meaningful to the other; Fruzzetti, 2006). For reasons that are likely evolutionary, validation and invalidation have very different immediate effects on negative emotional arousal. Even in ongoing stressful situations, validation helps reduce aversive emotional arousal, whereas being invalidated does not (Shenk & Fruzzetti, 2009). Thus, validating responses help soothe and reduce negative emotional arousal, which in turn make it easier for a partner to express him- or herself accurately. Validation is not appeasement, advice, or simply agreeing with someone. One partner may not agree, for example, that he or she did what the other says (e.g., spoke in a critical tone). However, that partner can still validate the others experience (it sounded that way to the other, therefore feeling hurt makes sense). And, validating is not always easy or pleasant to do. Just because a person tries to be validating does not mean that the other person will necessarily feel validated. It requires a willingness to experiment, to be curious about the other persons experience, and to ask questions. This may include asking a partner if he or she feels validated, understood, or valued. Just asking this question may be experienced as supportive and validating because it communicates caring and that one partner is putting a lot of effort into understanding and accepting the other (Fruzzetti, 2006). Thus, validating responses help to soothe emotions (i.e., to reduce negative emotional arousal) and to reduce reactivity. They help build trust and self-respect in both partners. Validating responses also help to create a context of safety (physical, sexual, emotional, and verbal; when we feel understood and accepted we tend to feel safe). Although validation is an acceptance strategy, it can also help to facilitate change (needed change is usually easier
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when we know we are also accepted as we are). By validating our partners behaviors, we are strengthening the relationship, facilitating problem solving (as needed), and laying the groundwork for getting the support we may need later. By soothing our emotions and creating a context of safety, validating one another (emotions, opinions, desires, and other experiences) makes it easier to tolerate lifes stressors (Fruzzetti, 2006). In essence, validating is effective support.
Invalidating Responses
When one partner understands and acknowledges or legitimizes the other partners experience or behavior, he or she accepts it as it is (at least at that moment). Communicating this acceptance and understanding helps to reduce high negative emotional arousal immediately, which helps the partner regulate his or her emotion, which in turn facilitates problem solving, realistic goal setting, frustration tolerance (including delaying of satisfaction in the service of long-term goals), and other effective action. As much as humans thrive on validation, we react negatively to invalidation. Invalidation, which conveys rejection or delegitimizing of the others experience as valid and/or disregard for the other persons experience (e.g., as unimportant or irrelevant), typically results in an increase in negative emotional arousal (Fruzzetti & Shenk, 2008; Shenk & Fruzzetti, 2009). Of course, this increases the likelihood that the partner being invalidated will not express him- or herself accurately, which elicits further invalidation, and the cycle continues. This is the situation experienced by many distressed couples. In addition to problems in the relationship, partners who are chronically invalidated (it may be one or both, depending on the pattern) are at high risk for developing severe individual distress associated with high negative emotional arousal and dysregulation (Fruzzetti, 1996; Fruzzetti & Iverson, 2004). Problems with emotion dysregulation are associated with a variety of psychological disorders, including depression, anxiety, and substance use disorders (cf. Barlow, 2004).
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DEVELOPMENT OF INTERACTION OR TRANSACTIONAL PATTERNS

Healthy couple interactions typically involve partners accurately identifying their emotions, thoughts, and/or wants/desires, and expressing these to their partner. For example (see Fig. 5.1), partner A accurately expresses his or her feelings about an event (the event may directly involve the other partner or not). Partner B responds by accepting partner As behavior and experiences,
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and attempts to understand those experiences. Partner B then communicates that acceptance and understanding (including asking questions to help understand). This helps to reduce the emotional arousal of partner A, who in turn is able to be more attentive and better able to listen to and validate partner B. Healthy transactions are characterized by each partners regulated emotion and nonjudgmental awareness (mindfulness) of his or her own, as well as the partners, emotions, thoughts, and/or wants and desires. This not only promotes satisfaction across a variety of relationship domains, it also promotes individual well-being for both partners. Unhealthy couples interactions are often characterized by emotion dysregulation, inaccurate expression, and a lack of mindfulness, acceptance, and validation that together result in an escalating cycle of conict and misunderstanding, culminating in both severe relationship distress and individual distress and psychological disorder in one or both partners (Fig. 5.3). When a persons emotional arousal is very high, his or her thinking and reasoning abilities tend to diminish precipitously, and the ability to take a balanced view (e.g., to see both sides of an argument) and to make effective decisions in the moment is compromised. Instead of taking a balanced view, the dysregulated partner is more likely to judge the other partner, to become defensive, to catastrophize about the situation, to make incorrect assumptions, and/or to start feeling hopeless (or other secondary negative emotions). The invalidated and dysregulated partner likely says and does things that do not reect authentic or primary emotions, wants, and desires (e.g., genuine desire for acceptance, understanding, and closeness). This inaccurate expression often leads to more negative emotional arousal, in part because it is likely to incite conict with a partner. Thus, high negative arousal and dysregulation lead to inaccurate expression in one partner, which likely results in him or her being invalidated, which leads to continued dysregulation. This partner, in turn, is very likely to respond to the other partner in invalidating ways, which further corrodes the possibility of meaningful communication, peaceful acceptance, negotiation of difculties, the provision of support, and closeness and intimacy. In contrast, when a person is emotionally regulated, it is easier to be descriptive rather than judgmental. It is also easier to communicate authentic (primary) emotions, thoughts, and wants and desires, and to be able to validate the other partners various expressions of his or her experiences. Reciprocity keeps this pattern moving forward (Fruzzetti, 2006), resulting in effective negotiation (or the ability to tolerate insoluble problems), and a pattern of effective communication, mutual understanding and acceptance, mutual support, and satisfying levels of closeness and intimacy.
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Couples tend to develop fairly consistent patterns of interaction over time, especially with respect to dealing with disagreements and conicts (Fruzzetti, 2006; Fruzzetti & Jacobson, 1990; Holtzworth-Munroe, Smutzler, & Stuart, 1998). The goal is a constructive engagement pattern in which partners bring up relevant issues in a nonattacking way that accurately reects what they are feeling or thinking, and what they want. One partner listens, accepts the other partners behavior, and tries to understand it. The other partner communicates his or her acceptance and understanding from a position of respect. In this way, many problems get resolved. However, this type of healthy interaction depends on both partners being aware of their own emotions, thoughts, and wants, and on each partners ability to regulate (or quickly re-regulate) his or her emotions (Fruzzetti, 2006; Fruzzetti & Iverson, 2006). In contrast, dysfunctional couples have frequent interactions marked by escalating negative emotional arousal, inaccurate expression, and invalidating responses. Unhealthy interaction patterns may be divided into three types, depending on a variety of factors (e.g., Fruzzetti & Fantozzi, 2008); a mutual avoidance and withdrawal pattern, a mutual destructive engagement pattern, and an engagedistance pattern. In the mutual avoidance and withdrawal pattern, when one partner has a negative reaction to the other and starts to become negatively emotionally aroused, the other partner reacts to this and also starts to become negatively emotionally aroused (perhaps fueled by their own judgments: e.g.,I didnt do anything wrong, whats the matter with him/her?). One partner may become very sensitive to the others tendency to become dysregulated and react negatively, then become dysregulated him- or herself. They tend to avoid bringing up important issues or generally avoid interactions (they may both feel like they are walking on eggshells). Partners in this pattern either nd it so aversive to engage in conict that they increasingly avoid it, or, they have better skills at recognizing the danger zone early on, opt out, and withdraw prior to becoming dysregulated per se. Of course, avoiding difculties does not resolve them, so over time more and more must be avoided, or they must engage in some kind of conict in an attempt at resolution. In the mutual destructive engagement pattern, partners engage in mutual attacks. However, the partners may not start out with rapid negative emotional arousal, but nd that it grows over the course of an argument into dysregulated affect. At some point in the transaction, they begin to display a great deal of negative emotion (especially anger), which interferes with their ability to listen, problem solve, and remember the reasons why they are together and that they love each other. This pattern is characterized by
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inaccurate expression (e.g., anger, when the more authentic emotion is something else, for example hurt or disappointment) and invalidation. This kind of interaction heightens vulnerability to greater negative emotional reactivity the next time a conict occurs. Attacking one another may leave them with more negative feelings (e.g., shame, in addition to sadness, worry, and anger), further adding to the mix of negative emotions. Finally, the engagedistance pattern is characterized by one partner moving toward the other (e.g., by wanting to be together, do things together, or discuss relationship-related topics) and the other pulling back or even seeking more distance. In this case, the conict often relates to one or the other partner not feeling heard or understood, or to issues of closeness. However, the most common form of this pattern is when the engaging partner (the one wanting more closeness, more response from the other) expresses these desires in an ineffective way. For example, the engaging partner may criticize the others independent activities, blame the other for a variety of apparent transgressions, or otherwise make caustic demands for the other to change. Each of these attempts is, of course, an example of inaccurate expression, and has a paradoxical effect: He or she wants more closeness but engages in a way that results in less closeness (more distance). The other partner likely responds to these criticisms and demands in an invalidating way, which typically ends in aversive withdrawal (and emotional distance). Often referred to as a demandwithdraw pattern (Christensen, 1987, 1988; Fruzzetti & Jacobson, 1990), the utility in describing it more as engagedistance lies in the fact that the partners original approach and desire may well have been less demanding and more afliative, but that over time (and following successive invalidating responses) the engager may become more negatively emotionally aroused and less accurate in his or her expression, ending up appearing only to make aversive demands. This pattern leaves both partners quite dissatised, and may also be associated with individual distress. In fact, each of these unhealthy interaction patterns results in less closeness and intimacy, more relationship-related stressors (negative relationship events), less relationship satisfaction, and more individual distress and emotion dysregulation. And, in all cases, inaccurate expression and invalidating responses predominate.
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BRINGING IT ALL TOGETHER

A healthy intimate relationship can be a major source of effective support to help a person cope with lifes stressors, and through the support process closeness can grow and individuals can thrive. Here, support is understood
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specically as those behaviors in transactions that include modulated emotional arousal; accurate expression of wants, emotions, opinions; and other experiences by one partner, about which the other partner is mindfully aware and to which he or she responds in a validating way. Partners, of course, take turns seamlessly being in the expressing or validating role. Healthy relationships tend to be characterized by higher rates of validation and lower rates of invalidation. In a healthy relationship, validation is made easier because both partners accurately express their primary emotions to each other, which not only facilitates communication and fosters closeness, but helps each partner manage his or her emotion and protects against chronic problems (psychological distress and disorders) related to emotion regulation (Baumeister, Zell, & Tice, 2007; Burum & Goldfried, 2007; Fruzzetti et al., 2005). Consistent accurate expression is easier because each partner is more emotionally regulated, and validation is easier because each persons expression is more descriptive and accurate. Lower arousal helps partners stay mindful of their long-term goals and mutual commitments and affection (e.g., remembering that they love their partner and that their partner loves them), which keeps them on track to meet these goals. In sharp contrast, a distressed or dysfunctional relationship, instead of being a source of effective support for a person, tends to be a major stressor. Thus, not only are partners left to manage life stressors from outside the relationship on their own, the relationship itself is an additional source of distress (and often the most signicant). Distressed and dysfunctional relationships are characterized by higher rates of invalidation and lower rates of validation, which contribute both to lower levels of closeness and relationship satisfaction and to higher levels of individual distress and psychopathology (Iverson, McLaughlin, & Fruzzetti, 2009). Partners tend to be more avoidant, less aware, and less accepting of their own experiences and those of the other partner, and they demonstrate lower levels of accurate expression (more inaccurate) commensurate with higher levels of negative emotional arousal and dysregulation (frequency and intensity), all of which result in a cycle of increasing and reciprocal relationship and individual distress.
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IMPLICATIONS FOR TREATMENT

Each step in this model of the breakdown of support and closeness offers opportunities for rather novel intervention approaches. For example, individual interventions that increase awareness of ones own experiences help foster accurate expression. Thus, mindfulness and emotion regulation interventions
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may be very useful. In addition, relationship skills such as mindful listening and very precise validation skills build closeness and support (Fruzzetti & Iverson, 2006). Interventions that help couples learn and apply these skill sets have been shown to help reduce individual and relationship distress (e.g., Fruzzetti & Mosco, 2009; Kirby & Baucom, 2007). The treatment goal is to change the transaction from one of negative emotional arousal inaccurate expression invalidating responses more negative emotional arousal and dysregulation (along with relationship distance and dissatisfaction, and psychological distress), instead to a transaction of modulated arousal accurate expression validating responses continued emotion regulation (along with relationship closeness and satisfaction, and individual wellbeing). Intervention can focus on any of these steps, and because the steps are cyclical, interventions may be effective in a variety of orders.
Mindfulness and Relationship Mindfulness

Mindfulness skills are essential to effective emotion regulation and interpersonal interactions. Linehan (1993a, 1993b) developed a set of mindfulness skills as part of dialectical behavior therapy (DBT) (these are called the DBT core skills), and many other applications of mindfulness are now employed in a variety of approaches to individual psychotherapy. However, they are less commonly found in relationship interventions (Fruzzetti & Iverson, 2004). Mindfulness skills may be learned and practiced in an individual or couples therapy setting or in a group setting, or they may be learned and practiced individually through the use of self-help materials (e.g., audio recordings or books). Individual mindfulness skills, in part, help the person become aware of his or her experience without judgments or interpretations (Bishop et al., 2004). This, of course, is the foundation for accurate expression. Relationship mindfulness skills involve practicing mindful awareness of the other person (Fruzzetti, 2006; Fruzzetti & Iverson, 2004). At a very basic level, relationship mindfulness provides the foundation for effective listening and is itself one simple way to validate. Being mindful of the other partner facilitates understanding and makes it possible to validate the other verbally and functionally. Mindful self-awareness helps the partner be aware of the larger context (e.g., of ones love for ones partner and their love for you) and relationship goals (e.g., to build a life together; Fruzzetti, 2006; Fruzzetti & Iverson, 2004). Together, these mindfulness skills operate on both sides of the transaction (increasing emotion awareness and acceptance and accurate expression on one side, increasing awareness and acceptance of the partner, and validating responses, on the other). Mindfulness is a component of several evidence-based individual psychotherapies, including DBT, acceptance and commitment therapy (Hayes & Wilson, 1994), mindfulness-based stress reduction (Miller, Fletcher, & Kabat-Zinn, 1995),
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and mindfulness-based cognitive therapy (Teasdale, Segal, Williams, Ridgeway, Soulsby, & Lau, 2000). As such, mindfulness has been used to help treat a wide range of psychological disorders, including depression and anxiety, eating disorders, bipolar disorder, and borderline personality disorder.
Emotion Regulation
Emotion regulation skills may involve both acceptance and change strategies (Fruzzetti et al., 2009; Linehan, 1993a). Acceptance-based skills include noticing, discriminating, labeling accurately, tolerating (including selfsoothing and self-validation), and accurately expressing emotions. Changebased skills include changing the type of emotion experienced, or altering the intensity or duration of the emotion (Fruzzetti & Iverson, 2004). Of course, the emphasis in emotion regulation is for partners to be able to identify, allow, experience, and express primary emotions, and to move away from getting stuck in secondary emotions. Given that anger in close relationships typically has mostly properties of secondary emotions, emotion regulation helps partners let go of anger and focus instead on more useful and accurate primary emotions. When partners are stuck in a highly reactive cycle of negative escalation (high negative emotional arousal and invalidating responses), partners need to regulate their own emotions prior to trying to express themselves or listen to and/or respond to their partners. Emotion regulation strategies can be powerful tools to help them do this. Emotion regulation is a core skill taught in DBT. Managing emotion is also an important concept in other models and therapies, although the specic techniques and language often differ (e.g., EFT; Johnson, 2007).
Accurate Expression
Accurate expression skills also build on both mindfulness skills and emotion regulation strategies. After using mindfulness skills to become aware of genuine goals and using emotion skills to let go of anger and identify the primary emotion, accurate expression, of course, includes expressing these more genuine thoughts, wants, emotions, and other experiences to the partner in a way that she or he can understand. The other key to accurate expression is that it is descriptive (rather than judgmental or evaluative). Accurate expression is an important target in particular in both DBT (Fruzzetti, 2006) and EFT (Johnson, 2007).
Validating Responses
Validating includes communicating acceptance and understanding of the partners experience (Fruzzetti & Iverson, 2004). Thus, validating does not necessarily mean agreeing in total with the partner. For example, one partner
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might be disappointed by something the other partner did, although the other partner does not believe he or she did what the rst one described. Regardless, the second partner can validate the rst partners disappointment (e.g., I understand that you are disappointed or I can see that you are disappointed or even it makes sense that youre disappointed). Thus, validating is the essence of support and, verbally, it can take many forms (cf. Fruzzetti, 2006 or Fruzzetti & Iverson, 2004, 2006 for more details): (a) attentive, genuine, mindful listening; (b) acknowledging what the other person is wanting, thinking, feeling (i.e., his or her descriptive experience: I can see that you feel frustrated or I know you are tired); (c) summarizing the others experience or perspective; (d) gently asking about (or hypothesizing about) what the partner might be experiencing, even if he or she is not expressing it (e.g., I wonder if youre also a bit disappointed it didnt go the way you wanted?); and (e) normalizing the partners experience (e.g., of course you feel this way or anyone would react that way). More subtly, validating also requires treating the other person in a respectful, equal way that demonstrates an active partnership, without any hint of condescension, nor any implication that the other person is fragile or incompetent. In addition, it is at times validating to respond nonverbally, with action. For example, if one partner is tired, it is validating (conveys understanding, legitimacy, and acceptance) for the other partner to do some of his or her chores. Or, if one is obviously confused, for the other to stop doing other things and help the partner sort out the confusion. Validating provides support, but also helps the other person manage his or her emotion. Being validated results in much lower emotional arousal even under ongoing stress, whereas being invalidated contributes to elevated levels of emotional arousal (Shenk & Fruzzetti, 2009). Thus, validating has an immediate impact both on the relationship and on the other partners well-being (and, reciprocally, on the partner doing the validating). Of course, the therapist can use validation in-session to help create a safe environment for both partners (a key intervention in EFT [Johnson, 2007] and other therapies), whereas explicitly teaching partners what, when, and how to validate is a core target in DBT (Fruzzetti, 2006).
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FUTURE DIRECTIONS
Although research has provided support for various components of the model described in this chapter, more basic observational/longitudinal research is needed to evaluate the model. In addition, more comprehensive treatment outcome studies are needed to evaluate the utility of the interventions based
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on this model. In particular, longitudinal research that evaluates longer-term outcomes with appropriate outcome measures (in addition to the observational coding approach often used to evaluate relationship functioning) is needed. Addressing these and other methodological issues with couples intervention research is required in order to integrate the various aspects of the model into effective treatment (cf. Whisman, Jacobson, Fruzzetti, & Waltz, 1989; Wright, Sabourin, Mondor, McDuff, & Mamodhoussen, 2007). The model presented in this chapter describes transactions that may underlie many of the processes that have been described for intimate relationships in the research literature. It helps to explain how individual emotion dysregulation and partner invalidating responses mediate the relation between individual distress or psychopathology, and couple dysfunction (Fruzzetti et al., 2005). If the interactions described in this model underlie many of the processes present in intimate relationships, integrating aspects of this model into others may help to inform changes in how individual psychopathology and relationship dysfunction are diagnosed and treated. Indeed, this has implications for the next version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). There is widespread, empirically supported clinical use of relational interventions (Beach, Wamboldt, Kaslow, Heyman, & Reiss, 2006, p. 366). However the importance and complexity of the connections between relational processes and individual psychopathology are not well addressed in the current DSM (DSM-IV-TR; American Psychiatric Association, 2000). Interpersonal stressors, including problems related to social support, and their bidirectional relation with individual psychopathology, are addressed via DSM Axis IV Psychosocial and Environmental Problems or on Axis I via Other Conditions That May Be a Focus of Clinical Attention. In connection to relational problems, the DSM states: These problems may exacerbate or complicate the management of a mental disorder or general medical condition in one or more members of the relational unit, may be a result of a mental disorder or a general medical condition, may be independent of other conditions that are present, or can occur in the absence of any other condition (American Psychiatric Association, 2000, p. 737). However, partner relational problems (DSM code V61.10) only get a short paragraph, and the social, relational, and intimate context of individual distress and disorder are essentially ignored (Fruzzetti, 1996). In contrast to 1994 (when the original DSM-IV was released) the current literature suggests a rich network of connections between relational processes and specic diagnostic outcomes (Beach et al., 2006, p. 360). Lebow and Gordon (2006) discuss a variety of obstacles to relational assessment and diagnosis, including the inherent complexity. Denton (2007)
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argues that important relational processes could become part of the text describing associated features in existing conditions. Beach et al. (2006, p. 1146) argue that a diagnostic system that better guided the use of relationship interventions would be of great clinical benet. The transactional approach explicated in this chapter could have a role in helping to understand psychopathology in the context of (putatively) intimate relationships.
CONCLUSION
This chapter presented a model for both relationship and individual distress that discriminates between the patterns of interaction found in healthy versus distressed and dysfunctional couple relationships. In essence, validation is effective support. When partners are validated, they feel emotionally supported, safe, understood, and accepted, and are more likely to experience primary emotions and be able to manage and regulate them. The model may help explain many healthy and dysfunctional relationship processes (e.g., support, communication, conict, problem-solving, negative escalation), as well as individual distress and psychopathology, in a clinically useful way. Interventions based on the model are promising, but considerably more empirical research studies, including randomized clinical trials, are needed to develop and evaluate interventions.
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REFERENCES
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Accurate Expression and Validation 2010

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OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

A TRANSACTIONAL MODEL: PRINCIPLES AND THEORY

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

Partner A expresses an emotion or other experience accurately

Partner B validates Partner A

Partner As arousal decreases

Figure 5.1 Accurate expression and validating responses: A transactional model 1.

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

Emotional Vulnerability: A) Sensitivity, reactivity B) Sleep, food, stress, etc

Heightened Emotional Arousal (primary emotional response to the situation)

Inaccurate Expression (secondary emotions, plus demanding, attacking, etc.)

Misunderstanding and Invalidation

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

Emotion Regulation and Dysregulation

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

Vulnerabilities to Negative Emotional Arousal and Dysregulation

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

Emotional Vulnerability: A) Sensitivity, reactivity B) Sleep, food, stress, etc

History of Conflict and Misunderstanding

Negative Relationship Event or Trigger

Heightened Emotional Arousal (primary emotional response to the situation)

Judgments and/or Learned/Repetitive Patterns

Inaccurate Expression (secondary emotions, plus demanding, attacking, etc)

Misunderstanding and Invalidation

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

Accurate Expression of Emotions, Thoughts, and Wants

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

DEVELOPMENT OF INTERACTION OR TRANSACTIONAL PATTERNS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

SUPPORT PROCESSES IN INTIMATE RELATIONSHIPS

BRINGING IT ALL TOGETHER

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH

Accurate Expression and Validating Responses

IMPLICATIONS FOR TREATMENT

OUP UNCORRECTED PROOF FIRST-PROOF, 05/02/2010, GLYPH