Who Attends Couples Counseling in the UK and Why?

In England, publicly funded couples therapy is reserved for couples where one or both partners present with psychological disorders, rather than relationship distress, despite evidence of a bidirectional relationship between the two. Demographics and presenting issues for 14,726 couples who received counseling through a third-sector counseling organization in England and Wales were investigated. Clients were often White, aged 25-54, and presented with interpersonal issues. "Mental health problems" were identified as an issue by about a quarter of all clients. This suggests that many couples seeking relationship counseling wish to address relational versus psychological distress, which has implications for publicly funded services.

Benchmarking Community-Based Couple Therapy: Considering Measurement Reactivity.

Couple therapy has been shown to be effective in randomized clinical trials; however, results from naturalistic couple therapy have been less consistent. This study utilized a benchmarking approach to compare the effectiveness of couple therapy in a community-based setting with findings from efficacy treatments, such as treatment within randomized clinical trials. The current study is the largest couple therapy sample published to date (N = 3,347 couples). Clients in couple therapy were asked to provide initial and weekly ratings of symptomology on the Outcome Questionnaire (OQ-45.2). We found that treatment effect sizes found at community clinics were smaller than efficacy studies (i.e., the benchmark). However, when taking into account measurement reactivity, the effect sizes were comparable. This is the first benchmarking study for community-based couple therapy, allowing for meaningful comparisons and understanding of outcomes in real-world couple therapy. Implications for the field are offered in terms of evaluating community-based psychotherapy studies with benchmarking for couple therapy. Results of this study provide clinicians and researchers a way to meaningfully compare couple therapy outcomes, accounting for differences in community-based practices and randomized clinical trials. This benchmark also underscores the impact of measurement sensitivity, an issue commonly overlooked in psychotherapy research and practice.

Se ha demostrado que la terapia de pareja es eficaz en los ensayos clínicos aleatorizados, sin embargo, los resultados de la terapia de pareja naturalista han sido menos consecuentes. Este estudio utilizó un enfoque comparativo para comparar la eficacia de la terapia de pareja en un entorno basado en la comunidad con hallazgos de los tratamientos de eficacia, como los tratamientos dentro de los ensayos clínicos aleatorizados El presente estudio es la muestra más grande de terapia de pareja publicado hasta la fecha (N = 3347 parejas). Se pidió a los pacientes en terapia de pareja que proporcionen calificaciones iniciales y semanales de la sintomatología en el cuestionario para evaluación de resultados (OQ-45.2).Descubrimos que los tamaños del efecto de los tratamientos hallados en las clínicas comunitarias fueron más pequeños que los de los estudios de eficacia (p. ej.: el estudio comparativo). Sin embargo, cuando se tomó en cuenta la reactividad a la medición, los tamaños del efecto fueron comparables. Este es el primer estudio comparativo para la terapia de pareja basada en la comunidad, el cual permite comparaciones significativas y comprensión de los resultados en la terapia de pareja en el mundo real. Se ofrecen las implicancias para el área en cuanto a la evaluación de los estudios de la psicoterapia basada en la comunidad con evaluación comparativa de la terapia de pareja. Los resultados de este estudio proporcionan a los clínicos y a los investigadores una manera de comparar significativamente los resultados de la terapia de pareja, así como de explicar las diferencias en las prácticas basadas en la comunidad y en los ensayos clínicos aleatorizados. Esta evaluación comparativa también subraya el efecto de la sensibilidad a la medición, una cuestión comúnmente pasada por alto en la investigación y la práctica de la psicoterapia.

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes: Results of a German Nationwide Naturalistic Study.

Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.

Aunque la terapia de pareja es eficaz, no se producen mejoras en hasta el 50 % de las parejas. Además, los tamaños del efecto hallados en los estudios de eficacia real en entornos del mundo real son considerablemente menores que los hallados en los estudios de eficacia teórica. Existe la necesidad de saber más acerca de la eficacia real de la terapia de pareja en la práctica clínica y de los factores responsables de los diferentes resultados. Un estudio alemán a nivel nacional sobre la eficacia real de la terapia de pareja en el que participaron 554 parejas aplicó la misma metodología que dos estudios anteriores en el mismo ámbito. Se halló una coherencia notable entre los tres estudios independientes en la carga con el distrés individual y relacional, así como en los índices de mejora. Esto respalda la percepción de que las mejoras logradas mediante la terapia de pareja en la práctica clínica es solo aproximadamente la mitad de los tamaños del efecto logrados en ensayos de eficacia teórica. Además, este estudio investigó 64 factores que demostraron ser influyentes para la calidad y la estabilidad de la relación en estudios anteriores, por su efecto en los resultados. Se descubrieron factores presentes en el inicio y el final de la terapia que se correlacionan considerablemente con los resultados y con la separación de la pareja en el seguimiento. Estos factores podrían incluirse en modelos de predicción sobre la mejora y la separación de la pareja. Se debaten las implicancias para la terapia de pareja y para futuras investigaciones.

The Relationship Between Social Support and Family Relationships Among Low-Income Couples Attending Relationship Education.

Results are mixed for relationship education (RE) interventions with low-income couples. For couples who experienced positive changes, it is not clear what aspects of program models contributed to change. Many low-income couples attend government-funded RE with limited access to social and community resources. Program models often provide related resources complimentary to RE skill-building. We examined the relationship between income, social support, and family functioning for low-income, ethnically diverse couples (N = 856) who attended RE, as well as the mediating effects of social support on family functioning outcomes. Analyses included three separate dyadic models that examined associations among constructs at baseline and immediately following the RE intervention. Results demonstrated relationships between participants' reported social support and family functioning such that (a) social support was associated with baseline family functioning for both men and women; (b) men's baseline social support was influenced by women's baseline family functioning; and (c) men's and women's social support change score had a positive influence on their own family functioning change score. However, social support was not a significant mediator of change in family functioning. Implications for RE practice and research are also discussed.

Los resultados de las intervenciones sobre educación para las relaciones (ER) con parejas de bajos recursos son variados. En el caso de las parejas que tuvieron cambios positivos, no está claro qué aspectos de los modelos del programa contribuyeron al cambio. Muchas parejas de bajos recursos asisten a ER financiadas por el gobierno con acceso limitado a recursos sociales y comunitarios. Los modelos del programa generalmente proporcionan recursos relacionados complementarios al desarrollo de habilidades para la ER. Analizamos la relación entre los ingresos, el apoyo social y el funcionamiento familiar en las parejas de bajos recursos y étnicamente diversas (N = 856) que asistieron a la ER, así como los efectos mediadores del apoyo social en los resultados del funcionamiento familiar. Los análisis incluyeron tres modelos diádicos independientes que examinaron las asociaciones entre los constructos al inicio del estudio e inmediatamente después de la intervención sobre ER. Los resultados demostraron las relaciones entre el apoyo social informado por los participantes y el funcionamiento familiar, por lo que (a) el apoyo social estuvo asociado con el funcionamiento familiar al inicio del estudio tanto en los hombres como en las mujeres; (b) el apoyo social de los hombres al inicio del estudio estuvo influenciado por el funcionamiento familiar de las mujeres al inicio del estudio; y (c) el puntaje de cambio del apoyo social de los hombres y las mujeres tuvo una influencia positiva en su propio puntaje de cambio del funcionamiento familiar. Sin embargo, el apoyo social no fue un mediador de cambio significativo en el funcionamiento familiar. También se debaten las implicancias para la investigación y la práctica en RE.

Introducing the Expectations and Preference Scales for Couple Therapy (EPSCT): Development, Psychometric Evaluation, and Suggested Use in Practice and Research.

While it is known that client factors account for the largest proportion of outcome variance across treatment modalities, little is known about how clients' characteristics affect the process and effectiveness of couple therapy. To further knowledge in this area, we created a brief, practice-friendly measure, the Expectation and Preference Scales for Couple Therapy (EPSCT). Three self-report scales assess clients' Outcome expectations (e.g., I expect our relationship to improve as a result of couple therapy) and role expectations for Self (e.g., I expect to listen to my partner's concerns) and Partner (e.g., I expect my partner to blame me). Three Cognitive-Behavioral, Emotionally Focused, and Family Systems preference scales use a forced-choice format to measure the comparative strength of respondents' preferences for interventions broadly reflective of each approach. A large item pool was developed from relevant literature and clinical experience and refined based on face and content analyses with two panels of experienced couple therapists and researchers. Across four studies with 1,175 participants, the scales' internal consistency reliabilities were similar and their construct validity was supported with confirmatory factor analyses and significant correlations with several established measures, including expectation measures developed for individual psychotherapy and measures of attitudes toward professional help seeking and valuing personal growth. Across all studies, participants had stronger role expectations for themselves than their partners, although gender effects differed by sample. We discuss how to use the 15-item EPSCT in clinical practice and in future research as a predictor of couple therapy processes and outcomes.

Aunque se sabe que los factores de los clientes representan la mayor parte de la variación en los resultados a través de las modalidades de tratamiento diversas, no se sabe mucho acerca de cómo las características de los clientes afectan el proceso y efectividad de la terapia de pareja. Para avanzar el conocimiento en este campo, hemos creado una breve medida favorable a la práctica, las Escalas de expectativas y preferencias para terapia de pareja (EPSCT en inglés). Tres escalas de autoinforme evalúan las expectativas de resultados de los clientes (p.ej. Espero que nuestra relación mejore como resultado de la terapia de pareja) y las expectativas de roles para sí mismo (p.ej. Espero escuchar las preocupaciones de mi pareja) y para la pareja (p.ej. Espero que mi pareja me culpe). Tres escalas de preferencias cognitivo-conductiva, enfocada en emociones y de sistemas familiares emplean un formato de elección forzada para medir la fortaleza comparativa de las preferencias de los interrogados por intervenciones que reflejan cada enfoque a grandes rasgos. Se elaboró un conjunto amplio de ítems a partir de la literatura y experiencia clínica pertinentes y se refinó a base de análisis de apariencia y contenido con dos paneles de terapistas de pareja e investigadores experimentados. En la totalidad de cuatro estudios con 1175 participantes, las fiabilidades de coherencias internas fueron similares y su validez de constructo fue respaldada por análisis factoriales confirmatorios y correlaciones significativas con varias medidas ya establecidas, incluyendo medidas de expectativas desarrolladas para psicoterapias individuales y medidas de actitudes hacia la búsqueda de ayuda profesional y la valoración del crecimiento personal. En todos los estudios, los participantes mostraron expectativas de roles más fuertes para sí mismos que para sus parejas, aunque hubo diferencias en los efectos de género por muestra. Discutimos cómo usar el EPSCT con sus 15 ítems en la práctica clínica e investigaciones futuras como predictor de procesos y resultados de la terapia de pareja.

The mediating role of the therapeutic alliance in understanding early discontinuance.

Objective: The objective of this study was to test whether the therapeutic alliance mediated the relationship between previously identified predictors of premature termination and dropout during the first three sessions of treatment. Method: In this naturalistic study, 994 cases receiving individual, couple and family, or high-conflict coparenting therapy provided demographic information and completed assessments prior to treatment. Following the first session, clients completed a measure of the therapeutic alliance. Two hundred and five (20.6%) discontinued therapy prior to the fourth session. Logistic and ordinary least squares regression was used across m = 20 imputed datasets to examine the effect of pressure to attend therapy, age, gender, education, distress, therapy format, and therapist experience on whether clients continued in therapy and whether the alliance mediated this relationship. Results: After controlling for age, therapist experience, education, and pressure to attend therapy; general distress and participating in high-conflict coparenting were associated with higher rates of early termination. The effect of both distress and therapy format on dropout, however, was mediated by the therapeutic alliance. Conclusions: By focusing on improving the therapeutic alliance with high-conflict coparenting cases as well as clients with higher levels of distress, therapists may be able to increase client retention.

Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy.

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist-control, short-term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate-to-large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work-team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.

Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout.

Family services within Veterans Affairs Medical Centers fulfill an important role in addressing relationship distress among Veterans, which is highly prevalent and comorbid with psychopathology. However, even for evidence-based couple therapies, effectiveness is weaker compared to controlled studies, maybe because many Veteran couples drop out early and do not reach the "active" treatment stage after the 3-4 session assessment. In order to improve outcomes, it is critical to identify couples at high risk for early dropout, and understand whether couples may benefit from the assessment as an intervention. The current study examined (a) demographics, treatment delivery mode, relationship satisfaction, and psychological symptoms as predictors of dropout during and immediately following the assessment phase, and (b) changes in relationship satisfaction during assessment. 174 couples completed questionnaires during routine intake procedures. The main analyses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out during the assessment phase and 24.74% of the remaining couples immediately following the first treatment session. More severe depressive symptoms in non-Veteran partners were associated with dropout during assessment. Relationship satisfaction improved significantly during the assessment phase for couples who did not drop out, with larger gains for non-Veteran partners. No demographics or treatment delivery mode were associated with dropout. Although more research is needed on engaging couples at risk for early dropout and maximizing early benefits, the findings suggest that clinicians should attend to the civilian partner's and Veteran's depressive symptoms at intake and consider the assessment part of active treatment.

A multivariate dynamic systems model for psychotherapy with more than one client.

The dynamics of the give and take between therapist and client(s) is frequently of interest to therapy process researchers. Characterizing the ways that therapists respond to clients and clients respond to therapists can be challenging in therapeutic encounters involving a single therapist and a single client. The complexity of this challenge increases as the number of people involved in a therapeutic encounter increases not only because there are more people responding to one another but also because the patterns of responding can become more complex. This manuscript demonstrates how dyadic cross-lagged panel models can be extended to psychotherapeutic encounters involving 3 people and used to test processes that exist between dyadic subsets of the larger group as well as the group as one cohesive unit. Three hundred seventy-nine talk turns of fundamental frequency from a couple therapy session were modeled using 3 dyadic cross-lagged panel models, and each individual's respiratory sinus arrhythmia (RSA) was treated as a moderator. Although the regression coefficients for each dyadic subset (e.g., therapist-husband) were nonsignificant, an eigenvalue/eigenvector decomposition of the regression coefficients from the 3 dyadic cross-lagged panel models suggests that interdependence exists at the level of the whole group (i.e., therapist-husband-wife) rather than between pairs of individuals within the group (e.g., husband-wife). Further, an interaction involving husband's RSA suggested that interdependence involving the husband ceased when the husband displayed greater regulatory effort. This combination of statistical methods allows for clearly distinguishing between dyadic therapeutic processes and group-level therapeutic processes. (PsycINFO Database Record

Helping Couples Fulfill the "Highest of Life's Goals": Mate Selection, Marriage Counselling, and Genetic Counseling in United States.

This article traces the history of modern genetic counseling to mate selection and marriage counselling practices of the early-20th century. Mate selection revolved around a belief that human heredity could be improved and genetic diseases eradicated through better breeding. Marriage counselling, though interested in reproduction, was also concerned with the emotional and psychological well-being of couples. These two practices coalesced most obviously in the work of well-known geneticist Sheldon Reed. Even as marriage and genetic counselling diverged in the post-WWII period, vestiges of these practices remain in contemporary counseling experiences with family planning and genetic screening programs. Emphasizing points of continuity between "positive" eugenic ideologies and modern genetic practices elaborates the diverse origins of genetic counseling. It also exposes how genetic counselors have become involved in genetic enterprises beyond standard clinical settings, and prods at key issues in the interaction between genetic science and social values.

Alliance and termination status in couple therapy: a comparison of methods for assessing discrepancies.

Much of the empirical data available about therapeutic alliance and its relationship to termination status come from individual psychotherapies. We know less about therapeutic alliance in couple therapy. A unique characteristic of alliance in couple or family therapy is the possibility of discrepancies in alliance between system members. In this study we sought to demonstrate three statistical techniques: standard deviations, the intraclass correlation to assess discrepancies in alliance over time during the initial stage of couple therapy, and the use of these various measures to predict termination status using a sample of 72 couples from a university-based training clinic. Differences in partners' alliances operationalized either as categorical or continuous variables but when analyzed separately at each time point were not predictive of termination status. When multilevel modeling was used, a difference in the way the discrepancies changed over a period of time was related to termination status.

Behavioral couples therapy for substance abusers: where do we go from here?

Behavioral couples therapy (BCT) is an evidence-based family treatment for substance abuse. The results of numerous investigations over the past 30 years indicate that participation in this treatment by married or cohabiting substance-abusing patients, compared with more traditional individual-based interventions, results in greater reductions in substance use, higher levels of relationship satisfaction, greater reductions in partner violence, and more favorable cost outcomes. This review examines the rationale for using BCT, the empirical literature supporting its use, methods used as part of this intervention, and future research directions.

Gay, Lesbian, and Heterosexual Couples About to Begin Couples Therapy: An Online Relationship Assessment of 40,681 Couples.

We currently have little idea of precisely who goes for couples therapy. This is a report of the results of a validated online assessment of relationship and individual functioning based on 39,251 heterosexual, 1,022 lesbian, and 438 gay couples about to begin couples therapy. Using validated and reliable questionnaires of relationship and individual functioning, this report presents and compares, for each sexual-orientation, the percentage of couples, pre-therapy, who are coping with a variety of relationship problems. To test for the replicability of results, the sample was divided randomly into two subsamples and statistical tests were performed on each sample. Couples initiating therapy suffer from greater distress and many more co-morbidities than has been presumed in previous literature, and same-sex couples present a particular set of both strengths and challenges compared to heterosexual couples. Gay-male and lesbian couples were very different on trust and monogamy, as were heterosexual and lesbian couples. Based on this epidemiologically sized sample, the challenge to our field may be to create interventions with much larger effect sizes than we currently have.

Differential use of premarital education in first and second marriages.

Although second marriages are more likely to end in divorce than first marriages, and thus represent an important target for intervention, there have been no detailed examinations of the use of premarital education in second marriages. Using random-digit dialing methods, 398 individuals currently in a second marriage and 1,342 individuals currently in a first marriage participated. Compared with those in first marriages, individuals in second marriages were significantly less likely to receive premarital education for their current marriage. This difference was fully mediated by differences between individuals in first and second marriages in pre-engagement cohabitation, education level, having children from a previous relationship, and being married by a religious leader. In both first and second marriages, those couples at most risk for subsequent marital distress and divorce were less likely to receive premarital education. Results suggest that more needs to be done to understand the barriers to the use of premarital education for second marriages.

Why do couples seek relationship help online? Description and comparison to in-person interventions.

Couples are increasingly utilizing newly developed online adaptations of couple therapy; however, different presenting problems could drive couples to seek either online or in-person services. This study compared the presenting problems of 151 couples seeking an online couple intervention for relationship distress (OurRelationship) with responses from 147 couples seeking in-person couple therapy. Presenting problems were generally consistent across gender and whether or not the respondent was the initial help-seeker. Online and in-person samples frequently endorsed difficulties with communication and emotional intimacy; however, they differentially endorsed trust, time together, and child/parenting difficulties. Therefore, while basing online interventions on existing couple therapies is generally supported, efforts should be made to tailor online services to meet the unique needs of this population.

Safety in numbers? Tackling domestic abuse in couples and network therapies.

Family, network or couples-based therapies have been helping to support people with substance problems for decades. Their value in supporting a person to change their alcohol or drug use is clear. However, as links between substance use and domestic abuse are increasingly recognised, these approaches need to reflect on the potential safety risks they present to people taking part. The prevalence of domestic abuse among people receiving drug and alcohol services is considerably higher than general population estimates, yet this does not appear to have been adequately addressed in network therapies. This article suggests that this needs to change and that safety of service users needs to be at least as important as the intervention itself. It offers for debate a number of potential safety issues raised by network therapies where there is evidence of domestic abuse; it provides examples of three approaches used to marshal social and network support in substance interventions; and offers a number of suggestions for how network therapies can ensure their use remains safe and supportive where there is domestic abuse.

Spatial Statistics for Dyadic Data: Analyzing the Relationship Landscape.

Spatial statistics has a rich tradition in earth, economic, and epidemiological sciences and has potential to affect the study of couples as well. When applied to couple data, spatial statistics can model within- and between-couple differences with results that are readily accessible for researchers and clinicians. This article offers a primer in using spatial statistics as a methodological tool for analyzing dyadic data. The article will introduce spatial approaches, review data structure required for spatial analysis, available software, and examples of data output.

A Systematic Review of Gay, Lesbian, and Bisexual Research Samples in Couple and Family Therapy Journals.

The purpose of this study is to review samples from research on gay, lesbian, and bisexual (GLB) issues and to evaluate the suitability of this body of research to support affirmative and evidence-based practice with GLB clients. The authors systematically reviewed the sampling methodology and sample composition of GLB-related research. All original, quantitative articles focusing on GLB issues published in couple and family therapy (CFT)-related journals since 1975 were coded (n = 153). Results suggest that within the GLB literature base there is some evidence of heterocentrism as well as neglect of issues of class, race, and gender. Suggestions to improve the diversity and representativeness of samples-and, thus, clinical implications-of GLB-related research in CFT literature are provided.

The State of Lesbian, Gay, and Bisexual Affirmative Training: A Survey of Faculty from Accredited Couple and Family Therapy Programs.

This study explored the state of lesbian, gay, and bisexual (LGB) affirmative training in the couple and family therapy field. LGB affirmative refers to holding positive views of LGB identities and relationships. A total of 117 faculty members completed the online survey for this study. Participants were asked to respond to items on the following topics: LGB affirmative stances, LGB affirmative program environment, LGB affirmative course content, self-of-the-therapist work, and professional opportunities to work with LGB topics and clients. The findings of this study were encouraging as participants reported holding positive beliefs about LGB individuals, that their training programs had fairly affirmative program environments, and that LGB affirmative course content was included in their program curriculum.

Does premarital education decrease or increase couples' later help-seeking?

Interventions intended to prevent relationship distress are expected to enhance relationship satisfaction and, in turn, reduce the need for later couples counseling. We test this prediction against an alternative possibility: participation in preventive interventions may operate as a gateway for later help-seeking, paradoxically increasing receipt of later couples counseling. A cross-sectional study of 2,126 married individuals examined whether participation in premarital education covaried inversely or directly with couples counseling. Consistent with the gateway hypothesis, receiving premarital education covaried with an increased likelihood of receiving couples counseling. The association between receipt of premarital education and pursuit of couples counseling was moderated by demographic indicators, with the association being stronger for African Americans and for individuals with lower incomes and less formal education. Encouraging the use of premarital interventions may increase the use of therapeutic interventions later in the relationship, especially among high-risk populations.