Couple Satisfaction, Depressive Symptoms, and the Therapeutic Alliance: A Systemic Perspective

Abstract

There is a well-established bidirectional, negative association between couple satisfaction and depressive symptoms. Yet, a family systems perspective emphasizes the role of the therapist in interrupting this recursive cycle between couple satisfaction and depressive symptoms. The current study utilized longitudinal data to explore the bidirectional associations between depressive symptoms and couple satisfaction, moderated by the therapeutic alliance over the course of therapy. The study included 108 couples participating in couple therapy at a university training clinic. Couples rated their depressive symptoms and couple satisfaction separately before the intake session and at the end of the fourth session, and they also reported their individual therapeutic alliance with the therapist at the end of the second and third sessions. Actor-partner interdependence moderation model analysis revealed several moderation effects. In general, with low therapeutic alliance, couples with higher initial symptoms (such as depressive symptoms and low couple satisfaction) reported more severe symptoms at the fourth session, compared to those who had fewer initial symptoms. The moderating effect of alliance on a couple's symptoms was found both among individuals, and between partners. Systemic clinical implications and suggestions for future research are discussed.

Individual’s pretreatment psychological symptoms and progress in couples therapy: A person‐centered analysis

“…This limited our knowledge on which systemic models improved relational outcomes in the current study and thus the replicability and generalizability of the current findings, and more research is warranted to test effects of specific systemic therapy models. Additionally, since this study only investigated one direction of the bidirectional feedback loop between mental health and relational quality (Wu et al, 2021), future studies are encouraged to examine the influences of relationship satisfaction on partners' symptoms or the bilateral process. Finally, as most couples in our sample had mild symptoms with only about 20% of the couples showing severe symptom levels, findings may not generalize to populations where most couples have severe symptomologies.…”

“…A systemic perspective assumes nonlinear causality in that the recursive feedback maintains a particular outcome, thus creating barriers to treatment and recovery. The complexity of the feedback loop between relationship discord and individual symptoms highlights the need to examine both partners in systemic investigations (Wu et al, 2021).…”

“…Such partner effects may vary based on presenting symptoms, and depression is a more significant predictor than anxiety in eliciting concurrent partner effects of couple satisfaction (Whisman et al, 2004). Notably, while individual symptoms can impact the relational experience, relational distress can feed into individual symptoms, likely forming a feedback loop (Wittenborn et al, 2019; Wu et al, 2021). A systemic perspective assumes nonlinear causality in that the recursive feedback maintains a particular outcome, thus creating barriers to treatment and recovery.…”

Prospective effects of internalized stigma on same-sex relationship satisfaction: The mediating role of depressive symptoms and couple conflict.

“…However, relationship distress is also a well-established predictor of depression (Whisman & Baucom, 2012). Research with different-sex couples suggests a bidirectional relationship between relationship functioning and depressive symptoms (e.g., Beach & Whisman, 2012; Wu et al, 2021), and negative cycles of interaction are well-established predictors of couple relationship distress (Halford & Pepping, 2019). Although our primary aim was to examine the mechanisms underlying the internalized stigma-relationship satisfaction association, future research should examine these bidirectional associations in same-sex couples, including moderating factors that might disrupt these cyclical patterns, such as the therapeutic alliance in couple therapy (Wu et al, 2021).…”

Session‐to‐session bidirectional associations of alliance with depressive symptoms and relationship satisfaction

“…Particularly, couples with higher depressive symptoms and anxiety among both partners had higher initial alliance in males and females, and declining rates of change across the first eight sessions of couple therapy for males but not females (Wu et al, 2022). Additionally, only higher alliance in females was associated with their own higher relationship satisfaction at session 4, but not depressive symptoms (Wu et al, 2021). In the same study, male's higher alliance was not associated with their own therapeutic alliance or depressive symptoms (Wu et al, 2021).…”