The effectiveness of couple therapy: Clinical outcomes in a naturalistic United Kingdom setting.

Abstract

Couple therapy outcomes tend to be judged by randomized controlled trial evidence, which comes primarily from the United States. United Kingdom and European outcome studies have tended to be naturalistic and there is a debate as to whether "laboratory" (RCT) studies are useful benchmarks for the outcomes of "clinic" (naturalistic) studies, not least because the therapies tested in the RCTs are hardly used in these settings. The current paper surveys the naturalistic studies in the literature and presents results from a U.K. setting of 877 individually and relationally distressed participants who completed at least 2 sessions of psychodynamic couple therapy and completed self-report measures assessing psychological well-being (CORE-OM) and relationship quality (Golombok Rust Inventory of Marital State, GRIMS). A clinical vignette is given that demonstrates the psychodynamic approach used. Analysis of the measure data conducted using hierarchical linear modeling showed an overall significant decrease in individual psychological distress for both male and female clients at the end of therapy, with a large effect size of d = -1.04. There was also a significant improvement in relationship satisfaction for both male and female clients, with a medium effect size of d = -0.58. These findings suggest that psychodynamic couple therapy is an effective treatment for couples experiencing individual and relational distress, with effect sizes similar in strength to those reported in RCTs. It argues that naturalistic effectiveness studies should be given a stronger role in assessments of which therapies work. (PsycINFO Database Record

What Every Therapist Needs to Know About Couple Therapy

“…However, it sparked some controversy about just how effective couple therapy was in practice. Subsequently, seven published effectiveness trials have evaluated change longitudinally across the course of couple therapy in routine clinical practice (Baucom et al, 2017; Doss et al, 2012; Hahlweg & Klann, 1997; Hewison, Casey, & Mwamba, 2016; Klann, Hahlweg, Baucom, & Kroeger, 2011; Lundblad & Hannson, 2006). In these effectiveness trials, effect sizes of treatments varied from small (Klann et al, 2011) to large (Hewison et al, 2016).…”

“…Subsequently, seven published effectiveness trials have evaluated change longitudinally across the course of couple therapy in routine clinical practice (Baucom et al, 2017; Doss et al, 2012; Hahlweg & Klann, 1997; Hewison, Casey, & Mwamba, 2016; Klann, Hahlweg, Baucom, & Kroeger, 2011; Lundblad & Hannson, 2006). In these effectiveness trials, effect sizes of treatments varied from small (Klann et al, 2011) to large (Hewison et al, 2016). Overall, the typical effect sizes of the earlier studies were much smaller than the mean effect size reported in the meta-analyses of efficacy trials (Halford, Pepping, & Petch, 2016), although more recent studies showed larger effect sizes (e.g., Baucom et al, 2017; Hewison et al, 2016).…”

“…In these effectiveness trials, effect sizes of treatments varied from small (Klann et al, 2011) to large (Hewison et al, 2016). Overall, the typical effect sizes of the earlier studies were much smaller than the mean effect size reported in the meta-analyses of efficacy trials (Halford, Pepping, & Petch, 2016), although more recent studies showed larger effect sizes (e.g., Baucom et al, 2017; Hewison et al, 2016). However, the effectiveness trials all had substantial attrition, with more than 50% of couples failing to complete the study in each trial (Doss et al, 2012; Hahlweg & Klann, 1997; Klann et al, 2011).…”

“…There is widespread use of non-evidence-based approaches to couple therapy in community practice, and the largest effect sizes have been reported in effectiveness studies with a particular evidence-based couple therapy approach being required in that setting (e.g., Baucom et al, 2017; Hewison et al, 2016). In addition, there is a lack of quality control procedures in routine delivery of couple therapy in many clinical settings relative to research settings.…”

Family Relationships and Family Justice in Europe: Changes and Challenges

“…Studies have found relationship counseling improves relationship satisfaction (Lundblad & Hansson, 2006), and couple therapy results in significant change in relationship satisfaction (Doss, 2012). Clinical practice studies show couple therapy reduces relationship distress and improves mental health (Klann, Hahlweg, Baucom, & Kroeger, 2011), and the recent largest naturalistic study of couple therapy in the UK found significant improvements in both general psychological health and relationship satisfaction (Hewison, Casey, & Mwamba, 2016). A study commissioned by the UK government found that the adult relationship counseling service offered by Relate, the largest relationship counseling agency in England and Wales, resulted in statistically significant positive changes in individuals' relationship quality, wellbeing, and communication, according to validated scientific measures of these (Spielhofer et al, 2014).…”