What Does “Couple” Mean in Couple Therapy Outcome Research? A Systematic Review of the Implicit and Explicit, Inclusion and Exclusion of Gender and Sexual Minority Individuals and Identities

Abstract

This study systematically reviewed extant couple therapy outcome studies (k = 111) through December 2018 to evaluate for implicit or explicit, inclusion or exclusion of gender and/or sexual minority individuals and identities. We evaluated sampling, participant demographic reporting, and language used in each manuscript for any reference or consideration given to participants' sexual and/or gender identity. Results indicate that couples have been historically presumed to be heterosexual and cisgender male or female without reported assessment. More recent inclusion and consideration of sexual minority individuals is limited and absent for nonmonosexual and gender minority individuals. These findings are contextualized in supplementary analyses of other sociocultural characteristics (e.g., race, age, length together). Suggestions are provided for affirmative consideration of the plurality of individuals' sexual and gender identities. Implications are discussed for research, training and practice of couple therapy with sexual and/or gender minority couples.

Representation of Diverse Populations in Couple and Family Therapy Intervention Studies: A Systematic Review of Race/Ethnicity, Sexual Orientation, Age, and Income in the United States from 2014 to 2019

“…Hartwell et al's (2012) content analysis of lesbian, gay, and bisexual participants in CFT research from 1996 to 2010 found only 2% of studies included these populations (Hartwell et al, 2012). More recently, Spengler et al (2020) conducted a systematic review of couple therapy studies published before 2019 and found the majority of studies assumed that participants were heterosexual and cisgender male and female, even though they did not report assessing sexual and gender identities.…”

Cognitive‐behavioral couple therapy for same‐sex female couples: A pilot study

“…Although efficacious couple therapies exist to treat relationship distress, they have been overwhelmingly studied with different-sex couples (Kelly et al, 2014;Scott et al, 2019). To-date, sexual minority-affirming couple therapies have not yet been systematically developed or evaluated (Spengler et al, 2020). Accordingly, the current study is the first to develop and pilot test a couple therapy that is culturally tailored for same-sex female couples.…”

“…The argument made by culturally tailoring care is that there is important population-specific awareness, knowledge, and skills providers should gather to deliver competent care. Though clinical chapters have begun articulating specific topics that may arise in relationships with one or more trans individual (e.g., implications of transitioning on non-transitioning partner's orientation and identity; Malpas, 2012), further basic research is needed on trans individuals' desires and needs in relationship services to inform more systematic movements in treatment tailoring and therapist training (American Psychological Association, 2003;Spengler et al, 2020). Finally, as a dissertation and pilot study, this project has methodological constraints (e.g., inclusion/exclusion criteria to ensure sample homogeneity, small sample size for feasibility, scope of practice considerations for training therapists in a limited timeframe to provide culturally competent care).…”

“…Despite their aforementioned health disparities and health care needs, same-sex couples are vastly underrepresented in couple treatment outcome research (Clark & Serovich, 1997;Hartwell, Serovich, Grafsky, & Kerr, 2012;Spengler, DeVore, Spengler, & Lee, 2020). However, over the past decade, an emerging body of research has begun to examine the exclusion of SM couples from treatment outcome research and begin efforts to tailor couple care.…”

“…The clinical utility of the treatment outcome research including SM couples is dampened by methodological limitations. For example, 100% of the 111 couple treatment studies reviewed assumed participant sexual orientation based upon the gender appearance of their partner (Spengler et al, 2020). Without accurate demographics, accurate conclusions regarding SM couples cannot be drawn.…”