Couple Counselling Outcomes in an Australian Not for Profit: Evidence for the Effectiveness of Couple Counselling Conducted Within Routine Practice

Over 30 randomised controlled trials have shown the efficacy of couple therapy under controlled conditions. However only four studies explore effectiveness of couple therapy as commonly practised in the community (i.e., routine practice). These studies suggest effectiveness is about half that reported in randomised controlled trials. Further, there are no published couple therapy effectiveness data currently from Australia or New Zealand. This is troubling because (1) couple distress has negative effects on individual adults, couples, and families; (2) funders increasingly want proof of return on financial investment; and (3) clients want hope that their emotional investment in therapy is worthwhile. The first aim of this paper is to report the outcomes of a milestone multi‐centre study of over 1,500 Relationships Australia clients attending couple counselling. It outlines a simple, intuitive method for assessing effectiveness of couple counselling in routine practice that may motivate others to conduct effectiveness studies. The study used a cross‐sectional design and assessed current couple satisfaction and retrospective recall of couple satisfaction before attending counselling. Results revealed a moderate effect size improvement in relationship satisfaction. The results support previous published studies of couple therapy effectiveness in routine practice. The second aim of the paper is to increase interest in others doing similar research by addressing key barriers to the implementation of effectiveness studies within routine practice. These barriers include administrative burden, integration across services, and conceptual buy‐in by practitioners. The use of the retrospective measure of ‘pre counselling’ couple satisfaction measure overcomes these barriers in part. The paper concludes with a discussion of design limitations and suggestions for counselling agencies seeking to conduct their own effectiveness studies.     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness

Meta‐analyses of randomized controlled trials of couple therapy find large improvements in couple adjustment, but published evaluations of the effectiveness of couple therapy in routine practice find only small‐to‐moderate effects. The current study analyzes possible explanations for the research‐efficacy to practice‐effectiveness gap and offers suggestions for enhancing couple therapy effectiveness. Major recommendations are that therapists should clarify whether couples’ therapy goal is to clarify commitment to the relationship or to improve the relationship; use standardized assessment of the individual partners and the relationship; and use systematic monitoring of therapy progress and the therapeutic alliance. It is also possible that the greater use of evidence‐based therapies when treating couple relationship distress could enhance couple therapy outcome.     

Two‐Year Follow‐up Outcomes in Emotionally Focused Couple Therapy: An Investigation of Relationship Satisfaction and Attachment Trajectories

Emotionally Focused Couple Therapy (EFT; The practice of emotionally focused couple therapy: Creating connection. New York, NY: Brunner‐Routledge) is an evidence‐based couple therapy that aims to create lasting change for couples (Clinical Psychology: Science and Practice, 6(1), 67–79). Although studies have demonstrated strong results in follow‐up (Journal of Marital and Family Therapy, 28(4), 391–398), less is known about relationship functioning across time after therapy has ended. We modelled change in relationship satisfaction and attachment from pre‐therapy through 24 months follow‐up in 32 couples. HLM results confirmed a significant growth pattern demonstrating increases in relationship satisfaction and secure base behaviour and decreases in relationship specific attachment anxiety over the course of therapy and across follow‐up at a decelerated rate. These findings support the theoretical assumption that EFT helps couples engaged in therapy create lasting relationship satisfaction and attachment change.     

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 Growth of Internet Research Methods and the Reluctant Sociologist*

Between 1999 and 2004 only one article appeared in the American Sociological Review, the American Journal of Sociology, or Social Forces using primary data collected with Web‐based research techniques. Since then there have been only a handful of studies published in these core sociology journals drawing on Web‐based surveys or other forms of Web‐based data. The use of Internet‐based data has become widespread in many academic fields, especially health research and education; Web‐based techniques are becoming routine in the practice and study of politics; and online commercial and market research has become a billion dollar industry. At the same time, the utility of random digit dialing surveys has eroded considerably owing to declining contact rates, increased use of technologies to screen unwanted telephone calls, and the replacement of landline telephones with cell phones. There is increasing evidence that Internet research can produce representative data. Although Web‐based surveys may overrepresent some populations, Internet usage in the general population is now well over 75 per cent and is especially strong among some hard to reach populations. Internet surveys have the potential to reduce measurement error, missing data, and respondent attrition. Sociologists must overcome their fear of participation in stigmatized Internet research and actively engage in the development of techniques and refinements that will increase the utility and validity of Internet‐based data collection.     

Getting Comfortable as “Fish Out of Water”: Using Qualitative Research Methods Training to Enhance the Technical Capacity of Family Therapy Trainees

This article describes a qualitative research methods training project undertaken in a COAMFTE‐accredited family therapy master’s‐level program. Graduate students were trained to collect research data for a qualitative study on the resilience of families displaced to the United States because of war and politically motivated violence in their country of origin. By involving trainees in a research project with refugees, the project was intended to address a gap in clinicians’ training, specific to the refugee population (Miller, Muzurovic, Worthington, Tipping, and Goldman, American Journal of Orthopsychiatry 2002; 72 : 341). However, the training process was also a way to increase the students’ skills at interviewing in complex situations, develop their cultural sensitivity beyond awareness, enhance their capacity for routine self‐reflection, and introduce them to basic practices of qualitative research methodology. In this article, we focus on the students’ experience of the training and discuss the potential implications of their feedback for family therapy training.     

Therapist effects on dropout in couple therapy

Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university‐based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.     

Changes in Relationship‐Specific Attachment in Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT; Johnson, The practice of emotionally focused couple therapy (1st/2nd edition). Brunner‐Routledge, New York, 2004) is an effective treatment of relationship distress (Johnson et al., Clinical Psychology: Science and Practice, 1999; 6, 67). However, less is known about EFT's impact on couples' relationship‐specific attachment bond. Using hierarchical linear modeling with a sample of 32 couples, we examined session‐by‐session changes in couples' relationship‐specific attachment anxiety and avoidance and pre‐ to posttherapy changes in their relationship‐specific attachment behaviors. Couples significantly decreased in relationship‐specific attachment avoidance, and those who completed a blamer softening significantly decreased in relationship‐specific attachment anxiety. Couples' attachment behavior significantly increased toward security. Finally, session‐by‐session decreases in relationship‐specific attachment anxiety and avoidance were significant associated with increases in relationship satisfaction across sessions. These results provide empirical support for the attachment‐based assumptions of EFT. Video abstract accessible by clicking here     

‘Change is Only Part of the Answer’: An Interview with Kim Halford

Kim Halford has conducted major research on the determinants of relationship satisfaction and stability, and how to promote healthy couple relationships both through relationship education for currently well‐functioning couples, and through couple therapy for distressed couples. Kim is Professor of Clinical Psychology at Griffith University, and Director, Queensland Cancer Fund, Griffith University Cancer Support Centre. He is the author of Brief Couple Therapy: Helping Partners Help Themselves; Australian Couples in Millennium Three: A Research and Development Agenda for Marriage and Relationship Education, co‐author of Clinical Handbook of Marriage and Couples Interventions; Report to the Australian Psychological Society on the Status and Future Directions of Health Psychology in Australia; Couple CARE: The Couple Commitment and Relationship Enhancement Program, Couple Guidebook (in press). He is also author or co‐author of over 90 book chapters, journal articles and audiovisual productions.     

Age‐at‐Arrival’s Effects on Asian Immigrants’ Socioeconomic Outcomes in Canada and the U.S.1

Age‐at‐arrival is a key predictor of many immigrant outcomes, but discussion continues over how to best measure and study its effects. This research replicates and extends a pioneering study by Myers, Gao, and Emeka [International Migration Review (2009) 43:205–229] on age‐at‐arrival effects among Mexican immigrants in the U.S. to see if similar results hold for other immigrant groups and in other countries. We examine data from the 2000 U.S. census and 2006 American Community Survey, and 1991, 2001, and 2006 Canadian censuses to assess several measures of age‐at‐arrival effects on Asian immigrants’ socioeconomic outcomes. We confirm several of Myers et al.’s key findings, including the absence of clear breakpoints in age‐at‐arrival effects for all outcomes and the superiority of continuous measures of age‐at‐arrival. Additional analysis reveals different age‐at‐arrival effects by gender and Asian ethnicity. We suggest guidelines, supplementing those offered by Myers et al., for measuring and studying age‐at‐arrival’s effects on immigrant outcomes.     

Marital Well‐being and Religiousness as Mediated by Relational Virtue and Equality

This study investigated religiousness and couple well‐being as mediated by relational virtue and equality. Relational spiritual framework theory posits that religiousness is associated with couple well‐being through relational virtues (e.g., forgiveness, commitment, and sacrifice). Theories of relational inequality postulate that religion decreases couple well‐being and indirectly lessens couple well‐being. Data from a 3‐year longitudinal community sample of 354 married couples were used. The authors found that religiousness's relationship to couple well‐being was fully mediated by relational virtue but was not connected to relational inequality. They also found that relational inequality was associated with women's conflict, men's conflict, and marital instability. They did not find that higher religiousness benefits marital outcomes directly. Although these findings do not support the idea that religious activities are directly associated with stronger relationships, the data did show that religiousness can contribute to expressed relational virtue, and relational virtue in turn is associated with marital well‐being.     

Individual Therapy for Couple Problems: Perspectives and Pitfalls

Despite the demonstrated efficacy of conjoint couple therapy, many clients seeking help for couple problems ultimately find themselves in individual therapy for these concerns. Individual therapy for couple problems (ITCP) may evolve from a partner's refusal of conjoint therapy or from the treatment format preferences of either the client or therapist. Having acknowledged the role of partner refusals, we offer some perspectives about the idiosyncratic personal factors and professional background factors that may lead therapists to provide ITCP and discuss the significant pitfalls in its practice. We emphasize five central areas of concern in the ongoing practice of ITCP: structural constraints on change; therapist side‐taking and the therapeutic alliance; inaccurate assessments based on individual client reports; therapeutic focus; and ethical issues relevant to both attending and nonattending partners. We conclude by urging that this very important but largely neglected topic be paid greater attention in psychotherapy research, training and continuing education.     

The Association Between Partner Enhancement and Self‐Enhancement and Relationship Quality Outcomes

The purpose of this research was to understand in greater detail, using 2 samples (Study 1 N = 4,881 heterosexual couples; Study 2 N = 335 heterosexual couples who completed the Relationship Evaluation Questionnaire), how partner or self‐enhancement patterns differentially influence relationship outcomes. A multivariate analysis of covariance was conducted comparing 4 outcome measures for different couple types in which individuals rated the partner higher, the same, or lower than they rated themselves on affability. Couples in which both individuals perceived themselves as more affable than the partner experienced poorer results on the relationship outcome measures, whereas couples in which both individuals perceived the partner's personality as more affable than their own experienced more positive relationship outcomes. Additional analyses with structural equation models demonstrated the consistent influence of enhancement measures on relationship outcomes for cross‐sectional and longitudinal samples.     

Interracial‐Interethnic Unions and Fertility in the United States

How does the fertility of interracial and interethnic couples compare to the fertility of endogamous couples? If exogamous couples have transcended the boundary between them, then exogamy should not affect fertility. Alternatively, opposition to the relationship from the couple’s family and friends may reduce fertility. This study uses 2000 – 2005 American Community Survey data on married (n = 272,336) and cohabiting (n = 48,769) couples to compare the fertility of endogamous and exogamous couples. Interracial and interethnic partnering do not affect fertility for cohabiting, Black‐White, Mexican‐White, and Puerto Rican‐White intermarried couples, but it does reduce fertility in Chinese‐White and Asian Indian‐White intermarriages. These results are largely consistent with the argument that intermarried couples have transcended group boundaries.     

The Efficacy of Emotionally Focused Couples Therapy and Behavioral Couples Therapy: A Meta‐Analysis

Behavioral couple therapy (BCT) and emotionally focused couples therapy (EFCT) are well‐established treatments to reduce couple distress. This meta‐analysis summarizes the current state of knowledge on the efficacy of these two therapy methods by focusing on randomized controlled trials only. A literature search revealed 33 suitable primary studies (2,730 participants in total), all of them measuring relationship satisfaction. Robust‐variance random‐effects meta‐analysis revealed medium effect sizes at post‐test (overall: g = 0.60; BCT: g = 0.53; EFCT: g = 0.73) and small effect sizes of 6 months after treatment (overall: g = 0.44; BCT: g = 0.35; EFCT: g = 0.66), but these gains were not maintained after 12 months (BCT only: g = 0.06). Between the two therapy methods, no significant effect size differences could be found. Results have to be interpreted with caution due to potential publication bias.     

Clients’ perceptions of marriage and family therapists’ way‐of‐being: a phenomenological analysis

Previous research highlights the influence of therapist factors on treatment outcomes. One therapist factor proposed as fundamental to the process of therapy is the therapist's way‐of‐being, a relational concept that refers to how the therapist regards a client—either as a person or object (Fife et al., [2014] Journal of Marital and Family Therapy, 40, 20–33). Although this case has been made conceptually, there is little empirical research on therapists’ way‐of‐being with clients. The primary purpose of this research is to investigate clients’ perceptions of their therapists’ way‐of‐being. Utilizing a common factors perspective, the study seeks to explore: (a) how clients experience their therapists’ way‐of‐being and (b) the influence therapists’ way‐of‐being has on clients’ engagement. Phenomenological methods were used to gain a nuanced understanding of the phenomenon. Qualitative data were collected through semi‐structured face‐to‐face interviews with clients (N = 10) who received individual therapy from a marriage and family therapist. Results were organized into two main themes: core tenets (attunement, congruency, and aligning with clients) and operational tenets (providing affirmation and validation, balancing flexibility and structure, and accomplishing goals). Findings are used to make a case for adding the concept of way‐of‐being as an overarching construct for several well‐established therapist factors. Clinical and training implications are discussed.     

Relationship Education for Stepcouples Reporting Relationship Instability—Evaluation of the Smart Steps: Embrace the Journey Curriculum

Smart Steps: Embrace the Journey is a research‐based educational curriculum for stepfamily couples (“stepcouples”). The curriculum is designed to build couple strengths while addressing the unique challenges of repartnering with a child or children from a previous relationship. This study evaluated the effectiveness of this curriculum with 151 individuals in relationally less stable stepcouple relationships who either engaged in the Smart Steps curriculum (n = 97) or were part of the comparison group (n = 54). This study represents methodological and conceptual advances in the study of stepfamily programs with the use of a comparison group, a racially and economically diverse sample, and a relationally at‐risk population. Results indicated that those who participated in Smart Steps reported significant increases in individual empowerment, couple quality, family harmony, and parenting efficacy while these measures were unchanged for those who did not receive the program. Implications for future research and for practitioners are provided.     

Promoting Fathers' Engagement With Children: Preventive Interventions for Low‐Income Families

Few programs to enhance fathers' engagement with children have been systematically evaluated, especially for low‐income minority populations. In this study, 289 couples from primarily low‐income Mexican American and European American families were randomly assigned to one of three conditions and followed for 18 months: 16‐week groups for fathers, 16‐week groups for couples, or a 1‐time informational meeting. Compared with families in the low‐dose comparison condition, intervention families showed positive effects on fathers' engagement with their children, couple relationship quality, and children's problem behaviors. Participants in couples' groups showed more consistent, longer term positive effects than those in fathers‐only groups. Intervention effects were similar across family structures, income levels, and ethnicities. Implications of the results for current family policy debates are discussed.