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

Abstract

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 Gap Between Couple Therapy Research Efficacy and Practice Effectiveness

“…The various organizational contexts within which couple therapy is provided might influence couple therapy service delivery and outcome. For example, in not‐for‐profit community organizations, therapists often have high administrative workloads (Petch, Lee, Huntingdon, & Murray, ; Riemer & Bickman, ) which include Government, insurance company, or organizationally mandated record keeping. Perhaps partly due to these competing demands on therapists’ time, and partly due to high demand for services, long waiting lists are common in community clinics, as are heavy caseloads (Petch et al., ).…”

“…For example, in not‐for‐profit community organizations, therapists often have high administrative workloads (Petch, Lee, Huntingdon, & Murray, ; Riemer & Bickman, ) which include Government, insurance company, or organizationally mandated record keeping. Perhaps partly due to these competing demands on therapists’ time, and partly due to high demand for services, long waiting lists are common in community clinics, as are heavy caseloads (Petch et al., ). This can mean clients are required to wait for several weeks for a first appointment and/or are unable to access weekly therapy sessions.…”

Expectations and Experiences of Couples Receiving Therapy Through Videoconferencing: A Qualitative Study

“…Rising rates of relationship distress and breakdown within Australia have led to increased demand for couple's therapy; however, due to a scarcity of available services this demand is not consistently being addressed (Petch et al, 2014;Halford et al, 2015;Doss et al, 2017). While psychological therapies have historically been conducted face-to-face, the rising demand for accessible mental health services, coupled with the advanced development of modern technology has rendered online therapies an increasingly viable method of service provision (Castelnuovo et al, 2003;Simmons, 2006;Lungu and Sun, 2016).…”

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes

“…They found a medium effect size for improvement in relationship distress from pretherapy to post‐therapy of d = 0.58. In a comparable study conducted in a nonprofit organization offering couple therapy in Australia, Petch, Lee, Huntingdon, and Murray () found a comparable effect size of d = 0.67. It has to be noted, though, that this study made use of retrospective data and the effect size may be overestimated.…”