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

Abstract

This study examined how individual pretreatment symptoms (depression and anxiety) predicted longitudinal, relational processes in couples therapy (the therapeutic alliance and couple satisfaction). This study included 99 heterosexual couples receiving systemic couples therapy. Partners reported their individual pretreatment symptoms of depression and anxiety before intake. Each member reported their therapeutic alliance with the therapist at the end of sessions 2–8, as well as their couple satisfaction before intake and at the end of sessions 4 and 8. A Latent Profile Analysis revealed four profiles characterizing couples on their pretreatment psychological symptoms, namely both higher (where both members of the couple had higher depressive and anxiety symptoms), female higher, male higher, and both lower profiles. Furthermore, longitudinal, dyadic multilevel models revealed that men in male higher, female higher, and both higher profiles had higher initial alliance levels, compared to men in the both lower profile. In contrast, only female partners in the both higher profile had a higher initial therapeutic alliance than those in the both lower profile. Men in the both higher profile had faster reductions in their alliance, whereas other profiles did not predict changes in male or female alliance. Additionally, the male higher and both higher profiles predicted a lower initial level of couple satisfaction in males but not females. The profiles did not predict changes in couple satisfaction, which may be a result of lowered power due to missing data. Findings were discussed in the context of systemic family theory, with clinical implications for distressed couples.

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

“…Furthermore, the focus of the study was on average weekly effects and it is possible that the bidirectional associations between alliance and depressive symptoms occur over longer periods of time during the treatment phase. For example, couples where both partners report higher depressive and anxious symptoms experience lower changes in alliance across the first eight sessions of treatment compared to couples where both partners report lower depressive and anxious symptoms (Wu et al, 2022). Another possible explanation is that both alliance and relationship satisfaction are inherently about interpersonal relationship dynamics, whether it be with a partner or therapist, whereas depressive symptoms are typically experienced as individual cognitive factors though they are also affected by other mechanisms (Wittenborn et al, 2016).…”

“…Specifically, two recent studies found mixed associations between therapeutic alliance, depressive symptoms, and relationship satisfaction among partners in couple therapy (Wu et al, 2021(Wu et al, , 2022. 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).…”

“…Findings show that a stronger therapeutic alliance between clients and therapists in couple therapy is associated with improved outcomes such as depressive symptoms and relationship satisfaction (e.g., Anderson & Johnson, 2010; Kuhlman et al, 2013; Wu et al, 2022). While research has predominantly focused on the unidirectional relationship among therapeutic alliance and outcomes, theories on therapeutic alliance often presume the relationship among alliance and clinical outcomes is reciprocal or bidirectional in nature (Escudero et al, 2008).…”

“…For example, one study of couple therapy found a significant association between therapeutic alliance and depressive symptoms, such that alliance explained nearly 20% of the variance in change in depressive symptoms (Kuhlman et al, 2013). Conversely, there is broad support that higher relationship adjustment predicts higher alliance (e.g., Anderson et al, 2020), while higher depression predicts lower alliance and split alliance (Parady et al, 2018; Wu et al, 2022).…”

“…Among couples with split alliances with their therapist, males report lower marital adjustment while female partners report lower psychiatric symptoms (Mamodhoussen et al, 2005). Specifically, two recent studies found mixed associations between therapeutic alliance, depressive symptoms, and relationship satisfaction among partners in couple therapy (Wu et al, 2021, 2022). 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).…”