The Clinical Representativeness of Couple Therapy Outcome Research

Abstract

The clinical representativeness of outcome studies is defined as the generalizability of recruitment processes, assessment/diagnostic procedures, treatment protocols, and therapeutic results from research settings to naturalistic treatment settings. The main goal of the present study was to examine the clinical representativeness of couple therapy in outcome studies. The data set was formed by 50 published clinical trials, including 34 couple therapy outcome studies for marital distress (CTMD) and 16 couple therapy outcome studies for comorbid relational and mental disorders (CTMD + C). The present findings showed that, overall, the clinical representativeness of couple therapy outcome studies is only fair (i.e., the mean global score is slightly lower than the midpoint of the rating scale used to assess representativeness). CTMD + C studies fared better than CTMD studies on many dimensions of clinical relevance. Studies in which pretherapy training was less intensive (for CTMD studies only), treatment was less structured, and therapists were more experienced showed larger effect sizes than those in which such was not the case.

Integrative Practice: Presentation of an Inpatient Family Therapy Program

“…However, judged as a longitudinal, naturalistic effectiveness study, it may meet the criteria for high external validity yielding clinically relevant findings (Christensen & Heavey, 1999;Leichsenring, 2004;Sexton et al 2004;Sexton et al, 2008;Whisman, 2001b;Wright et al, 2006). A limitation, as discussed later, is the unique context, and thus the selection of participants from the Family unit, that may reduce the generalizability of results.…”

“…Even though the ideal design is to satisfy criteria for both high internal and high external validity, most researchers are forced to prioritize one or the other. Therefore, within the field of couple therapy research it is most commonly recommended to conduct longitudinal, naturalistic effectiveness studies prioritizing high external validity that optimizes the generalizability and clinical relevance of the results (Christensen & Heavey, 1999;Leichsenring, 2004;Sexton et al 2004;Sexton, Kinser, & Hanes, 2008;Whisman, 2001b;Wright et al, 2006).…”

“…The uniqueness of the treatment context can be regarded as a strength because the field asks for clinical research that is conducted within a variety of settings (Wright et al, 2006).…”

The Therapeutic Palette: A Guide to Choice Points in Integrative Couple Therapy

“…Metaphors have a long history as useful tools in family therapy training (Duhl 1983). Although explicit, step-by-step treatment manuals have the advantage of concretely specifying therapeutic practices, researchers have noted that it is often difficult for therapists to adhere to such specificity without a high degree of external monitoring, a condition that is unlikely to prevail outside of carefully controlled studies conducted in university settings (Gollan and Jacobson 2002;Wright et al 2006). In contrast, metaphors, if linked to a set of clear treatment selection principles, provide a broader, overarching sense of direction in making these choices.…”

“…Meta-analyses of couple therapy outcome studies repeatedly find that approximately two-thirds of couples in treatment improve, regardless of treatment model (Gollan and Jacobson 2002). The ecological validity of many family therapy studies has been critiqued because outcome studies carried out in a controlled academic context may not be applicable or relevant to practice that takes place in outpatient clinics or private practice (Wright et al 2006).…”