The Gap Between Couple Therapy Research Efficacy and Practice Effectiveness

Abstract

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.

Treatment‐as‐Usual for Couples: Trajectories Before and After Beginning Couple Therapy

“…These findings, in conjunction with other effectiveness studies of couple therapy (Halford et al, 2015), suggest that there is a gap between the effects seen in clinical trials and those realized in day-to-day practice. Couple therapy as practiced in the community appears to have some beneficial effects, especially in preventing (or stopping) declines in relationship quality.…”

“…Although the findings from efficacy studies are noteworthy, several researchers and theorists have raised concerns about the gap between research on couple therapies and what is used in practice (e.g., Gurman, 2011;Halford, Pepping, & Petch, 2015). Several studies on treatment-as-usual couple therapy have demonstrated that treatment gains are about a half to a third as compared to couple treatments in efficacy studies (e.g., Anker, Duncan, & Sparks, 2009;Doss et al, 2012;Hahlweg & Klann, 1997;Klann, Halweg, Baucom, & Kroeger, 2011;Lunblad & Hansson, 2006).…”

Couple‐based Intervention for Depression: An Effectiveness Study in the National Health Service in England

“…Although it was not the primary focus of treatment, the findings indicated that there was only a modest improvement for clients overall in relationship satisfaction and no meaningful change for nonclient partners as a group; within-group effect sizes were 0.43 and 0.21 for clients and nonclient partners, respectively, compared to the average effect size of 0.6 in effectiveness studies for treating relationship distress as reported by Halford et al (2016). However, in an effectiveness study of Integrative Behavioral Couple Therapy (IBCT) for relationship discord currently being conducted in the Veterans Administration (Christensen & Doss, 2017) and perhaps more similar to this study (i.e., approximately 10 sessions on average with high rates of comorbid psychiatric diagnoses), Christensen (2017) reports effect sizes for relationship satisfaction ranging from 0.21 to 0.57, similar to the current effect sizes.…”

“…At present, there are no studies involving treating depression with a couple-based intervention in routine clinical settings (i.e., effectiveness research), and comparable effects to efficacy outcomes cannot be assumed. For example, Halford, Pepping, and Petch (2016) showed that the rate of couple recovery from relationship distress in clinical effectiveness trials was less than half of that reported in efficacy trials. Similarly, when comparing efficacy and effectiveness trials for individual or group CBT for depression (no partner involvement), Hans and Hiller (2013) concluded that CBT 1 For a history of the development of IAPT and how it has been implemented and evaluated, see Clark (2011).…”

How Routine Patient‐Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single‐Case Study

“…The idea of limiting clinical practice to treatments with experimental evidence of positive effects (i.e., evidence‐based practice) has given rise to a counter movement toward broadening of the concept of evidence, in order to consider knowledge derived from real practice (e.g., Gordon, Pell, & Pell, ; Halford et al., ). A strategy for gathering practice‐based evidence of the real effects of talking therapies consists of evaluating outcomes in each and every patient, and using technological platforms for treating and archiving the large scale resulting databases.…”