What Every Therapist Needs to Know About Couple Therapy

Abstract

This invited paper is a review of the significance of couple relationships to the practice of all therapists. The article begins with a summary of the evidence on the centrality of committed couple relationships to the lives and wellbeing of adults, and the association of the quality of the parents’ couple relationship on the wellbeing of children. We argue that the well-established reciprocal association between individual problems and couple relationship problems means that all therapists need to pay attention to how a couple relationship might be influencing a client's functioning, even if the relationship is not the presenting problem. There is an outline the evolution of current approaches to behavioural couple therapy, and the current state of the art and science of couple therapy. We present an analysis of the evidence for couple therapy as a treatment for relationship distress, as well as couple-based treatments for individual problems. This is followed by a description of the distinctive challenges in working with couples and how to address those challenges, and recommendations about how to address the needs of diverse couple relationships. Finally, we propose some core therapist competencies needed to work effectively with couples.

Depression Anxiety Stress Scale-10: A Brief Measure for Routine Psychotherapy Outcome and Progress Assessment

“…Anecdotally, it was our impression that the DASS-10 was not appropriate for assessing clients presenting with psychoses or autism spectrum disorders, as often these clients did not score in the clinical range on DASS items at presentation. Moreover, it is well established that while some clients with couple relationship distress have elevated stress, anxiety, or depression, perhaps as many as half of clients presenting with relationship distress are not in the clinical range on any of these symptom clusters (Halford & Pepping, 2019). There were clients in the current sample who presented with relationship distress, and for at least some of these clients, the DASS-10 is likely not an appropriate outcome measure.…”

Couple relationship standards in Thailand.

“…The current findings have implications for couple therapy. Evidence-based couple therapies (e.g., cognitive behavioral couple therapy, emotion-focused couple therapy) were developed in Western countries and prioritize enhancing the Couple Bond (Halford & Pepping, 2019). Given our finding that Thais place high importance on the Couple Bond, these approaches might be useful to assist distressed Thai couples, although this possibility needs to be evaluated in systematic trials.…”

“…Evidence-based approaches to couple therapy pay little explicit attention to religious beliefs (Halford & Pepping, 2019). Some Western couple therapists have added Christian concepts to couple interventions for religious couples.…”

Prospective effects of internalized stigma on same-sex relationship satisfaction: The mediating role of depressive symptoms and couple conflict.

“…However, the specific role of each partner during conflict cannot be identified. For instance, it remains unclear whether internalized stigma might lead to unhelpful behaviors such as criticism and blame, or withdrawal and stonewalling (Halford & Pepping, 2019). Given that internalized stigma is associated with feelings of shame (Miceli & Castelfranchi, 2018) and the tendency to conceal one’s identity (Pepping et al, 2017), it seems likely that partners who are higher in internalized stigma may engage in more withdrawal and avoidance behaviors during conflict.…”

“…However, relationship distress is also a well-established predictor of depression (Whisman & Baucom, 2012). Research with different-sex couples suggests a bidirectional relationship between relationship functioning and depressive symptoms (e.g., Beach & Whisman, 2012; Wu et al, 2021), and negative cycles of interaction are well-established predictors of couple relationship distress (Halford & Pepping, 2019). Although our primary aim was to examine the mechanisms underlying the internalized stigma-relationship satisfaction association, future research should examine these bidirectional associations in same-sex couples, including moderating factors that might disrupt these cyclical patterns, such as the therapeutic alliance in couple therapy (Wu et al, 2021).…”