- Describe your topic.
- Key questions: ▪ Which couple interventions work best, and for whom and under what conditions (e.g., differences based on type of relational problem; backgrounds/identities of the members of the couple; other comorbid conditions among the members of the couple; delivery setting, etc.)? ▪ What do we know from research about key processes and interactions between partners that either promote or undermine good relationships? ▪ What are the unique challenges in forming a positive therapeutic alliance with couples compared to individuals? What are the best predictors of couple distress? ▪ What are the change mechanisms in couple therapy? o Ages: over 18 o Same sex and heterosexual couples o In a committed relationship for at least 3 months o Can be dating, married, cohabitating, with or without children, or long distance. o Behavioral marital Therapy o Integrative Behavioral Couple Therapy o Insight Oriented Couple Therapy o Emotion Focused Couple Therapy o Integrative approaches to couple therapy (e.g., Integrative Systemic Therapy) o Common factors to couple therapy o Partner assisted treatments o Intimate Partner Violence Treatments (Acceptance and Commitment Therapy vs Cognitive Behavioral Therapy) o Improvement in chronic health conditions o Decrease in intimate partner violence o Decrease in comorbid symptoms o Improved relationship satisfaction/decrease in relational distress o Improved sexual satisfaction o Improved communication o Improvement in trust for infidelity cases, which is the most common presenting problem that brings couples to therapy o Increased clarity around commitment
- Describe why this topic is important.
- Many scholars have made the case for the importance of increased attention to couple distress (e.g., Lebow, Chambers, Christensen, Johnson, 2012; Rhoades et al., 2015). Intimate relationship health is at the core of our lives. Research has shown that healthy relationships are connected to individual adult’s wellbeing and health and is connected to improved outcomes for children. Unfortunately, it is also the case that unhealthy relationships are connected to a host of problems. The quality and stability of committed, intimate relationships have profound impacts on overall physical health, mental health, economic security, and child health and wellbeing. Unfortunately, recent statistics suggest that fewer people in the United States are married today than ever before, 42% of children are born to unmarried parents, the divorce rate hovers near 50%, and more than 30% of married couples are clinically distressed. Moreover, relationship distress is the leading reason for seeking mental health counseling. Relationship dysfunction and dissolution are robustly associated with: • Mortality • Depression, suicide, and other mood disorders • Alcoholism and substance abuse • Domestic violence • Obesity, elevated blood pressure, and diminished immune system functioning Parental relationship conflict, instability, and dissolution are also associated with negative outcomes for children: • Child abuse and maltreatment • Growing up in poverty • Poorer academic achievement • Poorer physical and mental health From an economic perspective, the direct and indirect costs of divorce alone (not including couple distress) for individuals, communities, states, and the federal government have been estimated to be over $33 billion annually. The formation of stable, healthy relationships is also a problem in the United States, and many Americans become parents together without being married. When unmarried childbearing is considered along with divorce, economic costs jump up to as high as $112 billion annually. Relevance to Health Disparities Concerns The evidence is clear that the issues described above impact racial/ethnic minority populations and those with low-income levels most dramatically. • The unmarried birth rate varies greatly by race/ethnicity as well as by income and education level. For example, 72% of African-American children are born to unmarried parents versus 36% of White children. • Among pregnant minority couples with low-income levels, only 44% will be together by the child’s first birthday. • Most models of intervention or education for couples are based on middle-class, mostly White samples. New research commissioned by the Administration for Children and Families suggests that these interventions may not work as well for disadvantaged populations, but no funding is available to develop or test new models. • Although many believe that the divorce rate is falling, new evidence suggests that the divorce rate has been increasing in recent decades. Further, researchers have known for some time that divorce is much more common among the least educated and among those who are racial/ethnic minorities.
- Tell us why you are suggesting this topic.
- Looking at who does couple therapy, the largest international study of psychotherapists (Orlinsky & Ronnestad 2005) found an astounding 70% of psychotherapists treat couples. This is a remarkable statistic, which may give some pause when one considers the limited training in couple therapy in professions other than marriage and family therapy and family psychology. In fact, the lack of couple therapy training may account for why, although couple therapy is highly effective when studied (Shadish & Baldwin, 2003, 2005; Snyder, Castellani, & Whisman, 2006), couple therapy is among the lowest rated for consumer satisfaction in the Consumer Reports study of psychotherapies (Seligman, 1995), which did not control for therapist training. Thus, having clear guidelines to help guide practitioners has the potential to significantly improve societies’ public health (Lebow, Chambers, Christensen, Johnson, 2012).
- Target Date.
- 2020-06-01
- Describe what you are doing currently and what you are hoping will change because of a new evidence report.
- There is a significant science practice gap meaning that very few therapists are familiar with, let alone using, interventions that are known to be effective for treating couple distress. In light of the data above about the prevalence of couple distress and couple therapy combined with the data on couple therapy receiving the lowest ratings among clients, it is clear that there is a public health crisis. Thus, there is a clear need for a new evidence synthesis of quality research on the effectiveness (and potential harms) of treatments for couple distress in order to guide clinical practice.
- How will you or your group use the information from a new evidence report?
- The proposed systematic review will provide an up-to-date synthesis of quality research on the effectiveness (and potential harms) of treatments for couple distress. Results from a new evidence report on this topic would be disseminated to our organization’s membership, which includes nearly 115,700 researchers, educators, clinicians, consultants and students. This information can help to guide the practice of clinicians as well as training of students. Further, the proposed systematic review will also identify gaps in research data and areas to target for improvement in treatment implementation, which will guide future research by psychologists and other disciplines on couple distress (and may result in greater funding for such research). Further, our organization would review the results of this report to consider whether we could develop an evidence based clinical practice guideline from it. Increasing awareness about the characteristics and availability of effective treatments for couple distress will encourage their use in clinical practice. Given that relationship distress is the leading reason for seeking mental health counseling and is significantly related to negative mental and behavioral outcomes (i.e., depression, suicide, domestic violence) and given that parental relationship conflict, instability, and dissolution are associated with negative outcomes for children, it is imperative to identify effective treatments for couple distress.
- How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to?
- Our organization would review the results of this report to consider whether we could develop an evidence based clinical practice guideline from it. Further, results from a new evidence report on this topic would be disseminated to our membership, which includes nearly 115,700 researchers, educators, clinicians, consultants and students. Our organization would disseminate information from a new report on this topic via email, newsletters, websites, social media, and special interest divisions of our organization, among others. Educator members of our organization could further disseminate the information to their students while clinician members could use the information with their patients. Researchers could use information from the report on gaps in the research to focus areas for their future research. It is worth noting that many individuals who are not members also look to our organization for guidance and information. Moreover, our organization’s websites are very popular, receiving hundreds of thousands of visits yearly.
- Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?
- There are several other organizations that could likely use an evidence report to inform clinical practice as follows: • American Academy of Couple and Family Psychologists • American Board of Couple and Family Psychology • Couple Special Interest Group of the Association of Behavior and Cognitive Therapists (ABCT) • American Association of Marriage and Family Therapists (AAMFT) • International Association of Marriage and Family Counselors (IAMFC) • Society for Couple and Family Psychology (Division 43 of APA) • American Psychiatric Association
- Information About You: (optional)
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- Provide a description of your role or perspective.
- The American Psychological Association (APA), in Washington, D.C., is the largest scientific and professional organization repre
- If you are you making a suggestion on behalf of an organization, please state the name of the organization.
- American Psychological Association
- Please tell us how you heard about the Effective Health Care Program.
- Through our organization’s use of systematic reviews commissioned by AHRQ in developing our clinical practice guidelines.
