Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy

• Author: Linda Gotthardt,Corina Aguilar‐Raab,Dennis Grevenstein,Beate Ditzen,Jochen Schweitzer,Marc N. Jarczok,Christina Hunger
• Date: 01 June 2018
• DOI: http://doi.org/10.1111/famp.12302
• Published date: 01 June 2018

Changing Me, Changing Us: Relationship Quality

and Collective Efficacy as Major Outcomes in

Systemic Couple Therapy

CORINA AGUILAR-RAAB*

DENNIS GREVENSTEIN

†

LINDA GOTTHARDT*

MARC N. JARCZOK*

CHRISTINA HUNGER*

BEATE DITZEN*

JOCHEN SCHWEITZER*

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale,

which assesses relationship quality and collective efficacy. In Study 1 we conducted a wait-

list-control, short-term couple therapy RCT study (N=43 couples) with five systemic ther-

apy sessions treating communication and partnership problems; our intent was to provide

high external validity. Construct validity of EVOS was assessed by comparison with addi-

tionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2,

N=332 individuals completed an experiment with high internal validity in order to verify

sensitivity to change in three different social contexts. Results from Study 1 revealed a sig-

nificant increase in relationship quality in the treatment group directly after treatment, as

compared to the control group. Sensitivity to change was slightly better for EVOS than for

other measures. While this positive change could not be fully sustained between posttreat-

ment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment

levels, supporting moderate-to-large sensitivity to change. Study2 supported high sensitivity

to change in EVOS for couplerelations, family relations, and work-teamrelationships. There-

fore, EVOS can be used as an outcome measure to monitor the process of systemic interven-

tions focusing on relationship quality and collective efficacy. Due to its sensitivity to change,

EVOS can provide evidencefor treatment success with regard to relationship aspects.

Keywords: Sensitivity to Change; Monitoring and Outcome Measure; Social

Relationships; Systemic Couple/Family Therapy and Counseling

Fam Proc 57:342–358, 2018

We have introduced a theoretically derived measure—the Evaluation of Social Sys-

tems Scale (EVOS)—as a new outcome measure for systemic interventions. EVOS

*Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg,

Heidelberg, Germany.

†

Psychological Institute, University of Heidelberg, Heidelberg, Germany.

Correspondence concerning this article should be addressed to Corina Aguilar-Raab, Institute of Medical

Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg University,

Bergheimer Str. 20, 69117 Heidelberg, Germany. E-mail: corina.aguilar-raab@med.uni-heidelberg.de.

The study was approved by the ethics committee of the Heidelberg Medical Faculty (S-508/2012). This

research was supported by the Heidehof Foundation. We thank all study participants and staff members

who supported this study. The authors thank Lisa M€

uhlhan, Ileana Steffens-Guerra, Katharina Hager,

and all laboratory members for helping with the data collection and preparation.

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Family Process, Vol. 57, No. 2, 2018 ©2017 Family Process Institute

doi: 10.1111/famp.12302

assesses major aspects relevant to systemic couple and family therapy: The domai ns com-

munication, cohesion, atmosphere, giving, and taking constitute the first facto r quality of

relationship. The domains collective aims, resources, decisions, finding solution s, and

adaptability are combined in the second factor collective efficacy, which points toward the

idea of collective efficacy and functioning. As Bandura (2000) aptly described: “People’s

shared beliefs in their collective efficacy influence the types of futures they seek to achieve

through collective action, how well they use their resources, how much effort they put into

their group endeavor, their staying power when collective efforts fail to produce quick

results or meet forcible opposition, and their vulnerability to the discouragement that can

beset people taking on tough social problems” (p.76). This concept fits perfectly into a sys-

temic understanding of a system working together to create unique solutions to achieve

their goals and to keep the system going. The first factor covers important affective

aspects and the second factor reflects crucial cognitive aspects of social relationships,

which have been described in established models of family therapy and organizational con-

sulting psychology (Aguilar-Raab, Grevenstein, & Schweitzer, 2015). EVOS was evaluated

for its psychometric qualities in different social contexts, such as couples, families, and

work teams. A two-factor model and measurement invariance across all social contexts

could be supported (Aguilar-Raab et al., 2015). In addition, EVOS can be applied to chil-

dren and adolescents at least 12 years old (Grevenstein, Schweitzer, & Aguilar-Raab,

2017). Thus, EVOS is a short, reliable, and valid measure of the quality of relationship

and collective efficacy, addressing the first-person plural (“we...” instead of “I...”). It fol-

lows a non-problem-oriented, non-normative, and constructivist approach. We have also

included a separate item assessing the perceived consensus within the social system to

allow for additional evaluations. EVOS was designed to answer the need of outcome

research for a short, standard tool for evaluating systemic interventions that can be

applied in a wide variety of private or organizational social systems. Only with a globally

applicable outcome measure can similar systemic interventions applied in different con-

texts be comparably evaluated with regard to their outcomes (Sanderson et al ., 2009).

One major issue is that the commonly used measures focus on a specific social context

(e.g., item wording), whereas EVOS enables assessment of the quality of the relationshi p

and the collective efficacy in different social contexts. It allows for comparison of systemic

interventions applied in both private and organizational contexts. With regard to affective

and cognitive aspects of social interactions, the same constructs are important targets of

change processes initiated by systemic interventions. For example, with EVOS, even

social systems like cross-generational households or arranged work teams can be

explored.

Several measures are already available for assessing social functioning with regard to

private social systems. For example, the Family Adaptability and Cohesion Evaluation

Scale is a two-dimensional scale designed for family interactions on the basis of the Cir-

cumplex Model (FACES; Olson, 1986). The Family Assessment Device—FAD (Epstein,

Bishop, & Levin, 1978; de Haan, Hafekost, Lawrence, Sawyer, & Zubrick, 2015; Mans-

field, Keitner, & Dealy, 2015)—is based on the McMaster Model of family functioning.

Covering six dimensions and overall functioning (problem solving,communication,roles,

affective responsiveness,affective involvement,behavior control plus general functioning),

its focus is a categorization of self-assessed satisfaction or dissatisfaction. However, gen-

eral functioning, a 12-item subscale, can only be used for capturing the health and pathol-

ogy of a family. The Dyadic Adjustment Scale (DAS; Spanier, 1976) is a 32-item measure

that assesses relationship adjustment in couples or marital satisfaction. It contains four

subscales, of which only three dimensions—dyadic consensus,dyadic satisfaction, and

dyadic cohesion (but not affectional expression)—have been confirmed (Graham, Liu, &

Jeziorski, 2006; South, Krueger, & Iacono, 2009). The Systemic Clinical Outcome and

Fam. Proc., Vol. 57, June, 2018

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