Couple Therapy with Veterans: Early Improvements and Predictors of Early Dropout

• Author: Julian Libet,Rawya Al‐Jabari,Melanie S. Fischer,Jenna L. Baddeley,Vickie Bhatia
• Published date: 01 June 2018
• DOI: http://doi.org/10.1111/famp.12308
• Date: 01 June 2018

Couple Therapy with Veterans: Early Improvements

and Predictors of Early Dropout

MELANIE S. FISCHER*

,†

VICKIE BHATIA*

,†

JENNA L. BADDELEY*

,†

RAWYA AL-JABARI*

JULIAN LIBET*

,†

Family services within Veterans Affairs Medical Centers fulfill an important role in

addressing relationship distress among Veterans, which is highly prevalen t and comorbid

with psychopathology. However, even for evidence-based couple therapies, effectiveness is

weaker compared to controlled studies, maybe because many Veteran couples drop out

early and do not reach the “active” treatment stage after the 3–4 session assessment. In

order to improve outcomes, it is critical to identify couples at high risk for early dropout,

and understand whether couples may benefit from the assessment as an intervention. T he

current study examined (a) demographics, treatment delivery mode, relationship satis fac-

tion, and psychological symptoms as predictors of dropout during and immediately follow-

ing the assessment phase, and (b) changes in relationship satisfaction during assessment.

174 couples completed questionnaires during routine intake procedures. The mai n analy-

ses focused on 140 male Veterans and their female civilian partners; 36.43% dropped out

during the assessment phase and 24.74% of the remaining couples immediately following

the first treatment session. More severe depressive symptoms in non-Veteran partners were

associated with dropout during assessment. Relationship satisfaction improved signifi-

cantly during the assessment phase for couples who did not drop out, with large r gains for

non-Veteran partners. No demographics or treatment delivery mode were associated with

dropout. Although more research is needed on engaging couples at risk for early dropout

and maximizing early benefits, the findings suggest that clinicians should attend to the

civilian partner’s and Veteran’s depressive symptoms at intake and consider the assess-

ment part of active treatment.

Keywords: Couple Therapy; Veterans; Treatment Dropout; Depression; Relationship

Satisfaction

Fam Proc 57:525–538, 2018

Veterans Affairs (VA) medical centers and clinics provide mental health and family ser-

vices to Veterans who often face great challenges in their intimate relationships.

Prevalence rates of relationship distress and divorce are higher in service members and

*Ralph H. Johnson VA Medical Center, Charleston, SC.

†

Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.

Correspondence concerning this article should be addressed to Melanie S. Fischer, Department of Psy-

chology and Neuroscience, Community Research Center and Clinic, CB# 3274, Chapel Hill, NC 27599-

3274. E-mail: melanie_fischer@med.unc.edu

Melanie S. Fischer is now at the University of North Carolina at Chapel Hill, Department of Psychology

and Neuroscience, Department of Psychiatry. Rawya Al-Jabari is now at the Rhode Island Hospital, Adult

Partial Hospital Program.

525

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

This article has been contributed to by US Government employees and their work is in the public

domain in the USA.

doi: 10.1111/famp.12308