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

• Author: Howard J. Markman,Jesse Owen,Scott M. Stanley,Galena K. Rhoades,Elizabeth S. Allen
• Published date: 01 June 2019
• DOI: http://doi.org/10.1111/famp.12390
• Date: 01 June 2019

Treatment-as-Usual for Couples: Trajectories Before

and After Beginning Couple Therapy

JESSE OWEN*

GALENA K. RHOADES*

SCOTT M. STANLEY*

HOWARD J. MARKMAN*

ELIZABETH S. ALLEN

†

Couple therapy has been shown to be a meaningful way to improve couples’ relation-

ships. However, less information is known about couples’ functioning prior to entering

treatment in community settings, as well as how their relationship functioning changes

from initiating therapy onward. This study examined 87 couples who began community-

based couple therapy during a longitudinal study of couples in the militar y. The couples

were assessed six times over the course of 3 years, including time points before and after

starting couple therapy. Using an interrupted-time series design, we examined trajectories

across the start of couple therapy in relationship satisfaction, divorce proneness, and nega-

tive communication. The results demonstrated that couples’ relationship satisfaction wa s

declining and both divorce proneness and negative communication were increasing prior

to entering couple therapy. After starting couple therapy, couples’ functioning on all three

variables leveled off but did not show further change, but previous experience in relation-

ship education moderated these effects. Specifically, those who were assigned to the rela-

tionship education program (vs. control) demonstrated greater reductions in divorce

proneness and greater increases marital satisfaction after starting therapy; however, they

also started more distressed.

Keywords: Couple Therapy; Therapy Outcome; Relationship Satisfaction; Divorce

Proneness; Communication

Fam Proc 58:273–286, 2019

There have been two common approaches to understanding the impact of couple ther-

apy: (i) efficacy trials wherein couples are randomized to a specific couple treatment

(typically manualized) or a control condition (e.g., no treatment, treatment as usual) and

the treatment conditions are highly monitored, and (ii) effectiveness trials, which examine

whether an intervention works in the “real world” and they commonly rely on clinical

practices that are routinely occurring in community based settings (Heppner, Wampold,

Owen, Thompson, & Wang, 2015). In efficacy studies, researchers have demonstrated the

superiority of couple treatments for couples over no treatment control comparison couples

*University of Denver, Denver, CO.

†

University of Colorado Denver, Denver, CO.

Correspondence concerning this article should be addressed to Jesse Owen, University of Denver, 1999

E. Evans, Denver, CO 80210. E-mail: jesse.owen@du.edu

The project described was supported by Award Number R01HD048780 from the Eunice Kennedy Shri-

ver National Institute of Child Health & Human Development (NICHD). The content is solely the respon-

sibility of the authors and does not necessarily represent the official views of NICHD or the National

Institutes of Health.

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Family Process, Vol. 58, No. 2, 2019 ©2018 Family Process Institute

doi: 10.1111/famp.12390