Does Couple Therapy Work? This Emotional Life - PBS

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Relationships / Blog

    Thomas Bradbury, Ph.D.

Thomas Bradbury, Ph.D.'s Bio

Dr. Bradbury studies how intimate relationships develop and change.

Does Couple Therapy Work?


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Surveys show that relationship problems are a leading reason – and perhaps THE leading reason – why anyone seeks help for personal issues in the United States.  Just released are the 5-year results from the largest-ever experimental study of therapies for unhappy couples, providing us with the best answer to date of whether two leading forms of these treatments produce lasting benefits for this common difficulty.

Therapists face an uphill struggle when working to improve relationships.  Couples are usually mired deeply in their unhappiness by the time they get around to consulting a mental health professional, and the distress they bring to the therapist is potent and rarely remits on its own.  And conducting a formal experiment of treatments that might work requires a large number of these couples, sound theories about what it takes to bring about lasting change in their relationship, and well-trained therapists to deliver the active ingredients. 

Dr. Andrew Christensen, one of the world’s leading scientists in this field, led a team at UCLA and the University of Washington that compared two types of therapies for distressed couples.  One therapy focused intently on changing the mechanics of couples’ communication, on restoring positive experiences between partners, and on solving problems ‘in the here and now.’  Hopes were modest for this approach because prior studies suggested that it did not produce lasting change.  The alternative treatment was designed, in part, to recognize the limits of this earlier approach:  if couples were not changing so much, then maybe they could learn to downplay the unpleasant parts of the relationship and focus on the strengths.  This alternative does aim to change communication, but it focuses a lot more on helping couples to accept their partner and to not over-react emotionally to the slights and gripes that occur routinely in intimate partnerships.

Participating spouses were in their early 40s and were well-educated; they had been married about 10 years on average.  Most of the couples – 68 of 134 – had children.  All couples were ‘chronically and seriously distressed’ according to measurement conventions in the field.  About half of the couples were assigned randomly to each of the two therapies, which were delivered by closely supervised practitioners over the course of 26 sessions.

So which works better:  helping couples change so they get what they want, or helping couples try to want (or at least tolerate) what they already have?  In fact, Christensen et al. (2010) report that both approaches work equally well over 5 years – couples in the two groups divorce at about the same rate (26-28%) and those who are still together after 5 years report virtually identical levels of relationship happiness. 

But how much improvement occurred overall?  Using the 5-year data, Christensen and colleagues classified all couples receiving therapy on the basis of whether they are deteriorated (this included all the divorces, and all other couples who did not divorce but indicated they were miserable), unchanged in relationship happiness compared to where they started, improved from where they started, or recovered (that is, improved and indistinguishable from happy couples in the general population).

Couples therapy, it seems, is largely a matter of up or out:  The highest proportion of couples – 38% -- deteriorated, and another 14% were unchanged.  Another 16% improved, and fully 32% recovered.  About half of all couples either fail to change or deteriorate, and about half improve – and most of these improve by a sizeable margin.  On balance, given the enormous difficulty of the task for couples and for therapists, this is very good news.

 

Christensen, A., Atkins, D.C., Baucom, B., & Yi, J. (2010). Marital status and satisfaction five years following a randomized clinical trial comparing traditional versus integrative behavioral couple therapy.  Journal of Consulting and Clinical Psychology, 78, 225-235.