Efficacy of Couple Therapy
Efficacy of a therapy can be understood as how effective a therapy is, and how good therapeutic outcomes are. When evaluated under the microscope of clinical efficacy, the results are usually not as impressive as the control groups. Until a few decades ago, when asked the question about what percentage of couples, who are treated, are in a happy marriage after the end of treatment, most treatments which are tested, reported only 50% success. It can be seen that there is significant uniformity, both, across studies and across different treatment modalities in the success rate.
In the yesteryears two of the most dominant approaches in the field of couple therapy were Behavioural Couple Therapy (BCT) and Insight oriented couple therapy (IOCT). However, these therapies could not yield very high efficacy rates. The BCT literature shows that, though couples improve by the end of the therapy, there are divorce rates as high as 30% after two years of therapy and 38% after four years of therapy (Jacobson, Schmaling, &Holtzworth-Munroe, 1987; Snyder, Wills, & Grady-Fletcher, 1991). Snyder et al. (1991) found that, though couples took time to improve with IOCT, it had long lasting effects and divorce rates, as low as 3%. Though these findings show a ray of hope, however, these findings couldn’t be replicated in subsequent studies. But in present, the good news is that Emotionally-Focused Therapy (EFT) now dominates the practice of couple therapy in the West and is also gaining momentum in India. According to the American Psychological Association, based on over 25 years of research, it can be stated that EFT’s efficacy is roughly 75 percent. Such findings have also been replicated for couple therapy for high-stress clients, such as, infertile couples, military couples, veterans with PTSD, and parents of chronically ill children. Results are also consistent across different cultures.
Whatever the approach to couple therapy is, the five basic principles which can contribute to effective couple therapy can be listed as follows (Benson, McGinn & Christensen, 2012).
1. Focus on Changing the View of the Relationship
The main focus of any competent therapist is on helping both partners to see their relationship in an objective manner. The therapist attempts to make the couple learn to stop the "blame game" and rather view whatever happens to them as an organic process which involves both partners. They also can benefit from seeing that their relationship takes place in a certain context. Therapists indulge in this process by trying to understand the interaction between both partners by observing how they interact. They then formulate hypothetical assumptions about what factors contribute to the way the couple interacts. The way in which the therapist prefers to share this information with the couple differs according to the therapist's theoretical orientation. Various therapists use varied strategies, but the main focus remains on altering the view of the relationship so that both partners start to seeing each other and their interactions in more adaptive ways.
2. Modification of Dysfunctional Behaviour
Apart from helping the couple improve their interactions, therapists also tend to ensure if the partners are behaving in adaptive and functional ways. More specifically they strive to ensure that their clients are not involved in actions that can lead to physical, psychological, or economic harm to each other or anyone else in the vicinity. To achieve this, therapists conduct assessments to establish whether their clients are at risk and if necessary, the therapist may recommend "time-out" procedures to put a stop to the escalation of conflict.
3. Promote Emotional Expression
It is usually seen that couples who do not express their private feelings are at greater risk of becoming emotionally distant and thereby tend to grow apart. Skilled and competent couple therapists actively indulge in helping their clients to express those emotions and thoughts that they fear revealing to their partners. Attachment-based couple therapy encourages the couple and creates a safe space where both the partners are not afraid to express their needs for closeness. Behaviourally-based therapists, are of the opinion that adults are afraid to express their true feelings because they did not receive "positive reinforcement" in the past. However, in their own sweet ways both the approaches are of the view that helping clients to express their inner true feelings can eventually draw them closer together.
4. Communication improvement
Being able to communicate effectively is key to a successful relationship. Almost all couple therapies aim to on help the partners in communicating in a more effective manner. As elicited by principles #2 and #3, this communication should be respectful, the partners must be able to express their true feelings to each other. Couples even require coaching to learn to speak their significant other in more understanding ways that makes other person feel a sense of support. The therapist also helps the clients identify what types of communication patterns are adaptive and what can cause more conflict. They are also taught to listen more empathetically and actively.
5. Promotes strengths
A good couple therapist should not lay his/her focus only on the problems in the relationship but also highlight the strengths in the relationship and attempt to develop resilience as therapy nears ending. Also, the therapist should allow the couple to define their strengths not try to define strengths of their relationship for the couple.
Asking for help in regard with private lives can be a challenge. There is no such thing as perfect relationship or perfect marriage. Hence, there should not be any shame or embarrassment attached to resolving issues related to relationships. Acknowledging the problem and acquiring required help reduces the vulnerability and empowers the couple in some way.
Couples therapy may or may not turn out to be the ultimate solution but to find out, it’s worth giving a try!