Publication year
2015
Citation Title
Improvements in closeness, communication, and psychological distress mediate effects of couple therapy of veterans
Journal Name
Journal of Consulting and Clinical Psychology
Journal Volume
83
Issue Number
2
Page Numbers
405-415
DOI
10.1037/a0038541
Summary
This study follows 161 heterosexual couples in 13-week couples' therapy program. Couples were assessed prior to each session to determine whether observed improvements in couple functioning were due to improvements in communication, emotional connectedness, behavioral intervention, or psychological functioning.
Key Findings
Before beginning treatment, data indicated that 76% of women and 61% of men showed relationship distress.
Improved communication and emotional closeness predicted improvements in relationship satisfaction for both men and women.
Improvements in men’s psychological distress improved subsequent relationship satisfaction.
Implications for Program Leaders
Provide classes to improve communication within romantic and family relationships
Develop educational resources to help couples identify relationship distress
Collaborate with family outreach services, to help military families identify symptoms of psychological distress
Implications for Policy Makers
Recommend screening for psychological distress among Service members and their partners who are seeking treatment
Providing screening for couples exhibiting symptoms of relationship distress
Support the development of protocols that encourage couples counselors to focus on emotional development, rather than exclusively behavioral intervention
Methods
Couples were referred for treatment by mental health (49%) or physical health (47%) providers, or were self-referred (4%).
Both partners completed an intake survey that included demographics, problematic behavior in the relationship, and psychological distress.
Prior to each therapy session, partners reported on relationship satisfaction, communication, emotional closeness, and psychological distress.
Participants
The sample included 161 heterosexual couples (322 individuals) seeking therapy at Veterans Affairs (VA) Medical Centers in Charleston, SC and San Diego, CA. Participants were generally either Vietnam-era or OEF/OIF Veterans.
Age and relationship duration were bimodal: men’s modal ages were 32 and 59 years, women’s modal ages were 30 and 55 years, and relationship modes were 5 and 30 years.
The majority of couples were White (69%) and most couples were married (85%) or cohabiting (11%), with only 2% in dating relationships.
Limitations
Given co-occurring conditions common among Veterans, results may not be generalizable to non-Veteran (e.g., Active Duty) couples.
Information on the treatment provided for the study is limited and therefore difficult to compare to standardized couples therapies for military couples.
Mediators were measured using truncated subscales, which may fail to measure important dimensions of each mediator.
Avenues for Future Research
Explore within-session experiences, and intervention techniques used by therapists
Examine more nuanced measures of potential mediators like emotional closeness and communication
Assess how improvements in one partner’s emotional functioning impacts relationship satisfaction
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Objective: Empirically based couple therapy results in significant improvements in relationship satisfaction for the average couple; however, further research is needed to identify mediators that lead to change and to ensure that improvements in mediators predict subsequentÑnot just concurrentÑrelationship satisfaction. In addition, given that much of the current literature on couple therapy examines outcomes in a research environment, it is important to examine mediators in a treatment-as-usual setting. Method: To address these questions, 161 heterosexual couples (322 individuals) received treatment-as-usual couple therapy at one of two Veteran Administration Medical Centers (M = 5.0 and 13.0 sessions at the two sites) and were assessed before every session. The majority of couples were married (85%) and had been together for a median of 7.8 years (SD = 13). Participants were primarily White, non-Hispanic (69%), African American (21%), and White, Hispanic/Latino (8%). Results: Individuals’ own self-reported improvements in communication, emotional closeness, and psychological distress (but not frequency of behaviors targeted in treatment) mediated the effect of treatment on their subsequent relationship satisfaction. When all significant mediators were examined simultaneously, improvements in men’s and women’s emotional closeness and men’s psychological distress independently mediated subsequent relationship satisfaction. In contrast, improvements in earlier relationship satisfaction mediated the effect of treatment only on subsequent psychological distress. Conclusion: This study identifies unique mediators of treatment effects and shows that gains in mechanisms predict subsequent relationship satisfaction. Future investigations should focus on the role of emotional closeness and psychological distressÑconstructs that have often been neglectedÑin couple therapy.
Abstract Document
PRTW Document
Attach