Publication year
2011
Citation Title
Premature termination in couple therapy with veterans: Definitions and prediction of long-term outcomes.
Journal Name
Journal of Family Psychology
Journal Volume
25
Issue Number
5
Page Numbers
770-774
DOI
10.1037/a0025239
Summary
Pre- and post-survey data for Veterans and their spouses were used to examine the frequency of premature termination (PT) of treatment for couples in therapy. In addition, given that multiple definitions are used for PT, the authors determined which of seven definitions of PT was most predictive of loss of gains made during therapy (e.g., declines in relationship satisfaction) between the final session and an 18-month follow-up. Most couple ended therapy prematurely and two definitions of PT significantly predicted reduced relationship satisfaction and stability.
Key Findings
All seven definitions of PT, both quantitative definitions (e.g., minimum number of completed sessions) and therapist definitions (e.g., the likelihood of future success) indicated that the majority of couples (50-80%) terminated treatment prematurely.
Two definitions of PT predicted larger decreases in relationship satisfaction and lower levels of satisfaction at the 18-month follow-up period: 1) whether or not the individual scored in the distressed range of relationship satisfaction at the end of therapy and 2) therapists ratings of the likelihood of the couples future happiness.
For both men and women, therapists ratings of future happiness independently predicted steps taken toward divorce 18 months later; ending therapy in the distressed range predicted subsequent steps toward divorce for women only.
Implications for Program Leaders
Continue to offer marriage workshops for military couples as this may be a preferred method for getting help over individule couples therapy
Clinicians and counselors could take into consideration both couples self-reported level of distress as well as their own ratings of likelihood of the couples future happiness when determining terminating therapy
Distribute information about services and resources available to military couples who are distressed
Implications for Policy Makers
Encourage ongoing training and education for service providers working with military couples on PT to better enable them to address risks for PT and warning signs
Encourage longer durations of couple therapy among military couples seeking care at DoD medical centers
Encourage collaboration between DoD and community-based service providers working with military couples to offer streamlined and continued care
Methods
Participants included couples who sought therapy at a VA clinic in Charleston, South Carolina or San Diego, California.
This study focused on couples of which at least one partner was a U.S. Veteran.
Relationship measures were completed prior to beginning therapy and before each therapy session.
Participants
Participants included 177 couples (354 individuals) who sought treatment at VA centers in South Carolina (N = 83) or California (N = 94).
The majority of participants were White (69%). Age and military affiliation of participants was not reported.
Eighty-five percent of couples were married.
Limitations
Selected participants may differ from nonparticipants in a way this is not measured, but affected the outcome variables. Only couples in which at least one partner was a military Veteran were included. These couples may differ from civilian couples as well as other military couples, particularly in response to experiences with deployment and separation.
The treatment approaches at the two VA medical centers differed, which may influence rate of PT and the course of therapy.
Average number of session at each VA center differed greatly (4.5 session in SC and 12.3 sessions in CA), which could bias the results.
Avenues for Future Research
Include more diverse samples across branches and components of couples seeking treatment particularly in light of current operational tempo
Utilize more than a single follow-up assessment in an effort to measure long-term stability of relationship functioning and make comparisons between PT and non-PT couples
Continue to investigate the predictive value of the different definitions of PT used in the present study
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Premature termination (PT) has been identified as widespread in individual, family, and couple therapy. Unfortunately, research on PT utilizes numerous definitions of PT without providing guidance on which definition may be most clinically useful. The current study investigated seven definitions of PT (three based on therapist ratings and four based on quantitative measures) utilizing a sample of 177 couples seeking treatment at two Department of Veterans Affairs medical centers. Results indicated that PT occurred in 50-80% of couples; however, agreement between the definitions of PT was generally only in the slight to fair range, making it difficult to determine whether a particular couple was ready to terminate treatment. Additionally, many commonly used definitions of PT were unrelated to level or maintenance of relationship functioning following treatment. In contrast, two definitions of PT (ending treatment in the distressed range and therapist-rated likelihood of future unhappiness) significantly predicted larger decreases in relationship satisfaction during the 18 months following therapy, as well as lower levels of satisfaction and relationship stability 18 months after termination. Additionally, long-term relationship functioning was especially poor when both these definitions of PT were met, suggesting that both qualitative and quantitative definitions should inform decisions about termination in couple therapy.
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