A Critical Review of Help-Seeking for Couples Therapy: Clinical Implications and Next Steps

Perceived overlap and therapy outcomes among couple clients

This article explores couples' perceptions and expectations of closeness in a clinical setting, and how relationship perceptions and expectations are associated with treatment outcomes. Bowen's theory of differentiation suggests that healthy relationships require a balance of autonomy and connection. However, some research suggests that contemporary societal expectations are pushing couples to expect greater degrees of closeness and less autonomy. Utilizing a clinical sample of 185 couples from an on-campus Couple and Family Therapy training clinic, this article explores couples' perceptions and expectations of relationship closeness utilizing graphics of overlapping circles. Latent profile analysis was conducted to identify three different profile groups based on perceptions and expectations. Wald tests for significant mean differences among the profiles were performed. Results identified significant differences between the three groups for satisfaction and separateness and connectedness variables, number of sessions and termination.

Understanding African American help-seeking for romantic relationships: Advocacy, barriers, and considerations

African American couples experience greater levels of relationship distress than other racial/ethnic groups, but they are less likely to seek formal couple counseling. Existing literature highlights the importance of community support in the form of church, family, and friends. While the literature suggests that African Americans encounter unique barriers, we do not know how racism and discrimination impact the couple help-seeking process. This study seeks to address this gap and better understand unique barriers in the African American couple help-seeking (AACHS) process via a grounded theory-informed qualitative study. Findings from interviews with 11 African American individuals in committed relationships highlighted mistrust as a significant barrier to AACHS, while community supports are frequently sought out. Our findings add to current understandings about AACHS and highlight important areas for future research. In the clinical implications section, the authors outline tangible steps that clinicians can take based on the findings from this study.

Hoe lang wachten mensen voordat zij hulp zoeken voor relatieproblemen? Een onderzoeksnotitie

Een vaak aangehaalde, maar slecht onderbouwde opvatting over relatietherapie is dat koppels gemiddeld zes jaar wachten voordat zij met relatietherapie beginnen voor ernstige relatieproblemen. Deze opvatting gaat vaak hand in hand met het idee dat veel koppels “te laat” komen en dat de vooruitzichten op herstel niet goed zijn. Dit is de eerste studie met een grote steekproef naar de tijd tussen het begin van de relatieproblemen en de start van relatietherapie (N = 270) of individuele therapie (N = 101). We hebben hierin een gemiddelde interval geconstateerd van 2,68 jaar; vanaf het begin van de problemen tot de start van de relatietherapie. De meeste koppels starten binnen twee jaar met de therapie. De bevindingen voor individuele therapie voor relatieproblemen zijn vergelijkbaar. De belangrijkste klinische implicatie is dat therapeuten zich geen zorgen hoeven te maken over het aantal koppels dat zo lang wacht met therapie dat hun problemen niet meer op te lossen zijn.

Understanding barriers to couples therapy

What prevents couples from entering therapy? Given that the rate of couple help-seeking is low, we need a better understanding of barriers to couple help-seeking. To expand our understanding of these barriers, we asked almost 300 people who expressed an interest in couples therapy, to clarify what kept them from seeking help. A content analysis of participant's responses found six distinctive categories: cost of treatment, logistics, the modality of treatment, trustworthiness, relational factors, and a clear therapeutic process. Additionally, some responses suggested that stigma and concerns around the emotional work involved deterred couples from seeking help. This expanded understanding of barriers to couples therapy can assist both researchers and clinicians address them in more intentional ways.

Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management

PURPOSE OF REVIEW

Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD.

RECENT FINDINGS

Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence-and are influenced by-stressful aspects of acute coronary crises and longer-term patient adjustment and management. Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.

How long do people wait before seeking couples therapy? A research note

A widely cited but poorly supported idea in the couples therapy field is that the average couple waits six years before starting therapy for serious relationship problems. This figure is often accompanied by the notion that many couples come "too late" and have poor prospects for recovery. This is the first large-sample study on the delay between the onset of serious marital problems and entry into couples therapy (N = 270) and individual therapy (N = 101) for relationship problems. We found an average interval of 2.68 years from onset of problems and entering couples therapy, with the great majority of couples entering therapy within two years. Findings were similar for seeking individual therapy for relationship problems. The main clinical implication is that therapists have little reason to be pessimistic about the majority of couples waiting so long before starting therapy that their problems are not resolvable.