Academic journal article Journal of Marital and Family Therapy

Change Processes in Couple Therapy: An Intensive Case Analysis of One Couple Using a Common Factors Lens

Academic journal article Journal of Marital and Family Therapy

Change Processes in Couple Therapy: An Intensive Case Analysis of One Couple Using a Common Factors Lens

Article excerpt

The article describes a research study that explored the process of how change occurred for one distressed couple and a specific therapist in a naturalistic setting. Quantitative and qualitative data were collected on the couple at multiple points in the therapy. A research team comprised of five members met regularly to analyze the data and collectively they arrived at a theory of change for the couple posttherapy. Conclusions are made related to how change occurred for the couple with an emphasis on the role of extratherapeutic events, client motivational factors, the therapeutic alliance, hope and expectancy factors, therapist factors, specific techniques and interventions, and other surprise factors that contributed to change.

Pinsof and Wynne (2000) challenge the marriage and family therapy (MFT) field to close the gap between practice and research. Their article inspired us to study, in detail, the process of change in couples seeking therapy at a midwestern university campus clinic. Our goal was to understand how couples changed without purposefully prescribing a specific type of theory to the clinical work. Using a common factors lens as a guide (Sprenkle & Blow, 2004a, 2004b), we gathered data from couples throughout the course of their therapy, and then, as a research team of five members, analyzed successful cases retrospectively with the intent of arriving at a comprehensive theory of how change occurred for specific couples. In other words, instead of applying a theory of change to a couple and then testing outcomes, we selected couples who achieved positive outcomes as a result of "therapy-as-usual," and then formulated a theory of change for the specific couples posttherapy. This article reports on our theory of change for one distressed couple who changed significantly over a 13-month period that included 15 therapy sessions. We discuss how the research allowed for both an in-depth understanding as well as unexpected discoveries related to clinical change. We make conclusions about the research, about common factors, and about how studying change in an intense way is an ideal means to generate theoretical ideas and enhance our understanding of how change occurs, both in and outside the therapy room.

THE RESEARCH PROBLEM

To date, researchers have accumulated a wealth of data on couples and couple therapy (Bradbury, Fincham, & Beach, 2000; Gottman & Notarius, 2000; Johnson, 2002). We know that therapy helps couples (Shadish & Baldwin, 2002), and that it not only helps with generic relational problems but also can effectively treat disorders such as depression. We also know quite a bit about satisfaction in couple relationships, and what factors might predict relationship stability and divorce (Bradbury et al., 2000; Gottman & Notarius, 2000). However, as Johnson (2002) points out, a central problem remains in our study of couple therapy:

The central issue with regard to research in couple therapy is quite simply that we, as researchers, have not made research clinically accessible and relevant enough, and we, as clinicians, have not seen research as an aid and so we have not used it. (p. 164)

Central to this concern is that much of the current research on couple therapy tells us little about how change occurs in the therapy room, only that it does occur (Sprenkle, 2002; Sprenkle & Blow, 2004a). This limits the ways in which research informs the actual therapy process, given that each therapy encounter is different, requiring different thought processes, moves, and strategies (Pinsof & Wynne, 2000). Beutler, Williams, and Wakefield (1993) report that clinicians desire to read research studies that focus on therapist and/or client behaviors and how these behaviors connect to important moments of change in, therapy. This was one of our primary goals in this research.

Efficacy Research

Efficacy research represents the gold standard for outcome research and consists of clinical trials in laboratory conditions using well-defined treatment manuals adhered to by therapists with high levels of fidelity. …

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