DIFFERENCES IN COUPLES PRESENTING IN THERAPY : A STUDY OF THE RATES AND TRAJECTORIES OF CHANGE

Couple and Family Therapists (CFTs), like other mental health professionals, set out to help clients address the various stressors in their lives. This is complicated, especially in that the therapist has to work with more than one person in session, and needs to manage the differing expectations and readiness for change in therapy in the couple. This complexity contributes to high dropout rates in couple therapy with premature termination rate of nearly 50% being common in this work. These rates of dropout have consequences for everyone involved, including couples and their families, funders of therapy and the community at large (Anker et al., 2009; Bartle-Haring et al., 2007; Knobloch-Fedders et al., 2015; Reese et al., 2009; Ward & McCollum, 2005; Wong et al., 2013; Yoo et al., 2016). The couple therapy literature has hypothesized a number of reasons for high dropout rates in couple therapy, one such being that clients require different dosages of therapy and that change happens at different rates (e.g., Roos & Werbert, 2013; Saxon et al., 2017; Stulz et al., 2007; Swift & Greenberg, 2012). This would suggest that there are different types of clients who present for therapy, and that these clients need something different in the process. One way to address these differences would be to understand more about the needs of couples in the intake process. While CFTs have assessed presenting issues and levels of distress through a number of methods, often self-report assessments at intake (e.g., Beck et al., 1988; Busby et al., 1995; Lambert, 1992; Lambert et al., 2005), these measures have rarely been used as an effective tool to help with treatment planning. Previous literature has discussed the idea of identifying types, or profiles, of couples that present for therapy. This idea of taxons, or profiles, has been explored using a number of qualifiers, such as mandates to therapy, clinical cut-off scores on assessments, and demographic factors (Beach et al., 2005; Whisman et al., 2008; Wong et al., 2013). When creating these profiles based on clinical cut-off scores, it has been the practice to combine both members’ scores to form one single product score to represent the entire couple, rather than treating each member separately. However, this research on profiles has been underexplored. Therefore, to expand on the existing literature base, the current study used a latent profile model to explore the possibility of different profiles of couples who present for therapy. A sample of 188 couples, who were former clients of a university-based CFT clinic at a large Midwestern university were analyzed. Intake scores from three assessments measuring both individual and relational distress were used for each individual. Scores for each member of the couple were included in the analyses, rather than forming a single product score for the couple. Results indicated that four distinct profiles of couples exist: male-distressed, no-distress, relational-distress, and high distress. Using a series of generalized linear models, differences between couple profiles in dosage and treatment response were examined, including likelihood of premature termination. A Multivariate Linear Mixed Model was used to explore differences in therapy trajectory between profiles. Significant differences in dosage, treatment response, and therapy trajectory were found between profiles. Implications and future directions for research are discussed.