Although a sizeable amount of research has investigated and demonstrated the effectiveness of couple therapy, a substantial number of couples still do not receive the optimal benefits of statistically and clinically significant change. This highlights the importance of moving from if to how couple therapy is effective. More specifically, it is important to understand client experience in therapy and those factors that influence both the course and outcome of therapy. This would facilitate the ability to more effectively adapt treatment to the needs of clients. Client-treatment matching research has attempted to accomplish this, but results have been disappointing as it has primarily focused on matching treatment models to specific diagnoses. A common factors perspective provides the insight that the core ingredients of change that exist across treatment models may be confounding results. If this is the case, it would be important to understand client-treatment matching from a more process-oriented approach that looks at how specific client and treatment characteristics interact to influence client experience and ultimately treatment outcome. This study sought to begin looking at treatment process from a common factors perspective by looking at how attachment as a client characteristic interacted with a low (semi-natural) or high (therapy-like) structure interactional context to influence two indicators of emotional experience, physiological arousal and interpersonal distress. Emotional experience, as defined by emotional processing and regulation, ultimately influences emotional expression and has been shown to influence therapeutic outcomes. Findings appear to indicate that attachment influences emotional experience and provides preliminary evidence that taking into account attachment may be useful in improving outcomes. Specific relationship process, clinical, and research implications are discussed. Overall, it is hoped that this study will provide the impetus for additional work that will continue to investigate how attachment and other client characteristics interact with elements of therapy process to positively influence client experience and outcomes. This will then facilitate the more effective adaptation of treatment to the specific needs of clients.
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