A fundamental premise of systemic therapy is that each part of a system is interconnected with every other part; that changes in a couple relationship will influence the parenting subsystem and children. While studies have demonstrated that couples therapy improves relationship quality and individual symptomatology, less attention has been paid to its impact on co-parenting and child adjustment despite our understanding that couple difficulties spill over into parenting directly affecting children’s wellbeing.
A study by Darwiche et al 2022 compared the effectiveness of the Integrative Brief Systemic Intervention, a 6-session therapy addressing both co-parenting and the couple relationship with Brief Systemic Intervention. Both resulted in significant improvements in individual, romantic, coparenting, and family relationships at the conclusion and 6-month follow-up with the authors postulating that this may reflect ‘shared mechanisms of systemic change’.
What Happens Long Term?
In an additional study, the authors examined the individual, couple, and family trajectories of both groups one year after therapy. They sought to determine whether changes were maintained, strengthened, or reduced, and links between these trajectories and treatment-related factors and family characteristics. Understanding these connections is important given that research has reported that 35% to 50% of couples experience decline in their relationship or divorce after therapy ends.
Post therapy trajectories were assessed in three ways. Firstly, they explored whether changes made in therapy were sustained a year later. A second question was to understand if couples differed in their post therapy outcomes and finally which treatment related and family variables predicted outcomes.
What Did They Find?
Results showed that changes made at the conclusion of both therapies were sustained a year later. However, five distinct patterns of change were identified characterised by varying levels of individual symptoms and coparenting and romantic relationship satisfaction. The majority of couples occupied Groups 1 and 2 and showed stable trajectories with high relationship quality and low symptomatology. Group 3 and 4 reflected gender-specific patterns with men in group 3 exhibiting higher individual distress and women in group 4 reporting greater individual distress and lower romantic and co-parenting relationships. Those in group 5 reported lower romantic and co-parenting satisfaction with little impact on individual distress or child adjustment.
Those who received Integrative Brief Systemic Intervention were more highly represented in the most favourable Group 1, suggesting that intervention which addresses both co-parenting and the couple relationship may provide a more stable basis for sustained change.
Context is also important, with couples with young children and larger families showing fewer positive outcomes. Longer relationships were also associated with those in group 4 where women report greater distress. One explanation is that women, who are often the initiators of therapy, may be embedded in relationship patterns that are harder to change in long term relationships and that brief therapy is insufficient to address these dissatisfactions.
In Conclusion
These results point to the importance of assessing long term outcomes on an individual basis rather than assuming the overall positive outcomes following couples therapy apply to all clients. Practitioners may offer additional or different follow-up for those who do not fall into the first two categories. In addition, these results highlight life cycle and relationship variables which may entail a greater burden on one person in the relationship, which should be explored and addressed if long term benefits are to be sustained. Appreciating that therapy may not finish with the last session can allow additional supports and services to be offered to couples as they face life transitions and stressors that threaten the positive changes they have made.
Darwiche, J., Nunes,C., Vowels,L., Esther Liekmeier,E., Antonietti,J. Post-Therapy Trajectories Following Brief Systemic Couple Therapy for Parents Family Process Vol 65,No 1
https://doi.org/10.1111/famp.70114
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