Elsevier

Behavior Therapy

Volume 43, Issue 1, March 2012, Pages 36-48
Behavior Therapy

Common Factors of Change in Couple Therapy

https://doi.org/10.1016/j.beth.2011.01.009Get rights and content

Abstract

Though it is clear from meta-analytic research that couple therapy works well, it is less clear how couple therapy works. Efforts to attribute change to the unique ingredients of a particular model have consistently turned up short, leading many researchers to suggest that change is due to common factors that run through different treatment approaches and settings. The purpose of this article is to provide an empirically based case for several common factors in couple therapy, and discuss clinical, training, and research implications for a common factors couple therapy paradigm. Critical distinctions between model-driven and common factors paradigms are also discussed, and a moderate common factors approach is proposed as a more useful alternative to an extreme common factors approach.

Highlights

► Most change in couple therapy is attributable to factors shared among models. ► The most salient common factors in couple therapy are outlined and discussed. ► The research implications of a common factors paradigm are discussed.

Section snippets

Common Factors and Model-Driven Change: Two Paradigms of How Couples Change

The common factors paradigm stands as an alternative to the model-driven change paradigm. Though we believe there are significant differences between the two paradigms, we also acknowledge that polarizing two paradigms overemphasizes differences and underemphasizes similarities. We outline below what we see as the polarities of these two paradigms, and discuss later our preferred “moderate” common factors approach. The traditional model-driven paradigm assumes that the primary explanation for

The State of the Research Surrounding Common Factors

Randomized clinical trials (RCTs) are widely considered the gold standard for establishing treatment efficacy. In both individual and couple therapy (though there are far fewer RCTs in couple therapy) RCTs routinely demonstrate that the model being tested outperforms treatment as usual and wait-list control conditions. Claims of efficacy solidify as RCTs accumulate for a particular model. However, meta-analytic reviews of RCTs suggest that when RCTs are compared to each other, differences in

Common Factors Shared by Individual and Couple Therapy

Most of the direct empirical support for common factors comes from the individual therapy literature. While much of what makes a good individual therapist likely also makes a good couple therapist, it is possible that there are differences (Blow et al., 2007). However, in most cases the limited direct inquiry into common factors in couple therapy tempers assertions linking common factors in individual therapy to couple therapy. Research reviewed below is for individual therapy unless otherwise

Common Factors Unique to Couple Therapy

Many of the common factors reviewed above apply to individual therapy as well as couple therapy. There may be a few important differences, however, between common factors in individual and couple therapy (Sprenkle et al., 2009).

Extreme Versus Moderate Common Factors Approaches

Although there is general agreement on what common factors are, there is disagreement about the clinical and research implications of common factors. Many scholars have taken what we consider an extreme “either/or” stance on common factors. For example, it is common to hear “All models work the same; therefore models do not matter,” “A strong therapeutic alliance is all that is needed for success,” or “Because meta-analyses reveal that no significant differences between treatments exist,

A Common Factors Couple Therapy Metamodel

The common factors movement is sometimes criticized as providing little more than lists of variables without any guidance as to how and when these variables interact to produce change (Sexton & Ridley, 2004). Similar to the principle- and process-based approaches discussed earlier, a common factors metamodel could address this problem by outlining a framework of conceptual principles and mechanisms of change that could be superimposed over diverse clinical approaches, allowing therapists to

Clinical Implications

Providing clinical guidance for each common factor is beyond the scope of this article. Interested readers can find such guidance in Sprenkle et al. (2009). We limit our discussion to the therapeutic alliance because it is one of the most robust yet complex common factors in couple therapy. Boszormenyi-Nagy coined the term “multidirectional partiality” (Boszormenyi-Nagy & Spark, 1984) to describe a process whereby the therapist actively takes each partner's side, pleading his or her case to his

Conclusion

We believe that the moderate common factors paradigm provides the best explanation of the data suggesting few differences between couple therapy approaches (Shadish & Baldwin, 2002). While much of the relevant research into common factors in couple therapy remains to be done, we nevertheless believe there is enough to suggest a strong basis for the ideas we have covered in this article. We hope that research into common factors in couple therapy will continue to gain momentum.

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