Evidence-Based 
Couples Therapy

Why Evidence-Based Therapy

When therapies for couples first emerged in the 1930’s, interventions were based on a multitude of ideas and theories with little or no scientific under-pinning and often unstructured. As a result, there was no way of knowing if they worked, or indeed if they were harmful. Therapies like these are still on offer at couples therapy/counselling practices today.

Since the 1970’s, there have been concerted efforts in the academic community to use scientific methods to learn more about what makes and brakes relationships in order to develop better interventions with clearly defined structure and tools.

At the Bath Couples Therapy Practice, a range of the most effective methods from empirically supported therapies, including the Gottman Method, Cognitive-Behavioural Couples Therapy and Emotionally Focussed Therapy, are employed and adopted to your needs.

I also draw on the wisdom and therapy methods developed by other experts to address in more depth issues such as trust ruptures, intimacy issues, baby decision, mental health issues, jealousy and any other topic relevant to your happiness.

After a comprehensive assessment, I make use of those approaches and methods to construct a bespoke treatment together with you.

What to expect

Guided by the research, I have found that the most successful delivery of therapy involves three distinct stages outlined below.

Stage 1: Assessment

Most people seeking therapy are eager to get started and make gains straight away rather than going through with an assessment. This is completely understandable. So why do most Couples Therapists, including myself, insist on a comprehensive assessment?

Well, you may consider other situations where an assessment is important, for example unexplained medical symptoms, a broken down car or a blue screen on your computer. Without fully diagnosing the problem, any rash remedy is unlikely to be successful. This is equally true for Couples Therapy.

• We cannot solve our problems with the same thinking we used when we created them. (Albert Einstein)

In Couples Therapy, the assessment offers many challenges and complexities. The therapist cannot rely on blood tests, eyeball examination or computer analytic tools to figure out what is going on. In addition, there are two people to understand as well as the intricacies of their interactions and often a long history of issues to consider. For this reason, the assessment is carried out over more than one session to make sure we come as close as possible to the heart of the matter.

• All truths are easy to understand once they are discovered; the point is to discover them. (Galileo Galilei)

The assessment is also a necessary part of the therapy itself, helping you to get a detailed understanding of what is going on in your relationship and how to reach your relationship goals. It is also not uncommon for couples to find the assessment edifying and even fun at times.

• As for the search for truth, I know from my own painful searching, with its many blind alleys, how hard it is to take a reliable step, be it ever so small, towards the understanding of that which is truly significant. (Albert Einstein)

The ultimate aim of the assessment stage is to develop a bespoke treatment programme together. If relevant and preferred, the assessment will be based on the Gottman Method, which is perhaps the most scientifically advanced assessment approach in the world.

The assessment stage is usually made up of two couples sessions and one individual meeting each:

The intake interview is where I invite both of you to talk about your relationship past and present needs and issues, and their relevant history and context. There will be ground rules to make sure you both have equal chance to talk about the things important to you.

The intake interview requires a 90-minute session or two shorter sessions. Many couples report that 90 minutes is not enough to cover everything. For this reason, and that of economy and efficiency, we will also use other methods of assessment, all of them optional. For example, you may be invited to complete some research based questionnaires, either paper-based or online.

The purpose of the individual interviews is to give each of you an opportunity to talk about relevant personal issues and voice thoughts, feelings, and perceptions, which may be difficult to relate in a three-person situation.

It will be explained that everything disclosed should also be open for the other partner to hear. If there are things one partner does not wish the other one to know, then I (unless it relates to safeguarding) will either ask you not to disclose them or discuss with you how a disclosure can form part of the therapy programme. Openness and impartiality are very important in Couples Therapy. I am there for both of you equally and keeping a secret from one of you will make neutrality and the application of effective therapy difficult if not impossible.

The two individual interviews will last 50 minutes each and can be scheduled back-to-back or on separate days.

In the final session of assessment, we will review all the gathered information. I will ask for your feedback about my understanding of your needs and issues, and invite you to add or correct anything wrong or missing. Finally, we will develop a therapy plan together, based on the assessment material, with mutually-agreed, specific and measurable goals. This session is either 50 or 90 minutes, depending on your preference.

Stage 2: Main Application

The main application is where all the therapy methods and tools relevant to your goals will be introduced and practised. It includes, if desired, general methods to strengthen and enhance your relationship. It concerns both what we do in the session and what you do between sessions. Our starting point in all our work will always be the highlighting of and building on your existing knowledge and skills, and relationship strengths.

Home Application

It is likely that you will be invited to carry out therapy activities between sessions. The best way to make Couples Therapy work effectively is to practice at home what you learn and discover in therapy. Many couples find these home activities gratifying and even fun at times.

Number of Sessions

The number of sessions of the main application are determined by you. Factors that will influence the speed of progress in therapy include the severity and longevity of the presenting issues, and the motivation and commitment of both of you. The more time and effort you devote to the therapy, the quicker the progress is likely to be.

There is some general guidance in the research literature to help you decide what would be best for you. For example, for less complex needs, less than six sessions could provide you with sufficient progress so to conclude the therapy and if applicable, continue and further develop the therapeutic work yourself. For more complex needs, there is some evidence to suggest that weekly sessions (6 to 12 sessions) is the most effective. Some couples need and request more than 12 sessions.

Spacing of Sessions

There is strong research evidence to suggest that sessions need to take place either weekly or fortnightly during the first phase of the main application. Longer gaps between sessions reduce the efficacy of the therapy.

About half into therapy, we will "phase out" our work by having longer breaks between sessions in order for you to test out what you have learned and discovered, and prepare for the end of therapy.

Duration of Sessions

Sessions last either 50 or 90 minutes depending on your preferences and the nature of the work we are doing. If there are many or complex issues to address, 90-minute consultations are recommended for the main application of therapy. Research has found that with 90-minute sessions, more progress is achieved. Indeed, it has been found that the last 40 minutes of a 90-minute consultation can be particularly productive. Also, the consultations need to be long enough for each of you to express yourselves fully.

Stage 3: Follow-up Application

You decide whether or not you want follow-up sessions and how many you want. Research has shown that follow-up sessions support the maintenance of gains made in therapy. The objectives are to fine-tune what you have learned, to coach you in developing new ways of connecting and dealing with issues as needed, and to receive support and encouragement on your new and more happy relationship journey.

If you wish to take up this offer, there are two types of follow-up services. One follows the Gottman Method evidence-based recommendation, which involves four 60 or 90 minutes sessions at 6, 12, 18 and 24 months after the end of the main application of therapy.

In the second option, you simply choose the number and spacing of the follow-up consultations yourselves.

Don't hesitate to contact me if you like to know more.