Couples therapy

Impact on crime
Evidence quality 4
Effect
How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 1
Moderator
How to do it
what full Evidence quality 0
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

What is the focus of the intervention?

Couples therapy is a means of attempting to resolve problems or conflict between two intimate partners. It involves both partners simultaneously meeting with a trained professional to undergo therapy.

Couples therapy is an alternative approach to gender-specific therapy or individual treatment which are programmes that often experience high dropout rates and sometimes have unwanted consequences such as the normalisation of aggressive behaviours and antisocial peer influences.

The focus of the review is on whether couples therapy can help adult, heterosexual couples to reduce mild-moderate (not defined in the review), situational domestic violence in their relationships. Situational violence in this context refers to violence between partners in response to specific stressors or life events.

The review focussed exclusively on the frequency of male-to-female physical violence. It did not include an assessment of the impact of the intervention on coercive control in these relationships.

This narrative is based on one meta-analytic review covering six studies. The primary studies in the review were all randomised control trials (RCTs) based on evidence from the United States.

 

EFFECT

How effective is it?

Overall, the evidence suggests that couples therapy has reduced instances of mild-moderate, male-perpetrated, situational relationship violence against females.

The meta-analysis of six studies found that domestic violence was significantly reduced through couples therapy when compared to an alternative, comparable form of therapy or no-treatment. However, the findings were heavily influenced by a single study due to its large sample size relative to the other studies. Although the effect sizes of most of the other studies were similar to this larger study, sensitivity analysis where the review authors remove the largest study shows similar effects but loses statistical significance. All studies used self-reported violence frequency measures before the intervention and as a follow-up measure.

How strong is the evidence?

The review was sufficiently systematic that most forms of bias that could influence the study conclusions can be ruled out. 

This evidence is taken from a meta-analytic review covering six studies, which demonstrated a high quality design in terms of having a transparent and well-designed search strategy, sufficiently assessing the risks associated with a number of possible biases, and weighting studies appropriately.

The primary studies included in the review were of moderate to high quality. However, attrition bias (where participant dropout rates may influence the effect of the study) may have been present in some of the primary studies. Not all of the studies reported data on dropouts and it is possible that participants with certain (unspecified) characteristics leave a study more frequently than others.

MECHANISM

How does it work?

The review proposes that couples therapy functions on a systemic level (individual, couple, societal, and intergenerational) and is effective when treating couples with dysfunctional relational patterns.

The review authors note that the key to effectively treating couple violence may be accurately classifying the violence in order to facilitate the prescription of specifically tailored therapies.

However, these assumptions were not empirically tested, as the original studies did not provide the necessary information to do so.

 

MODERATORS

In which contexts does it work best?

The review authors stress that the findings from this meta-analysis can only be applied to instances of mild-moderate, situational couple violence (as described in the first section of this narrative). However, the review authors suggest that based on empirical evidence and theory there is reason to believe couples therapy may be particularly effective for treating situational violence among couples who do not wish to separate.

The review authors suggest that the setting of treatment, for example as an outpatient or within a healthcare organisation, may be an important aspect, as couples may respond differently to therapy depending on the environment. Although the review did not find any influence of setting on the effectiveness of couples therapy, the review authors note that more targeted research would be needed to determine whether this is an important factor when treating domestic violence.

IMPLEMENTATION

What can be said about implementing this initiative?

The review gave no account of how the intervention was implemented, or of any implementation challenges which the primary studies encountered.

ECONOMIC CONSIDERATIONS

How much might it cost?

The review did not mention the costs or benefits of couples therapy, and no formal economic analysis was provided.

General considerations

  • Clinicians, case workers and some researchers have raised concerns that talking about sensitive topics in couples therapy sessions results in increased tension, which in turn creates a risk of domestic violence for the victims as well as the worry of a violent retaliation after a session.
  • Further research is needed to understand how couples experiencing different types of violence react to couples therapy. The review authors recommend using couples therapy only after careful assessment for the suitability of couples therapy for that particular couple, and after taking necessary precautions to ensure the safety of both partners.
  • Couples who participated in the primary studies had a mean age of 34 years, with approximately 70% of couples identifying themselves as White and approximately 21% of couples identifying themselves as African American. All studies involved heterosexual couples. This might make it difficult for the findings of the review to be generalised to other populations.  

Summary

There is evidence from this review that couples therapy is effective in reducing mild-moderate, male perpetrated situational domestic violence in relationships. Situational violence in this context refers to mutual violence between partners in response to specific stressors or life events. The evidence is taken from a meta-analytic review covering six studies, all of which were of moderate to high quality. The review proposes that couples therapy functions across individual, couple, societal and intergenerational levels and may be effective for treating situational violence among couples who do not wish to separate. Some concerns have been raised about a risk of increased violence or retaliation violence following couples therapy sessions and the review authors recommend that careful assessment of suitability be undertaking on a case by case basis, taking precautions to ensure the safety of both partners. There is no information on the implementation or costs of couples therapy in this context.

Ratings for Individual Reviews

Review 1

How it works
cog full Evidence quality 1
Mechanism
Where it works
where full Evidence quality 1
Moderator
How to do it
what full Evidence quality 0
Implementation
What it costs
cost empty Evidence quality 0
Economic cost

Resources

Review 1: Karakurt, G., Whiting, K., van Esch, C., Bolen, D.S. & Calabrese, J.R. (2016) 'Couple therapy for intimate partner violence: A systematic review and meta-analysis', Journal of Marital and Family Therapy 42(4): 567–583.

 

This narrative was prepared by UCL Jill Dando Institute and was co-funded by the College of Policing and the Economic and Social Research Council (ESRC).  ESRC Grant title: 'University Consortium for Evidence-Based Crime Reduction'.  Grant Ref: ES/L007223/1.


Uploaded 05/01/2018

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