ABSTRACT
Building on and continuing an earlier study, the effectiveness of couple therapy in practice settings in German-language countries was investigated in four independent studies using the same design: naturalistic prospective outcome study with three measurement points. The change in relationship quality was measured over the course of the therapy. In Germany and Switzerland, there is an extensive network of counseling centers run by non-profit organizations providing support to couples, in addition to couple therapists in private practice. Provision of couple therapy to the public is, therefore, on a high level compared to other countries, whereas research on its effectiveness is still scarce. Couple therapy has been found in experimental studies to be efficacious in reducing couple distress with a good effect size (d = 0.8). In naturalistic studies investigating couple therapy in everyday practice, however, the effectiveness is systematically lower (d = 0.5), only 40% of couples can be helped in a clinically significant way and 50% break off early. This discrepancy is known as the efficacy-effectiveness gap. The results reported in this paper show that couple therapy across four settings proved to be significantly effective. With effect sizes of d = 0.36–0.44, a drop-out rate of approximately 50%, and clinically significant improvements for less than 40% of the couples, the hypothesis of the limited effectiveness of couple therapy in real-life practice was further empirically substantiated. The findings confirm the hypothesis of an efficacy-effectiveness gap. Possible reasons for this limited effectiveness are discussed. As a potential way for improving the effectiveness of couple therapy in real life practice, EFT could serve as a potentially more effective method; this should be tested in direct comparison to other methods in the practice field.