Couples' agreement on presenting problems predicts engagement and outcomes in problem-focused couple therapy

This study investigated the impact of couples' agreement regarding relationship problems at therapy intake on subsequent treatment engagement and success. One hundred and 47 couples seeking marital therapy at one of two Veteran Administration Medical Centers completed questionnaires assessing relationship satisfaction and were asked to indicate their three biggest relationship concerns. Agreement on relationship concern was defined as one person's list containing the partner's top relationship problem. Pretreatment agreement on relationship problems was unrelated to treatment course or outcomes when the therapy was longer and more integrative in nature. However, when couples received a brief, problem-focused treatment, agreement predicted greater engagement in therapy process and more positive treatment outcomes. Specifically, couples who were in agreement were more likely to attend the minimum number of required sessions and were more likely to be assessed as having received a full course of therapy by their treatment provider. Additionally, partners who agreed with each other were more likely to experience clinically significant changes during treatment. Taken together, results suggest that therapists and researchers should consider assessing agreement on relationship problems at the beginning of treatment and potentially suggest that couples who perceive their relationship differently should receive more integrative treatment. Future research is needed to examine the most effective sequencing for addressing differing, presenting problems as well as the mechanisms through which disagreement on presenting problems impacts treatment course and outcomes.