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Evidence Base

CoupleCARE has been developed based on a program of research across the last 30 years. Some of that research has been basic research informing our understanding of what makes for a great couple relationship. That research has informed the content of CoupleCARE. For example, an extensive program of research on couple relationship standards (what people believe should be in a great relationship, and how standards vary by family-of-origin experiences and culture, informed the content in the first unit of CoupleCARE. In that unit partners are asked to reflect on their family-of-origin experiences, and how that might shape their ideas about relationships,  The CoupleCARE program has been evaluated in eight randomized controlled trials, all of which have been published in major international journals. In summary, the research shows that CoupleCARE helps couples learn crucial relationship knowledge and skills, and helps them sustain long-term relationship satisfaction. As well as assisting currently satisfied couples, trails suggest that CoupleCARE can help couples with mild to moderate distress to enhance their relationship satisfaction. There seem to be useful benefits for couples who have mild to The research also shows that CoupleCARE can be effective when delivered in traditional face-to-face mode or in a flexible delivery mode with couples completing the program in the privacy of their own home.

Research Abstracts

Bouma, R. O., Halford, W. K., & Young, R. M. (2005). Evaluation of the Controlling Alcohol and Relationship Enhancement (CARE) program with Hazardous Drinkers. Behaviour Change, 21, 1-22.

This paper reports on a randomised controlled trial of a program that combined Couple CARE with a brief counselling program to reduce problem drinking. The combined program was called the Controlling Alcohol and relationship Enhancement (CARE) program. Thirty-seven couples were randomly assigned to receive either CARE or a control condition. All the couples in the study had at least one partner who drank heavily. CARE enhanced couple communication, reduced problem drinking, and increased couple commitment to staying together.

Halford, W. K. (2011) Marriage and relationship education: what works and how to provide it. New York: Guilford.

This book describes the research on the influences on couple relationships, the different approaches to couples relationship education and their effectiveness, and how to conduct the Couple CARE program in face-to-face sessions. Rich in procedural detail it provides specific examples of how to use group processes to enhance couple relationship education.

Halford, W. K., & Bodenman, G. (2013). Effects of relationship education on maintenance of couple relationship satisfaction. Clinical Psychology Review, 33(4), 515-525. doi: 10.1016/j.cpr.2013.02.001

Couple relationship education (RE) is the provision of structured education intended to promote healthy couple relationships, and prevent future relationship distress. There is a well-replicated finding that 9-20 hours of curriculum-based RE produces short-term improvements in couple communication and relationship satisfaction, but that established finding does not test whether RE helps couples maintain high relationship satisfaction. The current paper summarizes 17 published studies evaluating RE that have follow up assessments of at least 1 year, of which 14 studies found RE helped maintenance of relationship satisfaction. Couples with elevations of modifiable risk factors benefit substantially from RE, while benefits for couples with low risk have not yet been reliably demonstrated. Couples with elevations on risk factors not readily modified by current forms of RE are likely to show little or no benefit.  Future research needs to clarify the mediators of RE effects, and how those mediators are moderated by couple risk profiles.

Halford, W. K., Chen, R., Wilson, K. L., Larson, J., Bussby, D., & Holman, T. (2012). Does therapist guidance enhance assessment-based feedback as couple relationship education? Behavior Change, 29(4) 199-212. doi:10.1017/bec.2012.20

Assessment and feedback of relationship strengths and challenges is a widely used brief approach to couple relationship education (CRE). It can be fully automated through the internet, with couples self-interpreting the feedback. This study assessed whether therapist guidance of couples to interpret the report and develop relationship goals enhanced the benefits of the feedback. Thirty-nine couples seeking CRE were randomly assigned to either self-interpretation of an internet-based relationship assessment report (RELATE), or therapist-guided interpretation of the same report (RELATE+). Participants were assessed on relationship satisfaction and psychological distress pre- and post-CRE, and at 6-month follow-up. RELATE and RELATE+ were not reliably different in outcome. Couples in both conditions sustained high relationship satisfaction and showed an overall decline in  psychological distress. However, consumer satisfaction was substantially higher for the
RELATE+ condition than the RELATE condition.

Halford, W. K., Lizzio, A., Wilson, K.L., & Occhipinti, S. (2007). Does working at your relationship help? Couple relationship self-regulation and satisfaction in the first 4 years of marriage. Journal of Family Psychology, 21, 185-194.

It has been proposed that the extent that individual partners work at their relationship, referred to as relationship self-regulation, is an important determinant of the extent to which couples sustain relationship satisfaction. We recruited 187 newlywed couples and had them complete assessments of relationship self-regulation and satisfaction across the first four years of marriage. As might be expected, just after marriage almost all couples showed high relationship satisfaction, but there was a gradual decline in average satisfaction across the next four years. Multi-level modelling showed that, as predicted relationship, individual partner self-regulation predicted couples better sustaining their initial high relationship satisfaction. The current study adds to the literature suggesting that working at your relationship does work.

Halford, W. K., Petch, J., & Creedy, D. K. (2010). Promoting a positive transition to parenthood: A randomized clinical trial of couple relationship education. Prevention Science, 11, 89–100. doi: 10.1007/s11121-009-0152-y

The transition to parenthood is often associated with a decline in couple relationship adjustment. Couples (n = 71) expecting their first child were randomly assigned to either: (a) Becoming a Parent (BAP), a maternal parenting education program; or (b) Couple CARE for Parents (CCP), a couple relationship and parenting education program. Couples were assessed pre-intervention (last trimester of pregnancy), post-intervention (5 months postpartum), and follow-up (12 months postpartum). Relative to BAP, CCP reduced negative couple communication from pre- to post-intervention, and prevented erosion of relationship adjustment and self-regulation in women but not men from pre-intervention to follow-up. Mean parenting stress reflected positive adjustment to parenthood with no differences between BAP and CCP. CCP shows promise as a brief program that can enhance couple communication and women’s adjustment to parenthood.

Halford, W. K., Petch, J., Creedy, D. K., & Gamble, J. (2011). Intimate partner violence in couples seeking relationship education for the transition to parenthood. Journal of Couple and Relationship Therapy, 10, 152-168. doi:10.1080/15332691.2011.562835

Intimate partner violence (IPV) is a prevalent and common problem yet is rarely screened for, or addressed in, couple relationship education (CRE). The current study examined the prevalence of IPV in 250 couples expecting their first child who were recruited into a study of CRE across the transition to parenthood. The couples were generally highly satisfied with their relationship, yet 32% reported at least one incident of IPV in the past 12 months, and 7% reported that at least one spouse had been injured by IPV. The majority of violence was of low severity (pushing, slapping, or shoving), and the most common pattern was of reciprocal aggression between the partners. Given that even low-severity IPV is associated with significant risk of injury and predicts risk of relationship separation, these high rates of IPV are concerning. CRE providers for expectant couples need to attend to prevention of IPV within their programs.

Halford, W. K., & Wilson, K. L. (2009). Predictors of relationship satisfaction four years after completing flexible delivery couple relationship education. Journal of Couple and Family Therapy, 8, 143-161.

The aim of the current study was to test predictors of sustained relationship satisfaction after couple relationship education (CRE). 66 couples were stratified into high- and low-risk for future relationship problems, completed the Couple CARE program, and were assessed on relationship self-regulation (RSR) and negative couple communication after CRE. Relationship satisfaction was assessed across the next four years. Multi-level modelling of the trajectory of satisfaction showed there was mean decline in satisfaction through the 4-year follow-up, and that sustained high relationship satisfaction after CRE was predicted by high RSR and low male negative communication, but not by risk level or negative female communication.

Halford, W. K., Wilson, K. L., Watson, B. Verner, T., Larson, J., Busby, D., & Holman, T. (2010). Couple relationship education at home: does skill training enhance relationship assessment and feedback? Journal of Family Psychology, 24, 188-196

In order to evaluate the effective components of couple relationship education, 59 newlywed couples were randomly assigned to one of two couple relationship programs (CRE): (1) RELATE, which involved receiving feedback on their relationship based on the on-line RELATE assessment; or (2) RELATE + Couple CARE, which was RELATE plus completing the 6 unit Couple CARE relationship skill training program. Relative to RELATE, RELATE + Couple CARE produced more improvement in couple communication, and high relationship satisfaction across the next 12 months in women. Men sustained high and similar relationship satisfaction in either condition. Skill training CRE has additional benefits for couples beyond assessment and feedback.

Halford, W. K., Rahimullah, R., Wilson, K. L., Occhipinti, S., Busby, D., & Larson, J. (in press). Four year effects of couple relationship education on low and high satisfaction couples: A randomized clinical trial. Journal of Consulting and Clinical Psychology.

Objective. Relationship education (RE) usually is conceived of as relationship enhancement for currently satisfied couples, with a goal of helping couples sustain satisfaction. However, RE also might be useful as a brief, indicated intervention for couples with low satisfaction. The current study evaluated the effect of RE on couples with low and high relationship satisfaction. Method. The study was a randomized controlled trial in which 182 couples were randomly assigned to: a book reading control condition (control); RELATE online assessment with feedback and relationship goal setting (RELATE); or RELATE with CoupleCARE (RCC), a flexible delivery skill-based education program. Couples were assessed on relationship satisfaction and individual mental health before and after RE, and through to 4 year follow-up. Results. Couples with high initial satisfaction showed no effects of RE on satisfaction. RCC but not RELATE increased satisfaction in couples with low initial satisfaction, but effects dissipated between 6 and 12 months after RE. There were no effects of RE on mental health.  Conclusion. Flexible delivery RE produces immediate effects as an indicated early intervention for couples with low relationship satisfaction, but the effects attenuate. Future research needs to seek methods to produce better maintained effects. 

Halford, W. K., Moore, E. M., Wilson, K. L., Dyer, C., & Farrugia, C. (2004). Benefits of a flexible delivery relationship education: An evaluation of the Couple CARE program. Family Relations, 53, 469-476.

The current study evaluated Couple CARE, a flexible delivery relationship education program. Fifty-nine couples were randomly assigned to either Couple CARE or a control condition and assessed on relationship self-regulation, satisfaction and stability, and communication. Retention, engagement, and satisfaction with the program were all high.
As predicted, Couple CARE increased relationship satisfaction and stability, and increased women’s report of relationship self-regulation, but did not have the predicted effect on communication.

Halford, W. K., O’Donnell, C., Lizzio, A., & Wilson, K. L. (2006).  Do couples at high-risk of relationship problems attend pre-marriage education? Journal of Family Psychology, 20, 160-163.

The effectiveness of pre-marriage education is limited by whether couples at high risk of future marital problems attend such education. In the current study 374 newly married couples were assessed on a range of risk factors for future marital problems, and whether they had attended marriage education. Couples with certain indices of relationship risk (non-religious and pre-marital cohabitation) were underrepresented in pre-marriage education. Suggestions are offered to attract more couples, particularly those at high-risk for future problems, to relationship education.

Halford, W. K., Pepping. C., Hilpert, P. Bodenmann, G., Wilson, K.L., Busby, D., Larson, J., & Holman, T. (2015). Immediate effect of couple relationship education on low satisfaction couples: A randomized clinical trial plus an effectiveness trial replication. Behavior Therapy, 46 (3) 409-421. doi:10.1016/j.beth.2015.02.001

Couple relationship education (RE) usually is conceived of as relationship enhancement for currently satisfied couples, with a goal of helping couples sustain satisfaction. However, RE also might be useful as a brief, accessible intervention for couples with low satisfaction. Two studies were conducted that tested whether couples with low relationship satisfaction show meaningful gains after RE. Study 1 was a three condition randomized controlled trial in which 182 couples were randomly assigned to RELATE with Couple CARE (RCC), a flexible delivery education program for couples, or one of two control conditions. Couples with initially low satisfaction receiving RCC showed a moderate increase in relationship satisfaction (d = 0.50) relative to the control. In contrast, couples initially high in satisfaction showed little change and there was no difference between RCC and the control conditions. Study 2 was an uncontrolled trial of the Couple Coping Enhancement Training (CCET) administered to 119 couples. Couples receiving CCET who had initially low satisfaction showed a moderate increase in satisfaction (g = .44), whereas initially highly satisfied couple showed no change. Brief relationship education can assist somewhat distressed couples to enhance satisfaction, and has potential as a cost effective way of enhancing reach of couple interventions.

Halford, W. K., Sanders, M. R., & Behrens, B. C. (2001). Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program. Journal of Family Psychology, 15, 750-768.

Eighty-three couples were stratified into high- and low-risk for relationship distress and randomized to either a behavioural relationship education program focused on self-change (this is a face-to-face early version of Couple CARE) or a control condition involving reading and discussion about couple relationships. As predicted, there were differential effects of Couple CARE on high- versus low-risk couples. Low statistical power means results must be interpreted cautiously, but at 1-year follow-up high-risk Couple CARE couples showed trends to better communication than control couples, but there was no difference in the communication of Couple CARE versus Control low-risk couples. High-risk couples receiving Couple CARE had higher relationship satisfaction at 4 years than control couples, but nit in low-risk couples. High-risk couples benefited from skills-based Couple CARE relationship education, but low-risk couples did not.

Halford, W. K., Sanders, M. R., & Behrens, B. C. (2000). Repeating the errors of our parents? Parental violence in the family of origin and observed communication in engaged couples. Family Process, 39, 219-235.

This paper is part of a program of research identifying risk factors for marital problems. Based on a developmental social learning analysis, it was hypothesized that observing inter-parental violence predisposes partners to difficulties in managing couple conflict. Seventy-one engaged couples were assessed on their observation of inter-parental violence in their family of origin. All couples were videotaped discussing two areas of current relationship conflict and their cognitions during the interactions were assessed using a video-mediated recall procedure. Couples in which the male partner reported observing parental violence (male-exposed couples) showed more negative affect and communication during conflict discussions than couples in which neither partner reported observing parental violence (unexposed couples). Couples in which only the female partner reported observing parental violence (female-exposed couples) did not differ from unexposed couples in their affect or behaviour. Female-exposed couples reported more negative cognitions than unexposed couples, but male-exposed couples did not differ from unexposed couples in their reported cognitions. Observing parental violence when growing up is associated with observable negativity in the adult relationships of offspring.

Markman, H. J., & Halford, W. K. (2004). International perspectives on couple relationship education. Family Process, 44, 139-146.

As a field, family psychology is faced with challenges in reaching people who need services. Many reviews are available that document how much high-quality, research based couple therapy can help distressed couples. However, we know that in the United States the majority of couples who have divorced (about 80%) have not consulted a mental health professional. In other words, practitioners generally have poor penetration in their efforts to help couples who are on a trajectory towards divorce and other negative outcomes. And certainly, most couples do not consider going to a mental health professional when they are getting married, even if they already are manifesting patterns that ultimately undermine their happiness and stability. In this special section of this issue of the journal we focus on international trends in a new set of services and service delivery systems that have the potential of reaching couples and individuals to improve couple functioning: couple relationship education.

Petch, J., Halford, W. K., Creedy, D. K., & Gamble, J. (2012). A randomised controlled trial of a couple relationship and co-parenting program (Couple CARE for Parents) for high- and low-risk new parents. Journal of Consulting and Clinical Psychology, 80 (4), 662-673. DOI: 10.1037/a0028781.

Objective: This study evaluated the effectiveness of couple relationship education in assisting couples to sustain relationship functioning and parenting sensitivity, and whether benefits were moderated by risk of maladjustment in the transition to parenthood (“risk’).  Method: Two hundred and fifty couples expecting their first child were assessed on risk and randomly assigned to Couple CARE for Parents (CCP) a couple relationship and co-parenting focused education program (n = 125) or the Becoming a Parent Program (BAP) a mother-focused parenting program (n = 125). Couples completed assessments of their couple relationship during pregnancy, after intervention at 4 months postpartum, and at 16 and 28 months postpartum. Observed parenting and self-report parenting stress were assessed at 4 months postpartum, and parenting stress was assessed again at 16- and 28-months postpartum. Results: Risk was associated with greater relationship and parenting adjustment problems. Relative to BAP, CCP women decreased their negative communication and showed a trend to report less parenting stress irrespective of risk level. High-risk women receiving CCP reported higher relationship satisfaction, and were less hostile and intrusive in their parenting, than high-risk women receiving BAP. There were no effects of CCP on sensitive parenting for women, and no effects of CCP for men on any outcome. Conclusions: CCP is a potentially useful intervention, but benefits are primarily for high-risk women. 

Sanders, M. R., Halford, W. K., & Behrens, B. C. (1999). Parental divorce and communication in engaged couples. Journal of Family Psychology, 14, 60-78.

It is known that parental divorce increases the risk of relationship problems and divorce in adult offspring, particularly for women. One possible explanation of the long term effects of parental divorce is that observing the negative conflict often associated with divorce may lead offspring to adopt similar negative patterns of communication with a partner. In order to test this proposition, we assessed the communication of engaged couples that did or did not have a history of parental divorce. Couples in which the woman’s parents had divorced were more negative toward each other than other couples. A history of parental divorce in the man’s family was not associated with couple communication. Programs that help couples develop effective conflict management might help reduce the risk of relationship problems in the adult offspring of divorce.

Scott, J. L., Halford, W. K., & Ward, B. (2004). United we stand? The effects of a couple-coping intervention on adjustment to early stage breast or gynaecological cancer. Journal of Consulting and Clinical Psychology, 72, 1122-1135.

Cancer diagnosis affects the psychological wellbeing of both patients and their partners, and effective coping has been suggested to be a conjoint process of mutual support. Ninety-four married women with early stage cancer and their partners were randomly assigned to couple-based coping training (CanCOPE), individual coping training for the woman, or a medical education control. Couples’ observed support communication, and self-reported psychological distress, coping-effort and sexual adjustment were assessed at diagnosis, after cancer surgery, and at 6- and 12-month follow-ups. CanCOPE produced significant improvements in couples’ supportive communication, reduced psychological distress and coping effort, and improved sexual adjustment. Training in couple rather than individual coping was more effective in facilitating adaptation to cancer. The CanCope program incorporated a number of elements of the Couple CARE program adapted to account for the unique challenges of cancer diagnosis and treatment, and added content specifically on how the partners could support each other during this shared journey.

Wilson, K. L., Charker, J., Lizzio, A., Kimlin, S., & Halford, W. K. (2005). Assessing how much couples work at their relationship: the Behavioral Self-Regulation for Effective Relationships Scale. Journal of Family Psychology, 91, 385-393.

It is widely believed that satisfying couple relationships require work by the partners. We equated the concept of work to relationship self-regulation and developed a scale to assess this construct. A factor analysis of the scale in a sample of 187 newlywed couples showed it had a two factors of relationship strategies and effort. The factor structure was replicated in an independent sample of 97 newlywed couples. In both samples the scale had good internal consistency, and high convergent validity between self- and partner report forms. Self- regulation accounted for substantial variance in relationship satisfaction in both newlywed samples, and in a third sample of 61 long-married couples. The self-regulation and satisfaction association was independent of mood or self-report common method variance.

Wilson, K. L., & Halford, W. K. (2008).  Processes of change in the flexible delivery of couple relationship education.  Family Relations 57, 625-635.

The current study examined the learning processes involved in professionally supported self-directed Couple Relationship Education (CRE). Fifty-nine couples completed Couple CARE, a systematic self-directed couple relationship education program designed so that it can be completed at home.  The learning processes involve couples watching a DVD introducing key relationship ideas and skills, and then completing a structured guidebook which helps them to apply the skills to their relationship and to focus their self and relationship change efforts.. The process is supported by six telephone-based coaching sessions from a professional relationship educator. Couples completed and valued the vast majority of learning tasks associated with the program, successfully implemented a wide range of relationship self-change, and most reported continuing implementation of program learning at six months follow-up. These results suggest that Couple CARE is readily accessible, and results in effective skill acquisition for couples.







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