F - cripcas

Clients’ Characteris6cs and Therapists’ Percep6on of Clients’ Difficulty Level and Capacity to Engage in Couple Therapy Les caractéris(ques des clients et la percep(on du thérapeute quant au niveau de difficulté du couple et sa capacité à s’engager envers la thérapie Melissa Callaci, Virginie Arpin, Alexandra Hart, & Katherine Péloquin Ph.D Université de Montréal Abstract Understanding factors related to marital therapy outcome is necessary (Snyder et al., 2006). How therapists perceive their clients is an important aspect of the therapeu(c rela(onship and is likely to impact the course of therapy (Wills, 1978). Most inves(ga(ons of clients’ factors in couple therapy, however, are imbedded in outcome studies relying on strict inclusion criteria and focusing on one approach (Perkins, 2010). This may limit the iden(fica(on of influen(al factors in natural seZngs. The present study examined rela(ons among therapists’ ini(al percep(on of their clients and clients’ characteris(cs in 141 couples seeking marital therapy in a private prac(ce. Partners’ reported on their rela(onship and sexual sa(sfac(on, psychological symptoms, and big-­‐five personality traits. Therapists (N = 10) evaluated couples’ difficulty level and capacity to engage in couple therapy. A repeated-­‐measure MANOVA showed that couples perceived as being difficult and more likely to drop out of therapy reported lower rela(onship sa(sfac(on and more psychological symptoms. Couples were perceived as being easier to work with when women reported higher agreeableness and when men reported higher neuro(cism. Furthermore, couples’ capacity to engage in therapy was perceived as ques(onable when partners differed on their sexual sa(sfac(on and more likely to abandon therapy when both partners report similar levels of anxiety symptoms. Results are discussed in light of clinical assessment and treatment planning with distressed couples. Résumé Comprendre les facteurs liés à la réussite de la thérapie conjugale est important (Snyder et al. 2006). La percep(on des thérapeutes de leurs clients est un aspect important de la rela(on thérapeu(que et elle peut influencer le cours de la thérapie (Wills, 1978). Cependant, la plupart des études sur les caractéris(ques des clients en thérapie de couple s’insèrent à l’intérieur d’études d’efficacité de la thérapie u(lisant des critères d'inclusion strictes et ciblant une seule approche thérapeu(que (Perkins, 2010). Cela peut limiter l'iden(fica(on des facteurs influents en milieu naturel. La présente étude a examiné les liens entre la percep(on ini(ale du thérapeute et des caractéris(ques individuelles auprès de 141 couples en thérapie conjugale dans une clinique privée. Chaque partenaire a rempli des ques(onnaires auto rapportés sur leur sa(sfac(on conjugale et sexuelle, leurs symptômes psychologiques, et leurs traits de personnalité. Les thérapeutes (N = 10) ont évalué le niveau de difficulté du couple et la capacité des partenaires à s’engager envers la thérapie de couple. Une analyse de variance mul(variée à mesures répétées montre que les couples perçus comme étant difficiles et plus suscep(bles d'abandonner la thérapie rapporte une sa(sfac(on conjugale plus faible et plus de symptômes psychologiques. Les couples sont perçus comme étant faciles lorsque la femme rapporte plus d’agréabilité et lorsque l’homme rapporte plus de névrosisme. De plus, la capacité du couple à s’engager envers la thérapie est perçue comme étant ques(onnable lorsque les partenaires ob(ennent des résultats divergents au niveau de leur sa(sfac(on sexuelle, et plus suscep(ble d'abandonner la thérapie lorsque les partenaires rapportent des niveau d’anxiété similaires. Les résultats sont discutés en lumière de l'évalua(on clinique et de la planifica(on du traitement avec les couples qui consultent en thérapie conjugale. Introduc6on •  Among the greatest challenges in couple therapy is the need to iden6fy effec6ve treatments, understand the mechanisms of change, and define which aspects of the therapist and client are most influen6al to successful therapy outcome (Snyder et al., 2006). •  Clinicians and researchers alike seem to emphasize the client as the main determinant of the outcome in couple therapy (Asay & Lambert, 1999; Miller, Duncan, & Hubble, 1997). However, there s(ll remains a need to iden6fy which client characteris6cs are most influen6al for predic6ng therapy outcome (Clarkin & Levy, 2004). •  Most studies aimed at iden(fying clients’ characteris(cs in couple therapy focus on outcome research, whereby researchers assess couples who’s therapy was successful or failed, and tend to rely on strict inclusion criteria; therefore limi(ng the generalizability of the results to a natural seZng (Perkins, 2010). •  First impressions and opinions that therapists’ form about their clients are related to treatment and therapy outcome (Wills, 1978) è therapists’ ini(al percep(on of therapy outcome could help iden(fy which client characteris6cs are most representa6ve of couples perceived as having favourable or non favourable outcomes. Doing so would allow researchers to iden(fy specific client characteris(cs indica(ve of poten(al therapy outcomes in natural therapy seZngs. Methods Clients Age Men Par6cipants •  10 experienced psychologists specifically trained for couple therapy •  Varying theore(cal approaches Measures Women University Educa(on 69% Employed 97% 70% 25 ☐ Easy
☐ Medium ☐ Difficult 88% Measures •  Dyadic Adjustment Scale (DAS) Rela(onship sa(sfac(on •  Global Measure of Sexual Sa6sfac6on (GMSEX) Sexual sa(sfac(on •  Psychiatric Symptom Index(PSI) Anxiety Depression •  NEO Five-­‐Factor Inventory (NEO-­‐FFI) Extraversion Agreeableness Conscien(ousness Openness to Experience Neuro(cism PERCEIVED CAPACITY TO ENGAGE IN THERAPY Interac(on Sex * Difficulty Level was found for sexual sa6sfac6on (F(2, 121) = 4.27, p = .016, ηs2= .07)) and anxiety (F(2, 121) = 3.65, p = .029, ηs2= .06)) . See Figure 3. Main effect of difficulty level was found for rela6onship sa6sfac6on (F(2, 121) = 5.10, p = .007, ηs2= .08) and depression (F(2, 121) = 4.40, p = .014, ηs2= .07). See Figure 4. Figure 3. Sex * Capacity to Engage in Therapy Interac(on Effects For each couple, therapists assessed: 1. Perceived Level of Difficulty of the couple: 43 years (24-­‐76) 41 years (22-­‐71) 2. What is your predic6on about the course of therapy for this couple? ☐This couple seems able to engage in treatment and follow the mandate to term. ☐The couple’s ability to engage in treatment and successfully complete the mandate is ques(onable. ☐This couple is likely to abandon treatment before having completed the mandate. 58 56 n.s. * 55 Couples are perceived as easier to work with by their therapist when the woman is high and the man is low on agreeableness. The reverse applies for neuro6cism. * n.s. 52 n.s. 48 Men Men 46 Women 45 Women 44 42 40 40 Easy Medium Difficult Easy Couples' Difficulty Level Medium Difficult Couples' Difficulty Level Figure 2. Main Effect of Perceived Difficulty Level 105 103 A Rela6onship Sa6sfac6on A B 40 25 35 Easy 99 Medium 20 97 93 Depression 45 B 101 95 Anxiety 30 B Difficult A A 15 B 10 Easy Easy A 30 Medium 25 Difficult 20 A, B 5 5 0 Couples' Difficulty Level 15 20 Capable Ques(onable Couples' Difficulty Level Couples with lower rela6onship sa6sfac6on and high symptoms of anxiety and depression are perceived as difficult. Annual Conven(on of the Canadian Psychological Associa(on (CPA), Otawa, June 2015. [email protected] Likely to Abandon 10 Capable Capacity to Engage in Therapy Ques(onable Likely to Abandon Capacity to Engage in Therapy Figure 4. Main Effect of Perceived Capacity to Engage in Therapy Rela6onship Sa6sfac6on 99 A Capable Ques(onable Likely to Abandon Depression 40 B 35 Capable Ques(onable Likely to Abandon A, B 30 A B B Couples perceived as capable to engage in therapy report higher rela6onship sa6sfac6on and less symptoms of depression 20 91 15 89 10 87 5 85 0 Capacity to Engage in Therapy Capacity to Engage in Therapy Discussion Ÿ Results indicate that rela(onship and sexual sa(sfac(on as well as psychological symptoms (anxiety and depression) reported at the beginning of therapy are important factors related to how clinicians perceive couples in therapy. Overall, couples repor(ng lower rela6onship sa6sfac6on and greater depression and anxiety symptoms are perceived as being more difficult and more likely to abandon therapy. Ÿ Partner differences on agreeableness and neuro(cism also seem to be associated with perceived difficulty level. Couples whereby the woman is more collabora(ve and inclusive (éagreeableness), as well as more in control of her emo(ons/able to effec(vely cope with stress (êneuro6cism) may be perceived as easier to work with in therapy. Women may buffer the poten6al nega6ve effects of the man’s lower levels of agreeableness and higher levels of neuro6cism. Also, neuro(cism may make individuals more atuned to recognizing and processing the nega(ve emo(ons of others (Hampson et al., 2006). Therefore men with higher neuro(cism may be be^er at picking up on their own and their female partner’s distress, poten(ally facilita(ng the therapists ability to address those emo(ons in therapy. Ÿ Partners’ similarity/ discrepancy on sexual sa6sfac6on and anxiety also appear to be related to therapists’ percep(on of couples’ capacity to engage in therapy. Findings suggest that women who report lower levels of sexual sa6sfac6on than their partner tend to be perceived as ques6onable in regards to whether or not they are capable of engaging in therapy. Given that sexual sa(sfac(on can be affected by individual , rela(onal, and social characteris(cs such as support (del Mar Sánchez-­‐Fuentes et al., 2013), discrepancies may make ini(al predic(ons about the course of therapy unclear for therapists without a beter grasp of the variables explaining this discrepancy in partners’ level sexual sa(sfac(on. 0 Couples' Difficulty Level * Capacity to engage in couple therapy is perceived as ques6onable when partners differ on sexual sa6sfac6on, and more likely to abandon therapy when both partners report similar levels of anxiety Ÿ Couples are perceived as more likely to engage in therapy when men report less anxiety than their partner and likely to abandon therapy when both partners are equally anxious. Pa(ents with an anxiety disorder are at a high risk of abandoning therapy (Santana & Fontenelle, 2011). As such, results may suggest that when both partners are similarly anxious they may feed off each others’ anxiety and exacerbate the likelihood of dropping out of therapy if tension or uncomfortable material were to be addressed in therapy. 10 85 Medium Difficult 15 87 n.s. 93 50 50 * 30 25 54 60 35 21 95 Neuro6cism 60 Men Women 20 97 Figure 1. Sex * Difficulty Level Interac(on Effects * n.s. Men Women 22 A main effect of difficulty level was found for rela6onship sa6sfac6on (F(2, 120) = 4.22, p = .017, ηs2= .07)), anxiety ( F(2, 120) = 7.18, p = .001, ηs2= .11)) and depression ( F(2, 120) = 4.43, p = .014, ηs2= .07)). See Figure 2. 65 * Anxiety 40 25 Agreeableness Sexual Sa6sfac6on 23 A series of repeated-­‐measures MANOVA were conducted to examine whether clients’ characteris(cs differed based on their therapist’s percep(on of their difficulty level and capacity to engage in therapy. PERCEIVED DIFFICULTY LEVEL A significant interac(on Sex * Difficulty Level was found for agreeableness (F(2, 120) = 4.57, p = .012, ηs2= .07)) and neuro6cism ( F(2,120) = 4.52, p = .013, ηs2= .07)). See Figure 1. 70 n.s. 24 Results 89 The present study aimed to iden(fy which client characteris(cs were most indica(ve of couples perceived by therapists as having a less favorable outcome (most difficult to work with in therapy and most likely to abandon therapy) Therapists Par6cipants •  141 heterosexual couples seeking couple therapy in private prac(ce •  Mean rela6onship dura6on: 14 years (1-­‐49 years) •  Status: 44% Married, 83% at least one child 91 Objec6ve Results Future Direc6ons and Clinical Implica6ons: Examining the accuracy of therapists’ ini6al percep6ons and couples’ actual behavior and engagement in therapy as therapy progresses. Clinical Implica6ons: Findings can be helpful to iden6fy couples that may be at greater risk of abandoning therapy and those that are likely to be more challenging to work with. Iden(fying which factors most influence therapists’ percep(ons may aid in clinical assessment and help predict therapy outcome.