Controlled studies evaluating the efficacy of behavioral marital therapy (BMT) have not shed light on the clinical significance of reported treatment effects, nor have proportions of improved clients been reported in a consistent or rigorous manner. Using a reliable change index to classify couples receiving BMT into categories of improved, unimproved, or deteriorated, and using a posttest score that falls outside the range of marital distress as a cutoff for clinical significance, data from four previous outcome studies were reanalyzed. Two types of questions were posed: First, what proportion of couples improve when they are treated behaviorally? Second, how often do these improved couples truly join the ranks of the nondistressed? Across the four studies, response to BMT was evaluated in 148 couples. Slightly more than half of the couples improved, ranging from 39.4% in one study to 72.1% in another; deterioration was rare. In about 40% of the improved couples, positive changes in marital satisfaction were confined to one spouse. Excluding the one analogue study, slightly more than one third of the treated couples actually changed their status from distressed to nondistressed by the end of therapy, ranging from 21.2% to 58.1%. During a 6-month follow-up period, the majority (about 60%) of couples maintained whatever gains they had made. In the absence of treatment, improvement was rare. (Author abstract)
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Variability in Outcome and Clinical Significance of Behavioral Marital Therapy: A Reanalysis of Outcome Data.