Efficacy of the Hope-Focused Couple Approach: Review of a 7-Year Clinical Trial Jennifer Ripley, PhD; Anna Shirokova Ord, MBA, MA; Aleksandra Wantke, MA; Olivia McFarland, BS; Nicole Scott, BA; Carolyn C. Bridges, MA; Candace Lassiter, MA Regent University ABSTRACT INTRODUCTION RESULTS Table 1. RDAS at Baseline, End of Treatment, and At 6-Month Follow-up by Treatment Condition and Religious Commitment This study explores how participants’ relationship satisfaction changes after Hope-Focused Couple Approach (HFCA). HFCA was developed as an approach to couple counseling that is built on the Christian principles of hope, love, faith, and work. Previous research has indicated that HFCA may be more effective than no treatment, and it is comparable in efficacy to other modalities of couple therapy. The present study includes 318 participants who completed a course of relationship enrichment or relationship therapy based on Hope-Focused Couple Approach between 2006 and 2013. Results indicate that on average couples who completed HFCA experienced significant improvement in their relationship satisfaction. No significant differences were found between standard treatment and religion-accommodative treatment. The level of couple’s religious commitment significantly affected the level of initial relational distress. Implications of these findings are discussed. Couple therapy has been shown to positively impact 70% of couples who are receiving treatment (Lebow, Chambers, Christensen, & Johnson, 2012). Psychotherapy that incorporates religion has been shown to have equal or improved outcomes as compared to forms of psychotherapy that do not acknowledge spirituality or religion (Worthington, Hook, Davis, & McDaniel, 2011). Hope-Focused Couple Approach (HFCA) is an empirically validated couple’s enrichment program that uses a combination of behavioral and emotion focused interventions (Jakubowski, Milne, Brunner, & Miller, 2004; Worthington, 1999). Broadly, the HFCA combines an emphasis on hope, simple but diverse techniques, emotional bonds, and forgiveness (Worthington, Ripley, Hook, Miller, & Crawford, 2007). HFCA has two modalities: standard and religion-accommodative treatment. HFCA has been found to be efficacious overall (Jakubowski, Milne, Brunner, & Miller, 2004) and specifically effective in improving couples’ relational satisfaction (Worthington, Hight, Ripley, Perrone, Kurusu, & Jones, 1997), communication behaviors (Ripley & Worthington, 2002), and overall quality of life (Burchard, Yarhouse, Kilian, Worthingon, Berry, & Canter, 2003). While there are over a dozen published articles on outcomes of HFCA, none have explored the specifics of what makes this treatment approach effective. The present study aims to address this gap in the literature. Repeated measures one-way ANOVA was conducted to investigate whether participants who undergo treatment within the HFCA experience significant change in their relationship satisfaction, and whether this change can be sustained after treatment. Results of this analysis indicated that the couples experienced significant improvement in their relationship satisfaction after they completed treatment, and this improvement was sustained over the course of six months, F(2, 634) = 62.82, p < .001, ηp² = .17. Specifically, participants scored above the clinical cutoff on the measure of relational satisfaction right after they completed treatment (Mpost = 48.22, SD = 7.82), which indicates that their relationship improved significantly during the course of treatment, as compared to their relationship satisfaction at the beginning of treatment (Mpre = 43.34, SD = 9.54). Participants’ relationship satisfaction after 6 months (Mfollow-up = 47.55, SD = 7.57) decreased somewhat as compared to the post-treatment measures, but this decrease was not significant, and couples’ relationship satisfaction 6 months after treatment was still significantly higher than their scores pre-treatment. No significant differences in efficacy were found between the standard and the religion-accommodative conditions, F(4, 626) = .75, p = .56, ηp² = .005. Finally, the level of couples’ religious commitment also did not affect gains that the couples made in treatment, F(2, 470) = .99, p = .37, ηp² = .004. However, religious commitment significantly affected the level of the couple’s initial distress which they experienced when the couple came in for treatment, F(1, 400) = 15.17, p < .001, ηp² = .04. Specifically, couples with low religious commitment reported significantly less satisfaction in their relationship (MRDAS = 40.91, SD = 9.95), as compared to the couples with high religious commitment (MRDAS = 45.01, SD = 8.98). Variable Pre-treatment Post-treatment 6-moth follow-up M SD Religious Commitment Low RCI 40.91 9.95 47.26 7.79 46.20 6.09 High RCI 45.01 8.98 49.85 7.62 49.47 7.32 Treatment Condition Standard 43.56 9.18 49.00 8.03 48.21 7.69 Religion-accommodative 43.21 9.78 47.86 7.66 47.07 7.53 DISCUSSION Results of these analyses indicate that couples who undergo treatment within the HFCA experience improvement in their relationship satisfaction, and some (but not all) gains made in treatment are sustained long-term. Further, results also suggest that religion-accommodative treatment was found to be as efficacious as the standard approach. Finally, religious commitment did not affect gains that the couples made in treatment. However, participants with low religious commitment reported higher levels relational distress when they came in to couple counseling, as compared to the participants with high religious commitment. This may be partially explained by the fact that religiosity may instill hope regarding a couple’s future together and a profound desire for permanence, which in turn may encourage couples to stay together and work through their conflicts. METHOD Participants A diverse group of participants (N = 318) from different ethnic, socioeconomic, and educational backgrounds, that is highly representative of the local community population, participated in the study. All participants completed 8-10 sessions of HFCA between 2006 and 2013. Participants were recruited as part of a larger study in the clinical trial for the Hope-Focused Couple Approach (HFCA) at Regent University. Ethnicity is well represented compared to ethnicity rates in the Virginia Beach area. Each couple completed 8-12 sessions of HFCA. Demographic data, as well as assessment data were gathered at the intake. Post-treatment assessment data were collected during the termination session. Follow-up data were collected at the 6-month follow-up appointment. Measure The Revised Dyadic Adjustment Scale (RDAS) was used as a measure of couples’ distress. RDAS is a widely used 14 item scale assessment of marital satisfaction (Busby, Crane, Larson, & Christensen, 1995). The RDAS is comprised of three subscales (Consensus, Satisfaction, and Cohesion) from which a total is derived. REFERENCES Figure 1. Mean Revised Dyadic Adjustment Scale (RDAS) Scores at Baseline, End of Treatment, and At 6-Month Follow-up Burchard, G. A., Yarhouse, M. A., Kilian, M. K., Worthington, Jr., E. L., Berry, J. W., & Canter, D. E. (2003). A study of two marital enrichment programs and couples’ quality of life. Journal of Psychology and Theology, 31, 240-252. Busby, D. M., Christensen, C., Crane, D. R., & Larson, J. H. (1995). A revision of the Dyadic Adjustment Scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy, 21, 289-308. Jakubowski, S. F., Milne, E. P., Brunner, H., & Miller, R. B. (2004). A review of empirically supported marital enrichment programs. Family Relations, 53, 528-536. Lebow, J. L., Chambers, A. L., Christensen, A., & Johnson, S. M. (2012). Research on the Treatment of Couple Distress. Journal of Marital and Family Therapy, 38, 145-168. Ripley, J. S., & Worthington, Jr., E. L. (2002). Hope-focused and forgiveness-based group interventions to promote marital enrichment. Journal of Counseling & Development, 80, 452-463. Worthington, E. L., Jr. (1999). Hope-focused marriage counseling: A guide to brief therapy. Downers Grove, IL: InterVarsity Press. Worthington, Jr., E. L., Hight, T. L., Ripley, J. S., Perrone, K. M., Kurusu, T. A., & Jones, D. R. (1997). Strategic hope-focused relationship-enrichment counseling with individual couples. Journal of Counseling Psychology, 44, 381-389. Worthington, E.L., Jr, Ripley, J.S., Hook, J.N., Miller, A.J. & Crawford, S. (2007). Why is the hope focused couple approach effective? Marriage and Family A Christian Journal. American Psychological Association Annual Convention 2014 Washington, DC August 9, 2014 Correspondence: jennrip@mail.regent.edu