Does Depression and Relationship Distress Predict Longer Couple Therapy Treatment in Naturalistic Settings?

The average couple therapy treatment length is 11.50 sessions in the United States, yet these estimates are supported by decades-old research. We update this prior work by accounting for therapist effects and investigating clinical cut-offs for depression and relationship distress. We used a sample of 417 mixed-sex couples and 122 therapists from the Marriage and Family Therapy Practice Research Network. Using multilevel modeling in Mplus, couples had an average of 11.73 sessions with therapists explaining 7.40% of the variance. Having one partner meeting the relationship distress cut-off as well as both partners meeting depression cut-offs were associated with longer treatment. Additionally, therapists in the Western region of the United States and treatment after the COVID pandemic were associated treatment length. These findings can aid clinicians in providing treatment plans and clearer expectations for treatment length. Couple therapy modalities can consider briefer adaptations to meet shorter treatment lengths.