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. Author manuscript; available in PMC: 2015 Nov 5.
Published in final edited form as: J Couple Relatsh Ther. 2013 Apr 28;12(2):168–185. doi: 10.1080/15332691.2013.779101

Web-Based Couple Interventions: Do They Have a Future?

Emily J Georgia 1, Brian D Doss 1
PMCID: PMC4634670  NIHMSID: NIHMS720606  PMID: 26550001

Abstract

To examine the current and potential future impact of formal and informal resources to enhance romantic relationships, 1,160 individuals were surveyed. When asked about resources previously utilized, participants reported that numerous forms of relationship help, including talking to a friend/coworker/family member, an individual therapist, and reading self-help materials had a larger impact than attending couple therapy. When asked about potential resources they would be likely to use in the future for relationship problems, participants indicated a strong preference for online self-help resources that included detailed feedback paired with a comprehensive, structured program. Implications for future development and dissemination are discussed.

With links to increased risk for psychological dysfunction (Whisman, 1999), physical illness (Kiecolt-Glaser & Newton, 2001), and negative outcomes for children’s mental health and behavioral conduct (Blodgett Salafia, Gondoli, & Grundy, 2008; Jenkins, Simpson, Dunn, Rashas, O’Connor, 2005), distress in intimate relationships is a topic of critical importance. Although research has demonstrated that efforts to reduce relationship distress are effective (e.g., Snyder, Castelanni & Whisman, 2006; Shadish & Baldwin, 2003; 2005) and long lasting (e.g., Christensen, Atkins, Baucom, & Yi, 2010), it is becoming increasingly clear that few couples actually seek couple therapy to improve their relationships. Only 19% of married individuals have attended to marital therapy to improve their current relationship (Johnson, et al., 2002), although over 30% of couples meet criteria for marital discord (Whisman, Beach & Snyder, 2008). In the same study, it was also found that fewer than 40% of divorced individuals attended couple therapy prior to ending their previous marriage. Individuals endorse a variety of reasons for not attending couple therapy, including unwillingness to share private life, partner’s disinclination to attend, not thinking anything was wrong with relationship, or thinking it was “too late” for marital therapy (Wolcott, 1986). Other barriers to receiving treatment likely include amount of time required to commit to in-person treatment, lack of health insurance coverage for relationship treatment, knowledge of available resources and social stigma.

Given that many couples are unlikely to utilize couple therapy for relationship problems, other attempts to reduce divorce rates have focused on intervening with currently happy couples, primarily through pre-marital education curriculums. Premarital education has been studied in closely-controlled efficacy (e.g., Markman, Floyd, Stanley, & Storaasli, 1988) and effectiveness trials (e.g., Stanley et al., 2001). Results generally suggest that relationship education can reduce rates of subsequent divorce (e.g., Markman, et. al., 1988; Stanley, Allen, Markman, Rhoades, & Prentice, 2010) and relationship aggression (Markman, Renick, Floyd, Stanley, & Clements, 1993) while improving communication (Stanley et al., 2001; Laurenceau, Stanley, Olmos-Gallo, Baucom, & Markman, 2004). Unfortunately, results of a recent nationwide effort to extend several types of premarital education to unwed parents were largely discouraging, suggesting that premarital education may have important limitations when delivered to diverse couples or in diverse settings (Wood, McConnell, Moore, Clarkwest, & Hsueh, 2010). Compounding these concerns, at-risk couples are even less likely to participate in premarital interventions programs (i.e., cohabitating – Halford et al., 2006; entering second marriages – Doss, Rhoades, Stanley, Markman, & Johnson, 2009b; less religious – Halford et al., 2006; Stanley et al., 2006; Sullivan Pasch, Cornelius, Cirigliano, 2004; and African-American – Stanley et al., 2006). As a result, the impact of premarital education programs – their ability to reduce relationship distress and divorce on a large scale – may be limited.

Improving the Impact of Couple Interventions

While not as common in psychology, public health research initiatives evaluate interventions by examining not only their efficacy but also their reach – the extent to which they reach their target populations (e.g., Flay, et al., 2005). The dimensions of efficacy and reach combine to create the overall impact of a specific intervention. As a result, although empirically-based couple therapy and relationship education are effective, their limited reach severely reduces their population-level impact. Therefore, there is a pressing need for interventions with a broad reach that intervene on a selective basis with couples who are at higher risk for relationship distress or who are showing early signs of relationship distress.

Fortunately, couple intervention efforts have started targeting at-risk couples who might otherwise be unlikely to receive relationship assistance. Two notable efforts in this vein are the Marriage Checkup (MC) and Couple CARE. The MC is a 6-hour, in-person intervention that combines assessment, therapeutic feedback, and brief intervention. It markets itself to couples as a “preventative checkup” and has been successful at attracting couples who are experiencing relationship problems but before those problems become too severe. Moreover, couples in the MC demonstrated significant improvements in satisfaction, intimacy, and acceptance during the intervention (Cordova, Scott, Dorian, Mirgain, Yaeger, & Groot, 2005). Couple CARE aims to reach at-risk couples by offering a flexible relationship education program (Halford, Moore, Wilson, Farrugia, & Dyer, 2004). Through videotapes, guidebooks and phone calls with a psychologist, Couple CARE provides skills and education in communication, commitment, and other topics relevant to relationship enhancement. Participating couples show improvements in relationship satisfaction and stability, although effect sizes were small to moderate (Halford et al., 2004).

While the efficacy of these interventions is promising, it remains unclear whether they are capable of reaching a large number of couples in need of relationship help. Notably, both interventions require substantial time and expertise of trained professionals, increasing costs and decreasing the number of couples that can be helped at any one time. Thus, to maximize the impact of couple interventions on a national and international level, couple interventions that can be delivered without extensive professional contact are needed (e.g., Sher & Halford, 2008).

Self-help resources specific to intimate relationships have long been available to couples, and may have a greater reach than couple therapy. For example, 23% of couples reported reading a book to improve their relationship in the first five years of marriage; marital therapy was sought by only 14% of those same couples (Doss, Rhoades, Stanley, & Markman, 2009a). Moreover, evidence from the same study revealed that couples who accessed relationship-oriented self-help books were more likely to have experienced relationship distress or physical aggression in the previous year, suggesting that self-help books may be an important first step for couples at the early stages of relationship dysfunction. Importantly, several studies have begun to demonstrate improvements in mental health through self-help books (e.g., depression – Gregory, Schwer Canning, Lee, Wise, 2004; anxiety – van Boeijen, van Blakom, van Oppen, Blankenstein, Cherpanath, van Dyck, R., 2005), however no studies we are aware of have directly tested the effectiveness of self-help books specific to relationship distress.

Web-Based Resources

A growing literature points to the internet as a new vehicle through which to provide interventions for relationship distress; the internet seems to have several advantages over other delivery methods. First, web-based interventions are easily accessible to individuals. A national survey reports that 78% of all American adults use the internet, many with high speed connections (Pew Research Center, 2011). Furthermore, a large percentage of African-Americans (67%) and English and Spanish speaking Hispanics (78%) are active internet users. Additionally, 72% of individuals living in rural areas are active internet users (Pew Research Center, 2011) – a population that likely experiences difficulty in locating in-person relationship interventions. Even more promising is evidence suggesting couples are already seeking relationship help on the web. An informal examination of the most popular relationship websites reveals that there were over 3.75 million unique visits to these sites from July 2010 to July 20111; the total number of visits to all relationship-oriented websites is likely substantially higher. Additionally, efforts to provide basic relationship feedback and help on the web drew nearly 13,000 dating, cohabiting, or married individuals, including nearly 2,000 minority participants, 3,000 cohabitating participants, more than 1,500 with a high school education or lower, and more than 1,500 with an annual household income less than $40,000 (Doss & Christensen, 2006). Although preliminary, these data indicate that web-based resources for couples may extend to previously unreached populations.

Early investigations into the efficacy of computer-based interventions for couples are promising. Braithwaite and Fincham (2007) compared the efficacy of ePREP, a computer-based version of an empirically supported relationship distress prevention program, Prevention and Relationship Enhancement Program (PREP; Markman, et al., 1993) to a psycho-education only control group. Post-treatment and eight week follow-up results indicated significant improvements in relationship variables such as psychological and physical aggression as well as trust. Braithwaite and Fincham (2009) later replicated and extended previous findings with ePREP showing improvements in relationship and mental health outcomes sustained at 10-month follow up. Further, compared to less engaged couples, couples who were more involved in the program (e.g., homework completion) showed greater improvements in communication, physical aggression, and men’s relationship satisfaction (Braithwaite & Fincham, 2011). In a separate line of research, a comparison of in-person and computerized relationship education found computerized education to be equally effective (Duncan, Steed, Martino, & Needham, 2009).

Research also suggests that providing feedback to couples can be helpful. For example, couples who completed the RELATE online program – which identifies both relationship strengths and problem areas – demonstrated improvements in communication and increased preparedness for marriage. Additionally, couples receiving personalized therapist assistance showing significantly greater gains than those completing just the automated feedback (Larson, Vatter, Galbraith, Holman, & Stahmann, 2007). In a separate study, compared to couples completing just the web-based RELATE program, couples completing both RELATE and the Couple CARE intervention demonstrated greater reductions in negative communication and increases in women’s satisfaction (Halford, Wilson, Watson, Verner, Larson, Busby, & Holman, 2010).

Overview of Present Study

Though these efforts demonstrate the potential for web-based intervention programs to create positive change in relationships, much remains unknown. For example, while couples appear to be seeking relationship help online, it is unclear what exactly couples are looking for online, how helpful couples are finding online resources, and how these patterns of help-seeking compare to currently available resources. Considering the limited scope of available empirically-supported interventions for couples in distress and the potential reach of web-based interventions, the current study has three goals. First, to discern the current impact of available resources for relationships, we examined the percent of individuals who had previously utilized currently-available resources (reach) and how helpful these were to their relationships (efficacy). Second, to assess the potential impact of currently-available resources, we examined the likelihood of seeking those resources for individuals who had not used them for their current relationship. The third and primary goal of the present study was to examine the potential impact of web-based resources for relationship improvement. Here we investigated the importance of various components of a web-based intervention as well as how much time one would spend using this type of resource for their relationship.

Method

Participants

In June 2010, The New York Times published an article covering advances in web-based interventions for couples wanting to improve their relationship. As part of this article, readers were encouraged to visit www.OurRelationship.com to complete an anonymous online survey asking for feedback on what they would like included in an online relationship program. Following procedures approved by the University IRB, data were analyzed from 1,160 currently cohabiting, engaged, or married heterosexual individuals; 81% of participants were women. The majority (80%) were married, with the remainder currently engaged (9%) or living together without being engaged (11%). The sample of individuals was 80% white, 7% Asian-American, 5% Hispanic, 2% African-American, and 6% multi-ethnic. Participants were generally in their late thirties (M = 38.71, SD = 11.28), 62% held graduate level degrees, with median annual household income of $100,000 – $125,000. The average participant reported relationship satisfaction in the distressed range, as described in more detail below.

Measures

Demographics and relationship characteristics

Participants reported their own and their partner’s gender, age, education, ethnicity, and employment status. Relationship status, number of children living in and outside of the home, household income, and premarital cohabitation history were also measured.

Relationship satisfaction

Relationship satisfaction was measured using the Couple Satisfaction Index (4) (CSI4 – Funk & Rogge, 2007). The CSI-4 has been found to correlate highly with longer measures of marital satisfaction and to provide similar or superior levels of information across a wide range of relationship distress (Funk & Rogge, 2007). Average relationship satisfaction in the current sample was in the distressed range (M = 11.25, SD = 4.86), with nearly 65% of the sample scoring below the clinical cut-off for relationship distress (13.5 on the CSI-4; Funk & Rogge, 2007).

Current impact and likelihood of seeking available resources

For each of 13 potential relationship resources, participants first rated whether they had used them (yes/no). If they had used the resource, they rated how helpful it was for their relationship (on a five-point scale, 5 = Very Helpful, and 1 = No Effect); if they had not used the resource, they were asked how likely they would be to use it in the future (five-point scale, 5 = Very Likely and 1 = Very Unlikely). To measure impact, we combined our helpfulness ratings and the proportion of people who had utilized the resource into a single impact score (e.g., Glasgow, 2011). This impact score was computed as a 1 (“no effect”) for those who had not utilized the resource and, for those who had utilized the resource, it was computed as a value of 1–5 (to match that individual’s helpfulness rating of that resource).

Potential effect of relationship focused web-based interventions

To assess the potential effect of a relationship focused web-based program, participants first rated the importance of seven possible components of a web-based program on a six-point scale (6 = Essential, and 1 = Would dislike it). These seven components are described in more detail below. Then, considering all the components rated “important” or higher, participants rated how likely they would be, and how likely their partner would be, to use their ideal version of a web-based program for relationship improvement on a five-point scale (5 = Very Likely and 1 = Very Unlikely). Participants then rated how helpful it would be for their relationship to use this web-based program on their own as well as with their partner on a five-point scale (5 = Very Helpful, and 1 = Would Make Things Worse). Lastly, participants were asked to consider how much time they, and how much time their partner, would likely spend completing an online program to improve their relationship (0.5, 1, 2, 4, 6, 8, 10, >10 hours).

Results

Impact of Currently-Available Resources

The first aim of the present study was to determine the impact of available resources on relationship functioning. Because sample size varied substantially by gender and level of relationship distress, average helpfulness was calculated using the unweighted means of four groups (distressed women, distressed men, non-distressed women, and non-distressed men). Across these four groups, the five resources with the greatest impact were (in order of impact): 1) talking to a friend or coworker; 2) talking to an individual therapist; 3) talking to a family member; 4) reading a self-help book; and 5) reading a relationship focused magazine article. Interestingly, attending couples therapy with their partner came in at a distant 6th, with notably less impact than relationship focused self-help books and magazine articles. The average impact scores, unweighted helpfulness scores, and utilization rates of all 13 resources are presented in Table 1.

Table 1.

Available Resources: Impact, Proportion of Sample Utilization, Perceived Resource Helpfulness, and Likelihood of Future Utilization

Resource Impact
M (SD) 		Proportion Helpfulness
M (SD)		 Likelihood
M (SD)
Talk to a friend or coworker 2.72 (1.38) 0.70 3.05 (1.25) 2.38 (1.15)
Talk to an individual therapist 2.27 (1.57) 0.42 3.70 (1.19) 3.03 (1.08)
Talk to a family member 2.25 (1.38) 0.60 2.79 (1.25) 2.08 (1.08)
Read a relationship focused self-help book 2.11 (1.27) 0.50 2.93 (1.08) 3.02 (1.14)
Read a relationship focused magazine article 2.09 (1.11) 0.65 2.52 (1.19) 3.16 (1.22)
Go to couples therapy together 1.68 (1.27) 0.29 3.25 (1.35) 3.42 (1.02)
Talk to a physical health professional (e.g., a nurse or M.D.) 1.33 (0.87) 0.17 2.83 (1.17) 2.12 (0.95)
Use a relationship-focused website 1.33 (0.84) 0.15 2.66 (1.12) 3.79 (0.82)
Talk to a religious leader 1.28 (0.86) 0.18 2.83 (1.37) 1.71 (0.98)
Go to a relationship focused retreat or workshop with partner 1.26 (0.86) 0.11 3.16 (1.42) 2.65 (1.12)
Watch a relationship-focused DVD with an accompanying workbook 1.10 (0.53) 0.05 3.03 (1.51) 2.75 (1.14)
Participate in a relationship-focused online forum or discussion group 1.09 (0.49) 0.04 3.28 (1.31) 2.71 (1.11)
Watch a relationship-focused DVD with an accompanying workbook with partner 1.04 (0.31) 0.03 2.78 (1.33) 2.94 (1.12)
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Differences in impact by gender and relationship distress were also examined; given the large sample size, only differences meeting Cohen’s criteria for a small effect size (d ≥ 0.20; Cohen, 1988) are discussed. Women, compared to men, reported a greater impact of reading a relationship focused self-help book, using a relationship-focused website, and talking to a family member or a friend/coworker (all Cohen’s d > 0.31). Non-distressed individuals reported a greater impact from taking to a family member or a friend/coworker; however, distressed individuals reported greater impact of going to couple therapy. No gender-by-distress interactions met the criteria of a small effect size (η2>0.01; Cohen, 1988).

Likelihood of Seeking Currently Available Resources

In addition to the perceived impact for individuals who had already utilized existing resources, we were interested in which currently-available resources participants were likely to use in the future to improve their relationship. To this end, participants who had not utilized a particular resource rated how likely they would be to use each for their relationship. The five resources participants were most likely to consider using to improve their relationship in the future were, in order: 1) using a relationship-focused website; 2) going to couple therapy; 3) reading a relationship-focused magazine article; 4) talking to an individual therapist; and 5) reading a relationship-focused self-help book.

Few gender differences were found in the likelihood to seek specific resources for relationship help. Women indicated they were more likely to talk to an individual therapist to improve their relationship (d = 0.22) and men were more likely to indicate that they would watch a relationship DVD with an accompanying workbook by themselves (d = −0.20), and with their partners (d = −0.29). Whether or not an individual was in the distressed range of relationship satisfaction also influenced the types of resources he or she was likely to seek. Compared to non-distressed individuals, distressed individuals were more likely to indicate that they would talk to an individual therapist, watch a relationship focused DVD with accompanying workbook (on their own or with their partner), go to a relationship-focused retreat or workshop with their partner, and participate in a relationship focused forum or discussion group (all Cohen’s d > 0.20). Non-distressed individuals were significantly more interested in talking to a family member (Cohen’s d = −0.26). There were no significant gender-by-distress interactions in the likelihood to seek specific resources for relationship improvement.

Potential Future of Web-Based Interventions

As one of the central aims of the present study was to investigate the potential future impact of web-based interventions, participants were asked to respond to a series of questions about their ideal version of a web-based program and the likely impact of such a program on their relationship.

Components of a web-based relationship program

Participants first rated the importance of seven potential components of a web based program (see Table 2). The component with the greatest unweighted mean importance score was a detailed report of relationship strengths and problems with suggestions for improvement (M = 5.22, SD = 0.83) followed closely by an effective and high-quality program that could be completed with their partner (M = 5.18, SD = 0.84).

Table 2.

Importance of Various Web-Based Program Components

Component Importance
M (SD)
A detailed report of strengths and problem areas in YOUR relationship and suggestions for improvement 5.22 (0.83)
An effective and high-quality program that my partner and I would do TOGETHER 5.18 (0.84)
Information on common relationship problems 4.59 (1.11)
An online forum that would allow me to get responses to my questions from relationship experts 4.23 (1.13)
An effective and high-quality program that I could work through entirely on my OWN 4.16 (1.25)
Phone calls with a relationship expert in addition to the web-based course 3.50 (1.30)
An online forum that would allow me to talk to other couples 2.79 (1.20)
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Distressed individuals rated the following components of a web-based program for relationships as more important than non-distressed individuals: A detailed report of strengths and problem areas, an online forum that would allow them to talk to other couples, an online forum that would allow them to get responses to their questions from relationship experts, and phone calls with a relationship expert (all Cohen’s d > 0.20). There were no significant gender-by-distress interaction effects that met criteria for a small effect size.

Helpfulness of using an ideal online program for relationships

Participants rated the potential helpfulness of completing their ideal version of an online web-based program, defined as including all the characteristics they rated as “important” or greater. Participants provided separate helpfulness ratings for a program completed on their own and completed together with their partner. Participants reported both conjoint and individual web-based programs would be helpful to them and their relationship. However, results indicated that participants felt completing an online program together with their partner would be more helpful than completing it on their own (together M = 4.62, SD = 0.62; on own M = 3.47, SD = 0.79, t(1159) = −41.26, p < .001, d = 1.62). Neither the mean helpfulness ratings nor the magnitude of the helpfulness difference between conjoint and individual programs significantly varied by gender or relationship distress; moreover, there was not a significant gender-by-distress interaction.

Likelihood of using an ideal online program for relationships

Participants rated that they were significantly more likely to use their ideal web-based program either on their own or together with their partner than they were to seek any of currently available resources assessed in the study. Participants also reported that both they and their partner were likely to utilize an ideal online program. However, whereas subjects rated completing an ideal online program together with their partner as more helpful than completing it on their own, they generally rated their partners as less likely to participate. Participant’s likelihood of using an online program was significantly greater than the likelihood rating one’s partner participating in online program (on own M = 4.53, SD = 0.64; together M = 3.60, SD = 0.94, t(1160) = 32.83, p < .001, d = 1.16).

The likelihood of using a web-based program varied with participants’ level of distress. Distressed individuals were more likely to consider using a web-based program than non-distressed individuals (d = 0.29). Although there was no significant difference between men’s and women’s ratings of their own likelihood to use their ideal web-based program, women rated their partners likelihood to use their ideal version of a web-based program significantly lower than men did (d = 0.94). No gender-by-distress interactions in the likelihood to use an ideal web-based program were found.

Time spent on web-based program

Lastly, individuals rated how much time they would spend using their ideal web-based program to improve their relationship. The median time was 6 hours. Distressed individuals reported that they would spend more time on a web-based program for their relationship than non-distressed individuals (distressed Mdn = 6 hrs, non-distressed Mdn = 4 hrs, U(1) = 130010, Z = −4.765, p < .001). Neither significant gender effects nor gender-by-distress interaction effects were found.

Discussion

Following public health research efforts, the first goal of the present study was to evaluate the overall impact of available resources for relationship improvement. Couple therapy, the most empirically validated resource for relationships, with small-to-medium effect sizes in community settings (d = .44–.47; e.g., Anker, Duncan, & Sparks, 2009; Doss, Morrison, Libet, Birchler, Madsen, & McQuaid, 2011), was accessed by less than one third of the sample. Combining these effect sizes of couple therapy in the community and the percent utilization in our sample, the impact score of couple therapy then is only 0.13 (0.29 × 0.45). This same impact could also be achieved by a resource with a large reach yet smaller effect. For example, self-help books were utilized by 50% of the sample; if it were assumed to have only a small effect size, d = 0.26, the impact would be equal to that of couple therapy with substantially less cost. Further, the effect size of speaking to a friend or coworker, utilized by 70% of the sample, need only be d = 0.19 in order to have a larger impact than couple therapy. Thus, to provide resources for couples’ relationships, the next steps are twofold: Evaluate and improve the efficacy of resources with large reach, and increase the reach of empirically supported interventions for relationships already demonstrating large effects.

Web-Based Resources for Couples

Given the extensive reach of web-based programs suggested by the present results, the internet seems to provide a promising medium for delivery of empirically validated interventions to target populations. Specifically, results from this population suggest that web-based programs are the resource individuals are most likely to seek for relationship improvement. Yet, online relationship-focused resources currently available to couples are in their infancy. Relationship-focused forums and discussion groups, though not accessed at a high rate in this sample, were rated as equally helpful as couple therapy. Although there currently are no data indicating that online forums and discussion groups are efficacious in improving relationships; this type of resource seems to have the potential to reach a large number of previously unreached couples and individuals in need of relationship help. In fact, one popular forum site, www.talkaboutmarriage.com, received nearly 80,000 unique visits in May 2011 (http://siteanalytics.compete.com).

Providing further support for the future of online resources, couples were highly interested in utilizing an online relationship program for relationship improvement. When considering relationship websites currently available, this resource was reported to be the one couples were most likely to use in the future for their relationship (M = 3.79; SD = 0.82). Participants were then asked to consider what components would comprise their ideal version web-based relationship program. The component rated as most important was a detailed report of strengths and problem areas in your relationship and suggestions for improvement. The second most important component of a web-based program was an effective and high quality program that partners could work on together. Taken together with participants preference for a program they could do with their partner, these results suggest that in addition to assessment and tailored feedback, individuals place considerable value in a validated and empirically support program built for both partners. Finally, providing further support and momentum for the development and evaluation of online couple programs, the likelihood of completing participant’s ideal version of an online relationship program was considerably higher than all currently available resources.

Future Directions

The reach of talking to friends or coworkers for relationship help is impressive, making it the resource with the highest impact score, even despite its somewhat low helpfulness rating. Thus, one important avenue for future research is to improve the quality of relationship advice provided by friends and coworkers. Seeking to do just that, scholars are beginning to improve college students’ relationship knowledge by implementing relationship education courses as part of the college curriculum (Braithwaite, Lambert, Fincham, & Pasley, 2010). This program educates participants on partner selection, healthy relationship transitions, communication skills, and the consequences of infidelity. Early results indicate that participating students reported less extradyadic involvement than controls and examinations of other positive outcomes are ongoing. Most notable given the results of the present study, the college student program is hypothesized to improve the participants’ support provision to their friends, family, and coworkers struggling with relationship issues.

With the fourth highest reach, relationship focused self-help books emerged as another important resource for couple relationships. There is a wealth of print material available for relationship improvement; in fact searching “marriage counseling” on www.amazon.com yields nearly 6,500 results. Fortunately, several of these books are based on empirically supported treatments for couples (e.g., Reconcilable Differences; Christensen & Jacobson, 2000; Fighting for Your Marriage; Markman, Stanley, & Blumberg, 1996; After the Affair; Abrahms Spring & Spring, 1997; The Marriage Checkup; Cordova, 2009), however we are unaware of any that have been directly tested. Considering that 23% of couples read relationship-oriented self-help books in the first five years of their marriage (Doss, et al., 2009a), elucidating the efficacy of these resources is one of the important next steps for couple intervention research.

Conclusions from the present study have to be considered in the context of several study limitations. Although the sample was large, it was largely female and Caucasian. Although we were able to investigate gender differences, there were too few ethnic minorities to make meaningful comparisons. Rather than reflecting users of the internet overall (Pew Research Center, 2011), the present sample likely represents a demographic of readers of The New York Times. Additionally, because the sample was referred from an article on web-based relationship resources, there are likely important group differences in help-seeking behaviors and preferences between the present sample and the general population. Thus, results from the present study should be considered as representing only those individuals already interested in considering web-based relationship resources. However, given that approximately 3.75 million individuals a year visit websites to improve their relationship, this is an extremely important group to consider. To place this number in context, only slightly more than two million marriages occur in the United States annually (Centers for Disease Control and Prevention/National Center for Health Statistics, 2010) and approximately 38% of those marrying receive premarital education. Thus approximately 760,000 couples receive premarital education annually, approximately one fifth the number of individuals who sought help for their relationship online. As a result, finding new and effective ways to reach couples online is an important frontier in the development of relationship resources.

Despite these limitations, the present study provides an important glimpse into the overall impact of currently available resources, and helps point to an important avenue for future research – web-based resources. As explained in Doss (2009), a considerable advantage of web-based couple interventions compared to traditional interventions delivered by trained professionals is their sustainability. Specifically, after initial start-up costs required for development, testing, and marketing, web-based interventions could be continually delivered with minimal maintenance cost. Continued monitoring and data collection throughout program could be handled relatively easily and cheaply with online tools.

Additionally, efforts to improve online engagement and alliance can also be undertaken. Though some authors argue that therapeutic alliance will suffer without in-person interaction (Rees & Stone, 2005), the preponderance of evidence suggests that telehealth can be utilized by individuals at a much lower cost compared to in-person treatment (Schopp, Johnstone, & Merrell, et al., 2000) without sacrificing treatment adherence, satisfaction, or outcomes (e.g., Ruskin, et al., 2004). The challenges of maintaining engagement and alliance during online self-help is somewhat more challenging in that it typically does not involve synchronous therapist-client interaction; however, research suggests that engagement can be improved with even minimal staff contact (e.g., Titov, 2011).

Currently, researchers are working to translate Integrative Behavioral Couple Therapy, an empirically supported in-person treatment for couples (IBCT; Christensen et al. 2010), into a web-based program designed to help couples at risk for severe relationship distress (citation removed for blind review). This ongoing effort, www.OurRelationship.com, targets couples in the midst of relationship distress before problems have reached a point where in-person couple therapy is absolutely necessary. As the authors explain, the overall goal of the program is to “…help a couple become “unstuck” in their efforts to resolve a specific core relationship problem.” To achieve this goal, the program provides tailored relationship feedback, guides individuals through a more nuanced and accurate understanding of their relationship difficulties and assists partners in sharing these new understandings in a productive way. This online program has the potential to overcome many barriers to traditional couple therapy experienced by couples. This program can be completed in a relatively short time, approximately 6 hours, much shorter than the typical couple therapy time requirement. The program also provides a way to communicate with relationship experts through online forums, as well as through periodic emails sent by program staff at specific times throughout the couple’s progress. In essence, the couple, and even each partner within the couple, is able to choose their desired level of personal contact, further tailoring the treatment experience.

Conclusions

In summary, while progress has certainly been made in the development of efficacious empirically supported treatments for couples, results from the present study indicate we have yet to fully implement these interventions in a way in which couples are able to adequately make use of them. Important next steps for couple researchers include improving the reach of already effective treatments, testing the efficacy of resources that sought at a high rate, and developing resources from the start with both efficacy and reach in mind.

Acknowledgments

This research was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under award R01HD059802. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We would like to thank Judith N. Biesen, Krystal Cashen, and Shannon McAllister who served as Project Coordinators for this study.

Footnotes

1

This program provides statistics on the trends of specific search terms and those most related to each term. From this data we were able to discover the most popular search terms in the United States related to relationship help seeking. Then, the most highly searched terms were entered into a standard search bar to determine the most popular relationship focused websites currently available. From the list of most popular relationship focused websites on the web we used another program, siteanalytics.compete.com. This site provides data on the number of visits to specific websites over time. So for example, we could find out that talkaboutmarriage.com received nearly 40,000 unique visits in July of 2010.

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