Etude cliniquement representative des problemes conjugaux, des mandats et des objectifs therapeutiques des couples consultant en therapie conjugale

The aim of this dissertation was to study the relationship problems, treatment goals and therapeutic mandates of couples consulting in couple therapy in a naturalistic setting. This dissertation includes two original articles. Using a relationship problems coding system on a sample of 108 couples seeking therapy, the first study identified that the most common relationship problems were related to communication, emotional affection or distance, specific areas of the current relationship, and lack of physical affection or sex. Comparisons of therapeutic mandates revealed that commitment or security problems and infidelity or flirting problems were more common among couples pursuing an ambivalence resolution mandate than among couples pursuing an alleviation of distress mandate. These results demonstrated the importance of identifying distinct therapeutic mandates in couple therapy and the need for further research about ambivalent couples. The second study aimed to evaluate change in couples that consulted in a naturalistic therapy setting using Goal Attainment Scaling (GAS). A categorization of treatment goals in couple therapy was proposed. Treatment goals and therapeutic mandates of 100 couples were categorized using standardized coding schemas. The results showed large pre-post changes in couples distress and severity of relationship problems. Therapists' expectations about the therapy process, treatment completion and separation were related to couples' goal attainment. Comparisons of therapeutic mandates revealed that couples pursuing an alleviation of distress mandate had more goals related to communication, problem-solving and acceptance of differences than couples pursuing an ambivalence resolution mandate. This study contributed to the field by providing preliminary data regarding the clinical utility of GAS in assessing change following couple therapy. Types of treatment goals set in naturalistic settings were presented and the results emphasized the need for further research on therapeutic mandates. In summary, this dissertation provided support to the construct of therapeutic mandates and presented clinical, methodological and theoretical implications.;Keywords : Couple therapy, relationship problems, therapeutic mandates, treatment goals, individualized measures, goal attainment scaling, clinical representativity, naturalistic therapy setting...