Preliminary estimates of cost-effectiveness for marital therapy

A recent study done by two Alliant faculty members suggests government funding for relationship counseling will ultimately save taxpayers money through reduced divorce rates.

The study, results of which were published in the July issue of the Journal of Marital and Family Therapy, also suggests that marital therapy, when paid for by insurers, will offset the increased health care expenses associated with divorce.

The study “Preliminary Estimates of Cost-Effectiveness for Marital Therapy,” is Co-Authored by Benjamin E. Caldwell and Scott R. Woolley of Alliant International University and Casey J. Caldwell of Arizona State University.

“I have been looking for quite a while at the effectiveness of marital therapy and the research on that,” said Dr. Caldwell, Assistant Program Director for Alliant's Marital and Family Therapy (MFT) program in Sacramento. “Our field has been steadily improving. Our techniques are getting more effective as we do more and better research.”

The study began with a simple question: If the government or health insurers paid for the screening and treatment of 100,000 randomly selected heterosexual married persons (50,000 couples) from the general population, would the financial benefits outweigh the costs? The study considered two types of therapy, behavioral marital therapy (BMT) and emotionally focused therapy (EFT). Both are popular techniques that have been the subject of many MFT studies.

“This is a projective study, a hypothetical study,” said Caldwell. “We wanted to ask the question: What would happen if...”

What would happen, according to the study, is that, “for every $1 spent on the screening and treatment of marital distress, the government would receive a return of up to $1.85 in reduced costs of handling divorces. Government would experience a net savings even if only 16% of couples identified as distressed in the screening process went on to begin treatment.”

The study also found that health insurers would benefit financially from decreased divorce rates resulting from MFT. Married people tend to take better care of themselves physically than single people of the same age, and health care costs go down significantly following marital therapy. The study concluded that health insurers could receive a return of up to $1.20 in reduced health-care expenses for every $1 spent on screening and treating marital distress. Even if only 41% of couples identified as distressed during screening went on to begin treatment, health insurers would still save money.

Another cost-saving technique the study proposes is the use of paraprofessional-non-licensed bachelor-level employee- to screen candidates for therapy. The paraprofessional would not treat the patient, but would screen him/her for therapy eligibility. Doing this via phone or internet would reduce the approximately $80/hour screening fee, a number determined by a 2004 survey of California MFT's. This hourly rate, when applied to the studies 100,000 married persons (or 50,000 couples) amounts to $4,000,000, a number that “could be considerably lowered if it were done by paraprofessional, via phone or Internet,” according to the study.

Marital and family therapy is a relatively young field, with recent studies, like this one, helping to bolster its legitimacy and defend its effectiveness.

“We want to be providing a service where we can tell people in the beginning ‘this therapy has proven effectiveness,” said Dr, Caldwell. “I think that we are moving more and more toward a fully flushed out science of MFT. Which is to say that treatment gets based more and more on what we know to be effective approaches rather than theoretical impressions. Now it is more of a science then a theory. It gives clients confidence that when they go to see a marriage therapist or MFT that they're going to be given proven effective treatment.”

About the Authors

Dr. Scott Woolley is a Professor and Systemwide Marital and Family Therapy Program Director at Alliant International University. He has a clinical specialization in couples therapy and MFT supervision and has trained mental health professionals in Finland, Hong Kong, Japan, Taiwan, Canada, and throughout the United States in couple therapy and/or supervision. In recent years, Dr. Woolley has worked closely with Dr. Susan Johnson, founder of Emotionally Focused Therapy, and with the late Jay Haley, a senior founder of the field of family therapy. Dr. Woolley is licensed in both Texas and California, and is an AAMFT Clinical Member and Approved Supervisor.

Dr. Ben Caldwell received his masters from Alliant and is a 2004 graduate of its MFT PsyD Program in San Diego. Since he was licensed in Jan 2006 he has run an EFT private practice in Sacramento. He has been working with couples and families for 8 years. He currently has several research articles under review and is conducting legislative work for American Association for Marriage and Family Therapy (AAMFT) - California. This year he taught MFT law and ethics, and MFT assessment.

Casey Caldwell was an MBA student at Arizona State University at the time of this study. He is now working for a private business in Phoenix, Arizona. His knowledge of business and economics was of great contribution to the study.

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