In-session intimacy processes and treatment outcomes for 2 couple-focused interventions for prostate cancer patients and their spouses

Abstract

Background: In a previous study, we compared the efficacy of intimacy-enhancing therapy (IET) a couple-focused intervention based on the Relationship Intimacy Model of couples’ psychosocial adaptation to cancer, and compared it with a General Health and Wellness (GHW) treatment and Usual Care. IET had limited effects on couples’ psychological adjustment and relationship satisfaction, and any benefits were short-lived. Understanding why treatments do not work is an important step in improving their efficacy. Toward this end, this study examined associations between intimacy processes targeted by IET (disclosure, responsiveness, closeness) and post-treatment outcomes. Methods: Patients with localized prostate cancer and their partners (n = 137) participated. Couples rated self- and partner disclosure, perceived partner responsiveness, and how close they felt to their partner during sessions and completed measures of psychological adjustment, depression, cancer distress and concerns, and relationship satisfaction and relationship intimacy at baseline and 6 months post-baseline. Results: In both treatments, patients who reported more self-disclosure during sessions perceived that their partner disclosed to them, and perceived greater partner responsiveness during sessions and reported better post-treatment outcomes. Increases in self-disclosure did not predict post-treatment outcomes, but patients who perceived increases in their spouses’ disclosure and responsiveness in sessions reported higher post-treatment relationship intimacy. Some results were contrary to our predictions. Conclusions: Increases in disclosure, responsiveness, and closeness were not predictive of better post-treatment outcomes in either IET or GHW, which may partially explain the lack of a significant treatment effect in the larger study. It is possible that the focus on disclosure and responsiveness did not solve or address the concerns that couples identified, and that increasing understanding is only a first step in an effective couple-focused treatment for couples dealing with prostate cancer.