The effectiveness of couples therapy and relationship support
| ISRCTN | ISRCTN82628699 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN82628699 |
| Protocol serial number | Nro20/2024 |
| Sponsor | University of Helsinki |
| Funders | Valtion tutkimusrahoitus (Finnish State Research Funding), Helsingin Kaupunki |
- Submission date
- 13/11/2025
- Registration date
- 18/11/2025
- Last edited
- 18/11/2025
- Recruitment status
- Recruiting
- Overall study status
- Ongoing
- Condition category
- Mental and Behavioural Disorders
Plain English summary of protocol
Background and study aims
A romantic relationship is, for many, the most important interpersonal relationship in life. However, various relationship problems, such as conflicts and difficulties in communication, are common. Relationship issues have a significant impact on both partners' mental and physical health. In addition to the partners' own health, parental relationship satisfaction is strongly associated with better mental health in children, whereas conflicts between parents increase both behavioral problems and symptoms of depression and anxiety in children.
This study, conducted at the Relationship Counselling unit of the City of Helsinki, aims to evaluate the effectiveness of different forms of relationship support, including two online self-help programs, one in-person manualized short-term intervention, and couple therapy as usual, by comparing four intervention groups with each other and with a waitlist control group.
Who can participate?
Parents of children under 7 years old, of whom one of the parents lives in Helsinki. The couple experiences serious distress in their relationship or a threat of separation or divorce.
What does the study involve?
The study is a randomly allocated study in which participants are allocated to a couple (cluster), with a parallel-group design comparing four intervention groups, both with each other and with a waitlist control group. The interventions include two online self-help interventions: (1) HUS Self-Help for Couples, (2) Fearless Relationship Course, and two face-to-face interventions: (3) Short Manualized Emotionally Focused Intervention, (4) Couple Therapy (Treatment As Usual).
Participants complete questionnaires at the beginning and end of the service, and at a 4-month follow-up. The questionnaires measure relationship satisfaction and mental health, experiences in close relationships and reflective functioning. In addition, feedback-informed treatment is collected at the face-to-face interventions.
The study is run from the Relationship Counselling Unit of the City of Helsinki’s social services, which provides counselling and family guidance under Section 26 of the Social Welfare Act to couples with children living in Helsinki. A total of 200 couples from the unit’s treatment queue will be invited to participate and randomly assigned to one of the interventions or the control group, with 40 couples in each group.
What are the possible benefits and risks of participating?
Participants may benefit from addressing relationship challenges, potentially improving relationship satisfaction and overall family well-being. Risks include being assigned to an intervention that may not fully meet the couple’s needs. However, after completing the research treatment, all participants in the self-help and waitlist groups will have access to the unit’s standard treatment-as-usual services.
Where is the study run from?
The Relationship Counselling Unit of the City of Helsinki’s social services, Finland.
When is the study starting and how long is it expected to run for?
The study enrolment starts in November 2025 to November 2027.
Who is funding the study?
1. Valtion tutkimusrahoitus (Finnish State Research Funding), Finland.
2. City of Helsinki, Finland.
Who is the main contact?
1. Clinical Senior Lecturer, PhD Petra Nyman-Salonen, petra.nyman-salonen@helsinki.fi
2. PhD, Docent Marjo Flykt, marjo.flykt@helsinki.fi
Contact information
Principal investigator, Public, Scientific
University of Helsinki, Haartmaninkatu 3
Helsinki
00014
Finland
 ORCID ID |
0000-0002-4532-3159 |
|---|---|
| Phone | +358504794405 |
| petra.nyman-salonen@helsinki.fi |
Principal investigator, Scientific
University of Helsinki, Haartmaninkatu 3
Helsinki
00014
Finland
| ORCID ID |
0000-0003-0874-4357 |
|---|---|
| Phone | +358503015679 |
| marjo.flykt@helsinki.fi |
Study information
| Primary study design | Interventional | |
|---|---|---|
| Allocation | Randomized controlled trial | |
| Masking | Blinded (masking used) | |
| Control | Active | |
| Assignment | Parallel | |
| Purpose | Supportive care, Treatment | |
| Scientific title | The effectiveness of couple therapy and relationship support: a randomized controlled trial | |
| Study acronym | ECot | |
| Study objectives | This study investigates the effectiveness of four different interventions for couples: two online self-help relationship support programs (HUS Mielenterveystalo and ‘Fearless Relationship’ course) and two face-to-face interventions (a manualized short-term intervention based on the Emotionally Focused Couple therapy and Couple Therapy ‘Treatment as Usual’) on Relationship Satisfaction and Mental Health, and interventions are compared to the waitlist condition. | |
| Ethics approval(s) |
Approved 06/11/2024, Research Ethics Committee of the Faculty of Medicine (University of Helsinki) (Faculty Office, P.O:Box 3 (Haartmaninkatu 8), Helsinki, FI-00014, Finland; +35829 41911; eettinen-toimikunta@helsinki.fi), ref: 20/2024 | |
| Health condition(s) or problem(s) studied | Relationship satisfaction and mental health | |
| Intervention | The couples are randomly assigned to the five arms based on their relationship satisfaction, mental health symptoms, and family form. Four interventions: 1) Self-help program for Couples (Mielenterveystalo.fi) developed by HUS (Helsinki University Hospital): couples receive psychoeducational content and practical exercises to enhance their well-being 2) The Fearless Relationship -course is designed based on Emotionally Focused Couple therapy principles. 3) Manualized Short-Term EFT-Based Couple Intervention is a structured program consisting of five weekly face-to-face sessions with a trained couple therapist. 4) Treatment as Usual consists of 1 to 10 in-person sessions with a couples therapist. Control group: Waitlist control (2 months). | |
| Intervention type | Behavioural | |
| Primary outcome measure(s) |
1. Relationship satisfaction measured using the Relationship satisfaction (R-DAS) before randomization, post-intervention and at 4-month follow-up | |
| Key secondary outcome measure(s) |
1. Adult attachment measured using the Experience in Close Relationships– Short Form (ECR-12) before randomization, post-intervention and at 4-month follow-up | |
| Completion date | 31/12/2027 |
Eligibility
| Participant type(s) | Resident, Service user |
|---|---|
| Age group | Mixed |
| Lower age limit | 18 Years |
| Upper age limit | 100 Years |
| Sex | All |
| Target sample size at registration | 200 |
| Key inclusion criteria | Participants include couples (including blended families or those expecting their first child) in which at least one partner is a resident of Helsinki. The couple must be experiencing one or more of the following: 1. Severe relationship conflict 2. A serious threat of separation 3. Significant challenges in forming a family or navigating a blended family relationship Couples must be eligible for treatment at the Relationship Counselling Unit of the City of Helsinki, Finland. |
| Key exclusion criteria | 1. Inadequate Finnish written language skills (the questionnaires are only available in Finnish) 2. If both spouses do not complete the baseline questionnaires within the given deadline |
| Date of first enrolment | 18/11/2025 |
| Date of final enrolment | 31/12/2027 |
Locations
Countries of recruitment
- Finland
Study participating centre
Helsinki
00170
Finland
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|---|
| IPD sharing plan summary | Not expected to be made available |
| IPD sharing plan |
Editorial Notes
18/11/2025: Study’s existence confirmed by the Research Ethics Committee of the Faculty of Medicine (University of Helsinki), Finland.
