The Effectiveness of Couple Therapy and Relationship Support

• Self-Help Program for Couples (Behavioral): Self-Help Program for Couples (Mielenterveystalo.fi) developed by HUS, this online self-help program provides couples with psychoeducational content and practical exercises designed to enhance relationship well-being. Partners can complete the tasks together or individually. The materials aim to strengthen emotional connection and improve communication.
• Peloton Parisuhde (eng Fearless Relationship) Online Course (Behavioral): Based on Emotionally Focused Couple Therapy, this course by Eira Eklund-Mikola and Hanna Pinomaa uses online lectures and exercises to help couples identify negative interaction patterns and strengthen their emotional connection.
• Manualized Short-Term EFT-Based Couple Intervention (Behavioral): Manualized Short-Term EFT-Based Couple Intervention is a structured program consisting of five face-to-face sessions with a trained couple therapist. Based on Emotionally Focused Therapy (EFT), the intervention helps partners explore emotional patterns, improve communication, and strengthen their bond through guided therapeutic exercises.
• Standard Face-to-Face Couple Therapy (Treatment as Usual) (Behavioral): This intervention consists of 1 to 10 in-person sessions with a couple therapist. The therapeutic approach varies depending on the therapist's professional background and training. It reflects typical clinical practice and is not standardized, allowing for flexibility in addressing the couple's specific needs.

Primary outcomes

• Relationship Satisfaction (Dyadic Adjustment Scale) [Measured at enrollment before randomization, after treatment (or waitlist condition) and at a 4 months followup.]: The Dyadic Adjustment Scale (DAS) is a self-report questionnaire assessing relationship satisfaction and adjustment between romantic partners. The scale measures consensus, satisfaction, cohesion, and affectional expression. Total scores range from 0 to 151, with higher scores indicating better relationship adjustment and satisfaction.
• Depression severity (Patient Health Questionnaire-9) [Measured at enrollment before randomization, after treatment (or waitlist condition) and at a 4 months followup.]: The Patient Health Questionnaire-9 (PHQ-9) is a validated self-report measure assessing the severity of depressive symptoms over the past two weeks. Total scores range from 0 to 27, with higher scores indicating more severe depressive symptoms.
• Anxiety Severity (Generalized Anxiety Disorder-7) [Measured at enrollment before randomization, after treatment (or waitlist condition) and at a 4 months followup.]: The Generalized Anxiety Disorder-7 (GAD-7) is a validated self-report measure assessing the severity of generalized anxiety symptoms over the past two weeks. Total scores range from 0 to 21, with higher scores indicating more severe anxiety symptoms.

Secondary outcomes

• Adult Attachment (Experiences in Close Relationships - Revised [Measured at enrollment before randomization, after treatment (or waitlist condition) and at a 4 months followup.]: The Experiences in Close Relationships - Revised (ECR-R) is a widely used self-report questionnaire that assesses adult attachment styles in romantic relationships. The instrument measures two dimensions: attachment anxiety and attachment avoidance, reflecting how individuals experience closeness, trust, and emotional connection with their partner. Scores on each subscale typically range from 1 to 7, with higher scores indicating greater attachment anxiety or greater attachment avoidance.
• Reflective Functioning (Reflective Functioning Questionnaire) [Measured at enrollment before randomization, after treatment (or waitlist condition) and at a 4 months followup.]: The Reflective Functioning Questionnaire - RFQ-8 is a brief self-report measure developed by Fonagy and colleagues to assess reflective functioning, or mentalizing-the ability to understand one's own and others' thoughts, feelings, and intentions. In couple research, it helps evaluate how well partners can interpret each other's behavior in emotionally meaningful ways, which is essential for healthy communication and emotional connection.
• Communication Patterns (Communication Patterns Questionnaire) [Masured at enrollment before randomization, after treatment (or waitlist condition) and at a 4 months followup]: Communication Patterns Questionnaire - Short Form (CPQ-SF) Developed by Christensen and Sullaway, the CPQ-SF is a self-report measure that assesses how couples communicate during conflict. It focuses on typical interaction styles-such as constructive communication, avoidance, and demand-withdraw patterns-providing insight into how partners argue and resolve disagreements in their relationship.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Parents (couple) and blended families, and at least one of the parents is resident of Helsinki
* Couples expecting their first child. The couple is 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 eligible for treatment at the couple counselling faculty of Helsinki

Exclusion Criteria:

* Inadequate Finnish written language skills (the questionnaires are only available in Finnish)
* if both spouses do not complete the baseline questionnaires within the given deadline.