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Couples therapy is an effective intervention for relationship problems. Despite the growing need and interest in online couples therapy during the pandemic, there is a dearth of outcome and/or process research. The current study applies the Hermeneutic Single Case Efficacy Design (HSCED) to examine the effectiveness of couples therapy across 24 weeks of treatment with a young couple who had to stay apart during the pandemic. A rich case record consisting of quantitative measures, change interviews and a case file was gathered. Based on the information, the authors developed opposing (affirmative and skeptic) arguments regarding whether the client changed over therapy and whether therapy was responsible for these changes. The results showed some improvement in the couple’s relationship attributes, attachment behaviors as well as presenting problems. The couple attributed most change to the therapy process and the relationship that they have with their therapist. It appeared that the change took place over the first 16 sessions, and together with extra-therapeutic factors, online couples therapy appeared to contribute to this change. The complex, nonlinear, and multi-layered nature of change in couples therapy was discussed in terms of clinical implications.

Change in One Couple’s Online Therapy Process: An HSCED Application