Abstract
The present study aimed to explore the lived experiences of married Iranian individuals regarding the failure of cognitive-behavioral couple therapy (CBCT). The primary focus was to identify the inhibiting factors that, within Iran's unique socio-cultural context, contribute to therapeutic failure from the clients' perspective. This qualitative research was conducted in 2023–2024 using thematic analysis. A purposive sample of 9 participants was recruited from independent clinics in Tehran, and data were collected through semi-structured interviews until saturation was reached. Data analysis followed the systematic method of Braun and Clarke (2016). The findings revealed that CBCT failure in Iran is the result of a vicious cycle in which the therapist's inability to manage sessions, lack of specialized knowledge, and low self-awareness—which leads to the expression of personal beliefs and cultural biases—merge with weaknesses in specialized couple-therapy competencies, such as ethical violations, disregard for therapeutic structure, excessive homework assignments, and failure to monitor progress. When these therapist-related factors combine with inhibiting couple characteristics, including mandated therapy attendance, responsibility avoidance, and blurred couple boundaries, they produce outcomes such as intensified hopelessness, negative attributions, and premature termination of therapy. These findings underscore the necessity of enhancing therapists' fundamental and specialized competencies, screening for negative prognostic indicators, and intelligently localizing treatment protocols to reduce therapeutic failure.

Introduction
Couple therapy holds a special place in the field of psychotherapy as one of the most effective interventions for resolving marital conflicts (Driver, 2006). Among various therapeutic approaches, Cognitive-Behavioral Couple Therapy (CBCT) has gained particular prominence due to its structured nature and strong empirical support. This approach, by integrating behavioral change strategies with cognitive restructuring, helps couples experience more constructive interactions (Halford, 2003). The necessity of applying CBCT in Iran becomes particularly evident when examining local evidence. Studies indicate that dysfunctional relationship beliefs and deficits in self-regulation—which are primary targets of this approach—are significant predictors of marital conflicts in Iranian couples (Khazaei, Pouladi Rishahri, & Eynipour, 2025). However, research warns that implementing standard protocols without attention to Iran's specific cultural components can lead to serious challenges (Kaveh Farsani, Safi, & Bahmani, 2019).
Numerous research studies support the efficacy of CBCT (Friedberg, 2006). Nevertheless, the phenomenon of treatment failure in this domain remains significant. Statistics indicate that a considerable percentage of couples do not achieve optimal improvement during therapy (Roesler, 2020). Furthermore, reports suggest that couple therapy clients report lower satisfaction levels compared to other forms of psychotherapy (Dattilio, 2010). The concept of treatment failure is complex and multidimensional. Failure can include premature termination, lack of meaningful change, minimal or slow changes, and sometimes negative effects (Lampropoulos, 2011). The consequences of treatment failure can be severe; couples may experience intense emotional distress when therapy fails to meet their needs, leading to hopelessness and disengagement from the therapeutic process (Verhofstadt, Lemmens, & Vanhee, 2021).
Recent studies clearly demonstrate that one significant cause of treatment failure is therapists' insufficient assessment and understanding of clients' issues. For example, in a recent study, 86.6% of patients identified this factor as contributing to treatment failure. Therapists' inability to adapt to patients' needs and lack of specialized knowledge were highlighted by 71.7% and 70.1% of patients, respectively, as major factors in treatment failure (Alfonsson, Fagernäs, Beckman, & Lundgren, 2024). Other contributing factors include unmet expectations and relational needs that, when unaddressed, lead to dissatisfaction (Stokstad & Parussa, 2023). This dissatisfaction and hopelessness during treatment often lead to deeper anger and frustration, pushing the relationship toward rupture. In these conditions, couples' unconscious defensive responses prevent effective communication and feelings of love, severely impacting therapeutic progress (Hao, 2022).
In Iran, premature termination is one of the most common problems in psychotherapy. Domestic research indicates that factors such as dissatisfaction with the quality of psychological services and the cultural mismatch of psychotherapy structures are among the most important reasons for treatment dropout (Khazaei, Rezaei, & Shahidi Pour, 2015). The present study, adopting a qualitative approach and using thematic analysis, seeks to explore the lived experiences of married Iranians regarding failure in CBCT. This study attempts to answer the fundamental question: "What is the lived experience of failure in CBCT for Iranian couples, and to what factors do they attribute this failure?" The findings of this study can provide a rich, context-based understanding for therapists, clinical supervisors, and family policy-makers, facilitating the localization of this approach and enhancing its effectiveness in Iran.

Research Methodology
This qualitative study was conducted using thematic analysis to explore the lived experiences of married Iranians regarding failure in CBCT (Braun & Clarke, 2016). The research field included couples who had attended psychological centers in Tehran during 2023-2024, completed at least 15 sessions of CBCT, and evaluated it as unsuccessful. A purposive sample of 9 participants (3 men, 6 women) was recruited from three independent clinics. Inclusion criteria included permanent marriage, active participation of both spouses, maximum 6 months since the last session, minimum 2 years of marriage, and age 25-50 years. Exclusion criteria included attributing treatment outcomes to external factors, infidelity, personality disorders, addiction, severe violence, or psychotic disorders. Data saturation was achieved after interviews with seven participants, with two additional confirmatory interviews ensuring saturation.
Data were collected through semi-structured interviews conducted online, averaging 60 minutes, covering demographic information, overall treatment evaluation, therapeutic relationship quality, treatment process, homework quantity and quality, and suggestions for improvement. The interview guide was developed based on literature review and expert consultation, piloted with two participants, and refined accordingly. Data analysis followed Braun and Clarke's (2016) six-step thematic analysis framework. To ensure trustworthiness, member checking, peer review, and rich description were employed. Inter-coder agreement (85%) was established through independent coding of 20% of the data. Ethical approval (IR.ACECR.REC.1402.008) was obtained, and confidentiality, voluntary participation, withdrawal rights, and use of pseudonyms were maintained.

Discussion
Therapist-Related Factors: The Professional Dimension of Failure
Therapist's Inability to Manage Sessions: Analysis of couples' experiences revealed that therapists' professional inadequacy manifested through lack of authority, diagnostic weakness, and low self-awareness. This finding, consistent with Gurman (2008) and Antaki and Jahoda (2010) regarding the importance of session structure and leadership, reveals a culturally specific dimension in Iran. In a hierarchical culture where clients perceive therapists as authoritative figures, this weakness directly leads to negative cultural attributions such as "this therapist lacks the necessary competence." As one participant stated: "I said the doctor shouldn't say such things, but he said with authority, 'I must say this.' He didn't accept that he was wrong." This suggests that in this context, loss of authority is not merely a technical flaw but a "cultural taboo" that accelerates and renders therapeutic failure inevitable.
Lack of Therapist Self-Awareness: The analysis showed that therapists' unresolved personal anxieties—manifested through expression of personal beliefs and transference of negative emotions—significantly compromised treatment. This finding aligns with Clements (2021) on the impact of personal characteristics on treatment outcomes and Prasko et al. (2023) on self-awareness enhancing therapist effectiveness. From the Cognitive-Appraisal Model perspective (Borkovec et al., 2002), therapists engaged in unresolved personal issues may be unconsciously evaluated as "untrustworthy" by clients, weakening the therapeutic alliance. One participant captured this: "The doctor had a very judgmental view of my husband... In a tone that showed anxiety and anger, he said 'you people are heartless' to my husband." This cultural sensitivity is particularly significant in Iran, where perceived judgment can be devastating to therapeutic relationships.
Ethical Violations: Analysis revealed that ethical violations—particularly forming alliances with one spouse, lack of confidentiality, and imposing personal preferences—constituted major factors in treatment failure. This aligns with research by Stiefel, Bourquin, and Saraga (2023) and Totton (2017). However, in Iran's cultural context, this issue becomes critical due to the conflict between the cultural taboo of divorce and client autonomy. As one participant explained: "The doctor clearly told me, 'Don't you dare separate... it's hard to find a good husband; you might not find anyone... if you separate, you might regret it later.'" Such interventions compromise client autonomy and create a cognitive-behavioral cycle of negative attributions, mistrust, and resistance, ultimately constituting an "unrepairable therapeutic catastrophe."
Lack of Adherence to CBCT Structure:** Participants consistently reported that therapists failed to maintain session structure, lacking clear objectives and appropriate intervention points. This finding fully aligns with Dattilio and Epstein (2016) and Kysely et al. (2020) on the importance of structured therapy. Epstein and Baucom's (2002) model suggests this failure stems from inadequate systematic assessment, poor case conceptualization, and unclear goal-setting, preventing the identification and disruption of dysfunctional cognitive-behavioral cycles. As one participant noted: "The therapist told me to think about what I want and what my husband wants; there was no specific structure."
Insufficient Competence for Couple Therapy:** Participants reported therapists' inability to identify appropriate interventions based on CBCT protocols, including failure to identify maladaptive beliefs and relational schemas, incorrect sequencing of interventions, and substituting specialized techniques with superficial solutions. One husband explained: "The doctor didn't address what made my wife cry; she had to recognize that issue herself. I think this was a serious problem."
Excessive Use of CBCT Techniques:** Analysis revealed that disproportionate, illogical homework assignments without clear rationale and without consideration of client capacity led to reduced implementation quality, mental fatigue, and decreased participation. This finding resonates with Castonguay et al. (2012) regarding potential negative effects of technique-driven therapy. From Beck's cognitive model (1988), when homework lacks cultural and personal relevance, failure reinforces beliefs such as "I can't change" or "this therapy doesn't work," reducing motivation and engagement. As one participant stated: "He gave too much homework, but it wasn't very useful; we didn't have time to do it all."
Therapy Without Progress Monitoring:** The absence of systematic assessment of cognitive and behavioral changes throughout treatment, without providing feedback on goal achievement, significantly reduced motivation and led to directionless sessions. This finding aligns with D'Aniello, Anderson, and Tambling (2021) on negative consequences of lacking progress monitoring. From a CBCT perspective, this reflects a systemic monitoring deficit (Halford, Pepping, & Petch, 2015). One participant illustrated: "The therapist suggested intimacy exercises, but when we fought during them and reported it, no guidance was provided on how to do it without fighting." This missed opportunity for corrective feedback perpetuates dysfunctional patterns.
Couple-Related Factors: The Client Dimension of Failure
Disrupted Couple Boundaries:** Participants reported blurred boundaries in emotional and behavioral domains, with each spouse inappropriately involved in the other's psychological space. This reduced autonomy, increased relational tension, and impeded therapeutic intervention.
Mandated Therapy Seeking:** When one partner attended therapy under coercion or external pressure rather than genuine intrinsic motivation, this created passive participation and resistance, blocking genuine engagement. As one participant stated: "My husband agreed to see the counselor so we would accept that his daughter has no problems and his behavior is normal."
Responsibility Avoidance:** Participants described patterns of blaming the partner, victimhood, and deflecting responsibility to external factors, reflecting coping strategies prevalent in collectivist cultures (Eghbal, Shariatmadar, & Khodadadi Sangdeh, 2022; Rezaei et al., 2021). Such avoidance prevents the acquisition of communication skills and disrupts the therapeutic process.
Negative Emotional Experiences:** Intense negative emotions experienced during couples' sessions caused participants to distance themselves from treatment and avoid confronting relational issues. These patterns align with Smoliak et al. (2021) regarding denial of responsibility and its negative consequences. In the Iranian cultural context, avoidance, withdrawal, and fate acceptance, combined with stigma avoidance and face-saving concerns, exacerbate treatment seeking delay and responsibility avoidance.
Consequences of Treatment Failure
The consequences of CBCT failure were profoundly distressing for participants, categorized into three themes: unmet treatment expectations, disappointing emotional consequences, and partner non-cooperation in continuing treatment. As one participant expressed: "Sometimes I get upset with my counselor; why didn't he tell me my husband won't change? If I'd known, I'd have made a more decisive decision and my life wouldn't have gotten to this point." This finding aligns with Knox et al. (2022) and Tambling and Johnson (2010) regarding the pivotal role of expectations in treatment continuation.
From the Cognitive Appraisal Model perspective (Borkovec et al., 2002), when initial expectations go unmet, negative evaluations of the entire treatment process are activated, generating disappointment and anger, fueling dysfunctional attributions, and ultimately leading to withdrawal behaviors that further reinforce the cycle. Participants reported intensified hopelessness, negative attributions (e.g., "the therapist is incompetent" or "this treatment method is useless"), and disengagement from treatment.

Conclusion
This qualitative study reveals that failure in CBCT in Iran is the product of a vicious, multi-factorial cycle emerging from the interaction of therapist deficiencies, inhibiting couple characteristics, and inappropriate protocol implementation. On one side of this cycle, unsuccessful therapists, through lack of professional authority, diagnostic weakness, and low self-awareness, undermine client trust—a problem intensified in Iran's hierarchical cultural context where clients expect strong professional leadership, compounded by tension between divorce taboos and client autonomy. On the other side, inhibiting couple characteristics—including responsibility avoidance, mandated therapy seeking, and resistance—combine with rigid protocol implementation (excessive homework lacking cultural appropriateness and inadequate progress monitoring) to disrupt therapeutic engagement and complete the cycle of hopelessness and withdrawal.
By revealing this interconnected network, the study emphasizes the necessity of enhancing therapists' foundational and specialized competencies, screening for negative prognostic indicators, and intelligently localizing protocols to interrupt this cycle and reduce the material and emotional costs of treatment failure. The findings have significant implications for clinical training programs, clinical supervision, and policy-making. Addressing these challenges can reduce premature termination rates and improve treatment outcomes. Future research should employ larger, diverse samples from various cities, document treatment histories, and utilize complementary methods such as session observation and joint couple interviews. A multi-stage research program centered on "Localizing and Evaluating the Effectiveness of CBCT in Iran" is recommended, beginning with qualitative exploration of therapists' experiences, leading to protocol design, and culminating in empirical testing of training effects on treatment outcomes.