In order to better understand the effects of initial level of psychological disturbance on treatment outcome, a retrospective case control study of 95 couples who received couple therapy was conducted by sorting couples into one of four groups based on the degree of distress reported by individuals at intake: Neither distressed; both distressed; male distressed, female not distressed; female distressed, male not distressed. When partners started treatment with similar levels of disturbance both responded well in couple therapy. However, if the female reported clinical levels of disturbance at intake but her partner did not, outcome for the female was especially poor in contrast to outcomes for females receiving individual therapy. Clinically disturbed males showed significant gains in treatment even when their partners were not disturbed. These suggestive results argue for the possible value of conducting controlled studies of treatment assignment decisions that maximize positive outcomes.