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In-session change in Emotionally focused Therapy
Abstract
This article presents 3 different studies of in-session changes in emotionally focused couples therapy (EFT). Studies of in-session conflict events demonstrate both that couples' conflict interaction at the end of treatment is more affiliative and interdependent than at the beginning of treatment and that peak session conflict interaction is deeper in level of experience and more affiliative than the interaction in poor session conflict episodes. In addition, events beginning with intimate, affective self-disclosure by one partner were found to involve greater affiliation in spouses' responses to the self-disclosure than in a control event not involving self-disclosure. The possible change processes in EFT are discussed in light of these results.
... Furthermore, influenced by Alvin Mahrer's (1981) suggestion that researchers concerned with the effectiveness of experiential family therapy focus on the process rather than the outcome, as well as other researchers with similar ideas, such as Nichols and Zax (1977), Leslie Greenberg and Susan Johnson have scrutinized EFT with a battery of research on in-session process (e.g. Greenberg, Ford, Alden, & Johnson, 1993;Johnson & Greenberg, 1988) and have even become spokespersons for such research (Johnson, 2003;Elliott, Watson, Goldman, & Greenberg, 2004). ...
... They, on the other hand, were able to reflect in a very immediate way, on the experiencing and emotion of marital conflict. Allowing for this rich process of exploring emotion in the context of conflict seems to be very beneficial to the growth of intimacy in marital couples (Greenberg, Ford, Alden, & Johnson, 1993;Johnson & Denton, 2002;Johnson, Makinen, & Milliken, 2001;Johnson & Talitman, 1997). ...
... & Johnson, 1994; Dunn & Schwebel, 1995;Greenberg, Ford, Alden, & Johnson, 1993;Greenberg & Johnson, 1985, 1986 Johnson & Best, 2003; Johnson & Greenberg, 1985a, 1985b Johnson, Makinen, & Millikin, 2001; Johnson & Talitman, ...
Who am I? The question haunts and thrills. The answer looms beneath me, girding me up to face that which I hope for. And I search it for meaning. I feel echoes within, voices from my past that converge in my heart and overflow my being. I am family rules and rituals, personal hopes and convictions, cultural movement. Who I am becoming has everything to do with who I have been and all I encounter. Who I am is who God has made me, and is making me, to be: a biological, psychological, social, spiritual human creature–a soul. I am the culmination of my innate potentials and history in this present moment, this sacred space of destiny in process, a weaving together of experiences and meanings, with the introjected reverberations of family past, community, society, relationships–unconscious memories and intentional motives. I am human potential itself, and I am being formed by touching all that is Other. I am the echoes; I am the past. I am also freedom in motion, choice, initiative, will. I am being but also becoming–a faith potential. I am a believer, looking beyond and drawing unto. I am vocational, more than my genetic makeup, more than even my community embeddedness. I am a purpose. I am a story being written, coauthor with God. Homo poeta, a meaning maker (Becker, 1968; Buechner, 1982; Fowler, 1981, 2000).
... EFT consists of three stages divided into nine steps; each stage has its own specific set of therapeutic goals. The steps and stages of EFT as it is taught and practiced today are the result of research into the process of change in couple therapy (e.g., Greenberg, Ford, Alden, & Johnson, 1993;Johnson & Greenberg, 1988). This section contains a brief overview of the basic components of EFT. ...
... Similarly, Greenberg and colleagues found in another investigation of in-session changes in EFT for couples that those who completed 8-10 sessions of EFT made significantly more affiliative statements (as measured by the SASB) after seven sessions than did couples in a waitlist control group, and that there were statistically significant differences pre-and posttherapy in the number of affiliative statements that couples who received EFT made (Greenberg et al., 1993). Another important finding in this study was that spouses were significantly more likely to engage in affiliative interactions when their therapist successfully facilitated intimate self-disclosure (as measured by the Self-Disclosure Coding System [SDCS; Waring & Chelune, 1983], as predicted by the EFT model [Greenberg et al., 1993]). ...
... Similarly, Greenberg and colleagues found in another investigation of in-session changes in EFT for couples that those who completed 8-10 sessions of EFT made significantly more affiliative statements (as measured by the SASB) after seven sessions than did couples in a waitlist control group, and that there were statistically significant differences pre-and posttherapy in the number of affiliative statements that couples who received EFT made (Greenberg et al., 1993). Another important finding in this study was that spouses were significantly more likely to engage in affiliative interactions when their therapist successfully facilitated intimate self-disclosure (as measured by the Self-Disclosure Coding System [SDCS; Waring & Chelune, 1983], as predicted by the EFT model [Greenberg et al., 1993]). ...
The focus of this article is on the link among theory, process, and outcome in the practice of Emotionally Focused Therapy (EFT) for couples. We describe the EFT model of change and the EFT perspective on adult love as the reflection of underlying attachment processes. We outline the manner in which theory and research inform EFT interventions. This leads into a detailed review of the literature on the processes of change in EFT. We highlight the client responses and therapist operations that have emerged from process research and their relation to treatment outcomes. We discuss the implications of this body of research for clinical practice and training.
Este artículo se centra en el vínculo entre la teoría, el proceso y los resultados en la práctica de la terapia focalizada en las emociones (TFE) para parejas. Describimos el modelo de cambio de la TFE y su perspectiva del amor adulto como el reflejo de procesos de apego subyacentes. Describimos la manera en la cual la teoría y la investigación guían las intervenciones de la TFE. Esto conduce a una revisión detallada de la literatura sobre los procesos de cambio en la TFE. Destacamos las respuestas del paciente y las actividades del terapeuta que han surgido de la investigación sobre los procesos y su relación con los resultados del tratamiento. Debatimos las consecuencias de este corpus de investigación para la práctica clínica y la capacitación.
本文重点关注夫妻情绪取向治疗(EFT)实践中理论、过程与结果之间的联系。我们描述了EFT模式的变化,也描述了将成年人爱情作为反映潜在情感过程的EFT视角。我们概述了理论与研究以何种方式展示EFT干预。这就要求我们对EFT变化过程的文献进行详尽的回顾。我们特别强调过程研究中出现的客户反响和治疗师的操作,及其与治疗结果的关系。我们讨论了这部分研究对临床实践和培训的意义。
... In still another variant on the events approach, task analysis (Rice & Greenberg, 1984 ), the researcher operationally defines a therapeutic episode with a clinically identifiable task that is successfully resolved during the session (Greenberg, 1984, p. 124). We located two such research programs, one concerning the expression of affect in emotionally focused therapy (EFT;) for couples (Greenberg, Ford, Alden, & Johnson, 1993) and one concerning family engagement in problem solving (Friedlander, Heatherington, Johnson, & Skowron, 1994; Heatherington & Friedlander, 1990a). Important moments. ...
... Change events. In contrast to Johnson and Greenberg's (1988) research on effective sessions , in more recent research Greenberg et al. (1993) sought to identify specific change events within sessions that could be linked to successful outcome in EFT couples treatment. This approach focuses on the expression of affect and averages 8 to 10 sessions. ...
... This approach focuses on the expression of affect and averages 8 to 10 sessions. Data for all three investigations reported in Greenberg et al. (1993) were drawn from a previously reported outcome study. In the first study, conflict events were identified by specific markers—SASB (Benjamin, 1974 ) codes indicating that the couple was engaging in negative complementarity or negative reciprocity—followed by a therapist intervention focusing on needs or emotions. ...
Despite convincing outcome evidence and the popularity of family therapy, little is known about how interpersonal change actually comes about in this context. To synthesize and integrate what is known and to offer recommendations for future, clinically relevant research, all published process studies on family therapy were reviewed. Included were naturalistic studies of conjoint treatment in which the focus was the in-session verbal behavior of the participants or their self-reported perceptions of actual interactions. Dating from 1963, 36 studies met the inclusion criteria. The review was organized according to 3 hierarchically ordered levels of in-session processes (L. S. Greenberg, see record
1986-17811-001): observations of (1) speech acts, followed by studies of (2) important incidents or change episodes and (3) the therapeutic relationship. The implications of what is "known" are followed by a discussion of what is not "known" and suggested directions for future research. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Insecurely attached individuals who struggle to ask for and receive support are likely not getting their needs met in relationships. Prior research has found that those who perceive that their needs are not being met are more likely to express hostility and escalate conflicts (Greenberg et al., 1993;Kobak & Sceery, 1988;Mikulincer & Shaver, 2012). These difficult relationship experiences may then contribute to increasing negativity and hostility over time. ...
... R. Kobak et al., 2009;Muris et al., 2004; see also Mikulincer & Shaver, 2011;Van IJzendoorn, 1997). Negativity and hostility may thus become natural, if secondary, consequences of attachment insecurity: Adolescents' negative expectations of others are likely to be reaffirmed across years, as individuals continue to face and recreate unhelpful relationship dynamics (through evocation, partner selection, or both) and to experience concomitant feelings of anger as their emotional needs are repeatedly frustrated (Greenberg et al., 1993;Kobak & Sceery, 1988). ...
Attachment theory suggests that insecurely attached individuals will have more difficulty seeking and receiving support from others. Such struggles in adolescence may reinforce negative expectations of others and contribute to relationship difficulties into adulthood. Using a diverse community sample of 184 adolescents followed from age 13 to 27, along with friends and romantic partners, this study found that more insecure states of mind regarding attachment at age 14 predicted relative decreases in teens’ abilities to seek and receive support from close friends from ages 14–18. In addition, greater attachment insecurity predicted greater observed negative interactions with romantic partners and relative increases in hostile attitudes from ages 14 to 27. The effect of attachment insecurity on observed negativity was mediated by difficulty seeking/receiving support in friendships during adolescence. Results suggest a type of self-fulfilling prophecy as insecure adolescents confirm their negative expectations of others through ongoing struggles to obtain support.
... In summary, this study suggests that research of processes of change is particularly fascinating, important and warrants further investigation. (Greenberg, et al., 1993;Greenberg, et al., 1988) beschrieben und in deren Untersuchungen als die zentralen Prozesse identifiziert. ...
... therapeutischen Intervention) zu sein. Oder wie es ein Klient in einem Interview in der Studie von Greenberg et al. (1993) ausdrückt: ...
... The sections and aspects of therapy identified for study are called events (Greenberg, 1984(Greenberg, , 1986. The selection of an event to study helps sharpen the focus and specify the context of how change occurs (Greenberg, Ford, Alden, & Johnson, 1993). Events are often chosen through directly observing the processes of therapy (Greenberg, 1986(Greenberg, , 1991Rice & Greenberg, 1984b). ...
... There are currently four outcome studies which demonstrate the effectiveness of emotionally focused therapy (Goldman, 1987;James, 1991;Johnson & Greenberg, 1985a;Johnson & Greenberg, 1985b). There are also at least three studies that investigate the process of change in emotionally focused therapy (Greenberg et al., 1993;Greenberg, James, & Conry, 1988;). ...
... EFT process research. Process research has been key throughout the development of EFT (Greenberg, Ford, Alden, & Johnson, 1993;Greenman & Johnson, 2013;Zuccarini, Johnson, Dalgleish, & Makinen, 2013), and studies have verified that therapeutic alliance with warmth is one of the most important variables promoting change in therapy (Johnson & Talitman, 1997). As the earliest authors of EFT, Johnson and Greenberg (1988) also discovered in their process research a specific type of interaction which occurred in a key change event, called "a Softening," (p. ...
... Warmth generated by a therapist may be an important opportunistic force that invites men to feel comfortable engaging with their spouses and thereby generating more positive engagement in therapy associated with change events. Because nurturing affiliative responses are often associated with change moments in EFT (Greenberg et al., 1993;Tilley & Palmer, 2012), this is important information adding to the body of existing EFT literature. Husband engagement in therapy is counter to typical patterns of stonewalling and withdrawal observed in therapy process (Greenman et al., 2012), and ultimately becomes a potential new experience for the wife in therapy. ...
This longitudinal dyadic clinical process study used coded data from eleven couples to determine the influence of therapist warmth behaviors on couples' warmth behaviors over time in therapy. A mixed effects model was used to examine within- and between-individual variability. Men and women were modeled separately. A series of two-level multilevel models of change were examined, where Time is Level 1 and Individual is Level 2. Findings were mixed. There was no significant relationship between therapist warmth toward wife and wife warmth toward husband; however, there was a significant relationship between therapist warmth toward husband and husband warmth toward wife. Findings demonstrated that 62.9% of the variance in husband warmth toward wife was accounted for by therapist warmth to husband across time in therapy. Specifically, therapist warmth toward husband was significantly and positively related to husband warmth toward wife over time in therapy. Clinical implications and directions for future research are discussed.
... Researchers in the field of couple therapy have long been interested in understanding for whom therapy works and why, calling for and reporting the results of clinical outcome research (Pinsof et al. 1996;Sprenkle 2003). In addition, a growing body of literature predicting therapy outcome from therapy processes (Gurman and Kniskern 1992) and reporting on the efficacy of popular models (Greenberg et al. 1993;Johnson and Talitman 1997), has enhanced the field's understanding of how couple therapy works. Despite these efforts, couple therapy researchers continue to report early termination from treatment (e.g. ...
... For example, research on Integrative Behavioral Couple Therapy indicates that the couples most likely to report positive outcomes after a course of therapy are those that are able to engage actively around shared problems (Cordova et al. 1998). Similarly, in Emotionally Focused Therapy, couples who saw engagement with one another as important to solving a shared problem were more likely to report positive outcomes (Greenberg et al. 1993;Johnson and Talitman 1997). The effectiveness of these, along with similar and popular interventions, is based on assumptions that couples believe they share problems, are able to speak openly about problems, and that each partner is ready to make changes to problem behaviors. ...
Assessing and measuring client motivation to change has been of great interest to therapists and researchers in a variety of fields. The authors of this manuscript present the results of a confirmatory factor analysis of the University of Rhode Island Change Assessment (URICA) in a sample of individuals in couple therapy. A sample of 603 individuals engaged in couple therapy completed the URICA as part of intake measures. Interpretation of the results indicated that a modified version of the URICA, the R-URICA provides a three-factor solution that best fits the data.
... Empirical research supports couple treatment that helps couples de-escalate conflict that occurs in the absence of empathy and compassion and treatments that help partners reveal more vulnerable emotions and experiences that have the potential to create new relational experiences (Greenberg, Ford, Alden, & Johnson, 1993;Greenberg & Johnson, 1988). Specifically, studies have shown that Emotion-Focused Couple Psychotherapy (emphasizing interventions that address vulnerable emotions) facilitates more change compared with Behavioral Couple Psychotherapy (emphasizing This document is copyrighted by the American Psychological Association or one of its allied publishers. ...
... To explore what promotes change in emotionally focused couple psychotherapy, Greenberg et al. (1993) studied change processes and found that couples focusing inward on their internal experience and integrating new meanings to their emotional reactions led to more intimate interpersonal interactions and resolution of conflict compared with blaming. Bradley and Furrow (2004) found that therapist interventions that promoted more vulnerable underlying emotions intensified the couple's emotional experience, facilitated insight, and changed attachment-related interactions. ...
One of the most critical goals for couple psychotherapy is to foster a new relational experience in the session where the couple feels safe enough to reveal more vulnerable emotions and to explore their defensive withdrawal, aggressive attacking, or blaming. The lived intimate experience in the session offers the couple an opportunity to gain integrative insight into their feelings, expectations, and behaviors that ultimately hinder intimacy. The clinical processes that are necessary include empathizing with the couple and facilitating safety within the session, looking for opportunities to explore emotions, ruptures, and unconscious motivations that maintain distance in the relationship, and creating a new relational experience in the session that has the potential to engender integrative insight. These clinical processes will be presented with empirical support. Experts from a session will be used to highlight how these processes influence the couple and promote increased intimacy.1 (PsycINFO Database Record (c) 2013 APA, all rights reserved).
... For example, Korman (1998) has shown that emotion-focused, PE therapy of depression, when successful, led to significant changes in clients' emotional states. This research used the Emotion Episode (EE) method (Greenberg & Korman, 1993; Korman, 1998) to identify in-session episodes in which clients talk about their emotions. Clients with better outcomes showed significantly more changes in their emotions from early to late sessions than did clients with poorer outcomes. ...
... These two studies highlight both the role that vivid description can play in promoting clients' emotional arousal during sessions and the role of selfreflection in the change process. These findings validate proposition that vividly re-evoking the situation, and clients' subsequent differentiation of their subjective experience, are both necessary but different aspects of productive therapy process, and in particular are important steps in resolving problematic reactions (Greenberg et al., 1993; Rice & Saperia, 1984). ...
reviews the research literature from 1978 to 1992 on [experiential] therapies, succeeding several major reviews of research on empathy and the client-centered relationship conditions / relevant research on experiential marital, family, and group therapy is included (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... The PSRQ contains four items, three of which are rated on a 5-Likert scale, and one of which is rated on a 7-point Likert scale. This measure only has face validity and has been used in previous studies [49,50] to identify the best and worse sessions for the use of psychotherapy process measures such as the SASB [51] and the ES [52]. Three of the questions are summed together for a PSRQ change score, where higher scores are indicative of higher perceived levels of change. ...
Background: Couple relationship distress is common and associated with poor physical, psychological, relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change.
Methods: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a wait list. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psychoeducational program based on EFT after completing the study.
Discussion: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the US and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy.
Trial registration: NCT04277325; February 20, 2020.
... From qualitative interviews with couple therapy experts, their students, and their clients, Piercy (2007a, 2007b) identified conceptualizing and interrupting negative interaction cycles as a common factor for improving couple relationships. In a series of EFCT change process studies, Greenberg, Ford, Alden, and Johnson (1993) found that in later sessions of therapy, couples were more affiliative and less hostile. They also found that a spouse's affiliative behavior can be promoted by a therapist encouraging self-disclosure. ...
We explored Masters of Social Work (MSW) student discourses of learning experiences related to Noticing and Attending to Relational Process (NARP) in a course devoted to clinical practice with families and couples. Within two to three weeks after completing recorded peer role-play assignments and receiving audio-recorded feedback from the instructor, five randomly selected students participated in an unstructured interpersonal process recall (IPR) interview. The instructor/first author queried students about specific role-play moments and reactions to instructor-produced, audio-recorded feedback regarding NARP competencies. We used dialogical analysis to identify discourses and rhetorical features of interview data. Five primary themes emerged. Based on our Bahktinian interpretation of interview data with students, our findings also demonstrated multi-voiced discourses, indicating students’ internal struggle to make sense of NARP and respond to instructor feedback. Educators and practitioners can more intentionally attune themselves to these discourses, potentially opening avenues for stronger social work service provision.
... In the day to day of relational trauma work, clinicians diligently utilise cognitive therapies to challenge distorted and self-blaming beliefs and perceptions to assist clients towards a 'reappraisal of the meaning of the trauma' (Cloitre, 2015, p. 3). Therapists working from an attachment perspective attempt to facilitate validating, secure, and safe bonds between carers and children and between two partners in the couple relationship (Ainsworth, 1991;Bowlby, 1988;Farber, Lippert, & Nevas, 1995;Greenberg, Ford, Alden, & Johnson, 1993). Given the privileging of the centrality of the therapist/client relationship within most therapeutic discourses (cf. ...
Clinicians are charged with being diligent in gaining competency in the latest trauma-informed interventions when working with relational trauma. This may invest therapists with an overresponsibility that is not only overwhelming and unrealistic, but serves to reduce autonomous functioning in family members. Therefore, clinicians need to become clear about what they are responsible for and what they are not, particularly when family members present as irresponsible or too anxious to think and act more effectively. Using a case vignette, this paper discusses how a clinician's focus on increasing their differentiation of self, a concept embeded in Bowen family systems theory, protects against vicarious traumatisation, secondary traumatic stress, and burnout whilst contributing to more autonomous functioning and better wellbeing outcomes for both clinicians and clients alike.
... It is not enough to see this relationship as ground for technique or as reflection of personal dynamics, but the potential for change is maximized by the recognition of relational experience as it unfolds. This is a process-experiential orientation (Greenberg, Ford, Alden, & Johnson, 1993) with a relational twist (Safran & Muran, 2000). Accordingly, agency can be courted as one observes an experience emerge in the therapeutic relationship, which in turn can transform the experience of the relationship: For example, as one recognizes an impulse emerge, one can choose to act or not on it; and even the recognition alone can make acting on the impulse different. . ...
Objective: The study of alliance rupture has become quite prevalent since 1990 and especially in the past 10 years where we have seen a noticeable surge in empirical publications on the subject. This honorary paper attempts to provide a critical review of this literature from the perspective of someone who has contributed to it in his collaborative work on a research program designed to investigate ruptures and to develop intervention and training models to resolve them. Method: This paper is organized into three topics or sections: (1) alliance rupture, (2) rupture resolution, and (3) alliance training; and it addresses definitions, findings, questions, and lessons with regard to each topic. Results/Conclusions: It suggests some clinical conceptualizations (concerning agency and communion as well as mutual recognition), training implications (regarding emotion regulation and deliberate practice), and methodological considerations (promoting pluralism and contextualism), along with future directions.
Clinical or methodological significance of this article: The paper provides a critical review of research on a possible risk factor and potential change process in psychotherapy, including related training strategies, that has important implications for treatment outcome and professional development.
... Johnson emphasizes the role of attachment in couple's functioning (Johnson, 2004) whereas Greenberg and Goldman (2008) consider affect regulation to be the central force that organizes couple's dynamics and that also governs the motivational systems in couples of attachment, identity and attraction. At clinical level, there are more similarities than differences between the two 'versions' of EFT-C as both use the same core interventions developed by , for which there is substantial empirical support (Greenberg, Ford, Alden, & Johnson, 1993;Johnson, Hunsley, Greenberg, & Schindler, 1999). ...
Emotion-focused therapy for couples (EFT-C) is an empirically validated approach that views affect as the central force organizing couple’s interactions. Specifically, affect works through three primary systems of motivation: attachment, identity/validation and attraction/liking. This article outlines the theoretical framework of EFT-C, its intervention strategies and includes a review of research studies that support the efficacy of the approach, as well as the research that has focused on the process of change in EFT-C.
... Greenberg and Goldman (2008) refer to this process as emotional coaching, by which they mean teaching the individual to better tune in to their own emotional experience, and using that emotional mindfulness constructively within their relationship. Three studies of emotion focused couple therapy show that couples make the predicted increase in emotional expression, particularly revealing more primary and vulnerable emotions across the course of therapy (Bradley & Furrow, 2004;Greenberg, Ford, Alden, & Johnson, 1993;Makinen & Johnson, 2006). ...
Being in a satisfying romantic relationship is one of the strongest predictors of overall life satisfaction and well-being. In the present chapter, we examine the possibility that mindfulness may be beneficial to romantic relationships. To date, most of the scientific literature has examined whether mindfulness enhances individual well-being and functioning or reduces individual distress. However, more recently, there has been increasing focus on the potential benefits of mindfulness for interpersonal outcomes. We begin with a review of the available theoretical and empirical evidence pertaining to the influence of dispositional mindfulness on couple relationship processes and discuss a range of potential mechanisms that might explain why mindfulness may facilitate healthy relationships, including enhanced emotion regulation, increased acceptance, and greater capacity to engage in self-change to enhance the relationship. We then discuss the use of mindfulness-based interventions to enhance couple relationships and alleviate couple relationship distress. We conclude with a discussion of the clinical utility of mindfulness for use with distressed couples and outline directions for future research.
... In an initial 310 pilot study comparing IBCT with TBCT, Cordova, Jacobson, and Christensen (1998) 311 found that couples in IBCT showed relatively more constructive detachment over the 312 course of therapy, and that these changes predicted couples' gains in relationship satisfac-313 tion. Three task-analytic studies of EFCT (Greenberg, Ford, Alden, & Johnson, 1993) 314 showed that: (a) couples receiving EFCT demonstrated more shifts from hostility to affi-315 liative behaviors than waiting-list couples; (b) best sessions as identified by couples were 316 characterized by more depth of experiencing and affiliative and autonomous statements 317 than were sessions identified as poor; and (c) intimate, emotionally laden self-disclosure 318 by one partner was more likely to lead to affiliative statements by the other partner than 319 were other randomly selected responses. A more recent task analysis of four EFCT ses-320 sions by Bradley and Furrow (2004) found that specific therapist interventions linked to 321 ''softening events'' (reformulations of partners' hostile or critical comments as expressions 322 of vulnerability) involved intensifying a couple's emotional experience and promoting 323 intrapsychic awareness and interpersonal shifts in attachment-related interactions. ...
... The above three general processes of dysfunction are supplemented by the operation of a large variety of more specific cognitive/affective processing difficulties that help explain different types of dysfunctional experiential states. A variety of particular experiential difficulties have been described by Greenberg, Ford, Alden, and Johnson (1993). Difficulties such as problematic reactions, in which one's view of an experience and one's reaction don't fit; self-evaluative splits, in which one part of the self negatively evaluates another; unfinished business, involving unresolved emotional memories; and statements of vulnerability involving a fragile sense of self. ...
... The six approaches that research participants discussed were: the Social Ecological Approach [5,6], Attachment-Based Family Therapy [7], Gottman Couples Therapy [8], Imago Relationship Therapy [9], McMaster Approach [10], and Emotionally Focused Therapy [11][12][13]. Beginning with a general overview of couple and family therapy, the literature reviewed here will then look briefly at evidence-based practices in couple and family therapy. The research literature about the benefits, challenges, and social justice considerations of evidence-based practices was located across mental health fields such as psychology and social work, and to a lesser extent, the CFT literature. ...
http://www.mdpi.com/2076-0787/4/4/861
This paper will present research that explored the experiences of couple and family therapists learning about and using an evidence-based practice (EBP). Using a phenomenological approach called Interpretative Phenomenological Analysis, three themes emerged from the participants’ experiences: the supports and challenges while learning an EBP, the experience of shame while learning, and the embodiment of a therapy practice. This paper will focus on the theme of embodiment. Research participants’ experiences will be reviewed and further explored using Merleau-Ponty’s notion of embodiment and Gendlin’s (1978) more internally focused understanding of how awareness of a felt sense is experienced as a move “inside of a person”. As researchers, educators, administrators, policy makers, and counselor struggle with what works best with which populations and when, how best to allocate resources, how best to educate and support counselors, and the complexity of doing research in real-life settings, this research has the potential to contribute to those varied dialogues.
... These differences highlight the therapist's position and behavior in session, but the authors did not attempt to link behaviors with couple outcomes or in-session exchanges between partners. Several studies have investigated specific processes of EFT and couple change (Furrow, Johnson, & Bradley, 2011;Greenman & Johnson, 2013;Greenberg, Ford, Alden & Johnson, 1993;Lebow, Chambers, Christensen, & Johnson, 2012;Zuccarini, Johnson, Dalgleish & Makinen, 2013), but little have examined the aforementioned linkage of therapist behavior/interventions and couple processes. ...
This is a longitudinal multilevel analysis using third party coded data of 15 couples
therapy sessions to identify which therapist Emotion Focused Therapy interventions
(Management of Couple’s Interaction, Working with Primary Emotion, Managing Defensive
Responses, Reframing the Problem in Terms of the Cycle, and Placing Emerging Emotions into
the Cycle) influenced husband-to-wife and wife-to-husband exchanges of Positive Behaviors
(warmth, prosocial behaviors, communication, assertiveness, and listening). A mixed effects
model was used to examine within- and between-individual variability. Men and women were
modeled separately. A series of two-level multilevel models of change were examined, where
Time is Level 1 and Individual is Level 2. Results indicated no significant relationship between
Management of the Couple’s Interaction, Managing Defensive Responses, and Reframing the
Problem in Terms of the Cycle with both wife-to-husband and husband-to-wife positive
behavior. Findings demonstrated that 44.5% of the variance in wife-to-husband positive
behaviors and 66.5% of the variance in husband-to-wife positive behaviors was accounted for by
the therapist Working with Primary Emotion and Placing Emerging Emotions in the Cycle.
Specifically, these therapist interventions were significantly and negatively related to wife-to-husband
and husband-to-wife positive behaviors over time in therapy. Clinical implications and
directions for future research will be discussed.
... Process research has been influential in the development of EFT (Greenman & Johnson, 2013;Greenberg, Ford, Alden, & Johnson, 1993;Zuccarini, Johnson, Dalgleish, & Makinen, 2013), as proponents of EFT have used it to identify the key, in-session predictors of change in couples (Furrow, Johnson, & Bradley, 2011). However, much of the process literature in EFT has only investigated client (i.e., couple) behavior. ...
The purpose of this study was to explore and compare high-fidelity and low-fidelity Emotionally Focused Couples Therapy sessions across the course of treatment. Data were taken from sessions 3, 7, and 11 from two different couples. Grounded theory was used to identify emerging themes from the data. Further, a word frequency query was performed to understand the differences in language use. Results indicated that more primary emotion words were used in high-fidelity than low-fidelity sessions, while more cognitive words were used in the low-fidelity sessions. Different themes were found when comparing the high- and low-fidelity sessions and include primary focus and identifying the couples’ cycle. Additional results and clinical implications are discussed.
... In EFT, peak sessions have been characterized by deeper emotional experiencing than have poor sessions (Johnson & Greenberg, 1988). The sessions where the most progress is made are ones in which there presence of deep emotional experiencing (Greenberg et al., 1993). These confirmatory findings are of great importance in process research (Johnson et al., 1999), building on evidence indicating that deep emotional experiencing is associated with the best session, that EFT is successful in helping to expand emotional experiencing, and that deep in-session emotional experiencing is a key component to change (Johnson & Greenberg, 1988). ...
In emotionally focused couple therapy (EFT), the completion of a blamer-softening event has been related to deeper emotional experiencing and relationship repair. However, the characteristics of those who are able to complete this event are unknown. The authors examined emotion regulation at intake in relation to key change processes in EFT. Results indicated that emotional control and emotional self-awareness, two emotion regulation strategies, at intake did not predict in-session emotional experiencing or the completion of a blamer-softening event. Results also indicated that gender was a significant predictor of emotional experiencing in the best session. Results attest to the efficacy and generalizability of EFT.
... For example, research on Integrative Behavioral Couple Therapy indicates that the couples most likely to report positive outcomes after a course of therapy are those that are able to increase their incidence of nonblaming discussions during therapy (Cordova, Jacobson, & Christensen, 1998). Similarly, in Emotion Focused Therapy, couples who experienced a softening of emotions in communication events related to the problem in session were more likely to report positive outcomes (Greenberg, Ford, Alden, & Johnson, 1993; Johnson & Talitman, 1997). Thus, to fully understand changes in satisfaction, we need to be able to measure satisfaction during the session and be able to link changes in satisfaction to events happening within therapy sessions. ...
This study examines in-session changes in sentiment override over the first three sessions of couple therapy. Couples viewed a video recording of therapy sessions immediately after each of the first three sessions and continuously rated their level of sentiment override. Ninety-eight changes were randomly chosen for analysis. Three talk turns prior to each change was coded using the Family Relational Communication Control Coding System. Results show that changes in sentiment override occur frequently. Repeated incidents of communication control were related to negative change in sentiment override for females. Repeated incidents of being left out of the conversation were related to negative changes in sentiment override for females and positive changes for males.
... It is this new emotional experience between the partners rather than insight that leads to the new relationship meaning and, consequently, more functional interaction patterns (Johnson & Greenberg, 1988). Successful counseling occurs when animosity and distancing maneuvers are replaced with reassuring emotional engagement and intimacy (Greenberg, Ford, Alden, & Johnson, 1993). ...
Partner violence is a societal problem that cuts across all socioeconomic and racial/ethnic lines. Approximately 50% to 60% of couples presenting for counseling have reported at least 1 incident of violence in their relationship history. Many counselors are ill equipped to work with partner violence cases. This article provides an overview of partner violence research as it pertains to incidence, partner abuse typologies, etiology/explanation, and treatment. Developmental and integrated models for explaining and treating partner abuse are given particular consideration.
... Johnson and Greenberg (1988) note that best sessions of EFT are more likely to include heightened levels of emotional experience, interactions that include emotional disclosure and validation, and a softening event. Similarly, Greenberg, Ford, Alden, and Johnson (1993) demonstrate how deepening emotional experience is related to more affiliative responses and changing patterns of interaction. Furthermore, Bradley and Furrow (2004) found that successful softening events are more often associated with deep client experiencing and disclosure of attachment-related affect (e.g., sadness, shame, fear). ...
The Blamer Softening event in Emotionally Focused Couple Therapy is a critical change event that is indicative of successful treatment outcomes. Fa- cilitating this event is a common challenge for the EFT therapist. This ar- ticle reviews a mini-theory of blamer softening based on the work of Susan Johnson, co-author of the approach. Additionally, five common obstacles that often derail the softening process are identified and explained. Clinical ex- amples are used throughout to highlight best therapist practices associated with successful softening events. This work represents another step forward toward a detailed understanding of the softening event.
... A limitation of previous marital therapy outcome research is the use of predominately white, non-representative samples. In many of these studies ethnicity and race were simply not reported (e.g., Jacobson, 1977;1978;1984;Jacobson, Schmaling, & Holtzworth-Munroe, 1987;Jacobson, Follette, & Pagel, 1986;Jacobson & Anderson, 1978;1985;Johnson & Greenberg, 1985a, 1985b, 1988Greenberg, Ford, Alden, & Johnson, 1993;James, 1991;Johnson & Talitman, 1997). In others, the sample is either entirely Caucasian (e.g., Goldman & Greenberg, 1992), or essentially Caucasian (Snyder & Wills, 1989: 15.9% non-White). ...
... Similarly, in emotion-focused therapy (EFT) (Greenberg & Johnson, 1988) one important strategy is to move the blamer away from attacking; toward expressing a softer, more vulnerable position. Process research on EFT has shown that partners tend to respond to "softening" with warmth and concern rather than with defensiveness (e.g., Greenberg, Ford, Alden, & Johnson, 1993). ...
Blaming events (N=25) were identified in seven interviews conducted by prominent theorists who espouse a constructionist or narrative approach to family treatment. Congruent with this perspective, we used conversation analysis (Gale, 1996) and the grounded theory method of constant comparison (Corbin & Strauss, 1990) to identify the therapists behaviors and strategies following blame expressed by family members. Results indicated three core categories or themes of therapists responses to blameIgnoring/Diverting, Acknowledging/Challenging, and Reframingsubsuming 17 individual codes (e.g., challenging all-or-none thinking, highlighting neutral information, interrupting, focusing on competence). The most frequent code was focusing on the positive.
... If we are to have an understanding of how change takes place, it is essential at least to be able to specify when and in what context disclosure takes place and what the disclosure is about. For example, disclosures of an affiliative or nurturing nature in response to a partner's disclosure of vulnerability or hurt are a sign of intimacy (Greenberg, Ford, Alden, & Johnson, 1993). Particular moment-by-moment processes at the level of the speech act (such as blame, criticize, agree, or paraphrase) should be studied in the episodic context of the particular type of in-session problem in which they occur. ...
The author recommends a systematic, context-sensitive method for using observation to increase understanding of how change actually occurs in couples and family therapy. In this method, a task analysis of in-session performances on a specific task leads to the building of a model of the change process. This approach is exemplified in the process of in-session conflict resolution in couples therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background
Exposure to rape, sexual assault and sexual abuse has lifelong impacts for mental health and well‐being. Prolonged Exposure (PE), Cognitive Processing Therapy (CPT) and Eye Movement Desensitisation and Reprocessing (EMDR) are among the most common interventions offered to survivors to alleviate post‐traumatic stress disorder (PTSD) and other psychological impacts. Beyond such trauma‐focused cognitive and behavioural approaches, there is a range of low‐intensity interventions along with new and emerging non‐exposure based approaches (trauma‐sensitive yoga, Reconsolidation of Traumatic Memories and Lifespan Integration). This review presents a timely assessment of international evidence on any type of psychosocial intervention offered to individuals who experienced rape, sexual assault or sexual abuse as adults.
Objectives
To assess the effects of psychosocial interventions on mental health and well‐being for survivors of rape, sexual assault or sexual abuse experienced during adulthood.
Search methods
In January 2022, we searched CENTRAL, MEDLINE, Embase, 12 other databases and three trials registers. We also checked reference lists of included studies, contacted authors and experts, and ran forward citation searches.
Selection criteria
Any study that allocated individuals or clusters of individuals by a random or quasi‐random method to a psychosocial intervention that promoted recovery and healing following exposure to rape, sexual assault or sexual abuse in those aged 18 years and above compared with no or minimal intervention, usual care, wait‐list, pharmacological only or active comparison(s). We classified psychosocial interventions according to Cochrane Common Mental Disorders Group’s psychological therapies list.
Data collection and analysis
We used the standard methodological procedures expected by Cochrane.
Main results
We included 36 studies (1991 to 2021) with 3992 participants randomly assigned to 60 experimental groups (3014; 76%) and 23 inactive comparator conditions (978, 24%).
The experimental groups consisted of: 32 Cognitive Behavioural Therapy (CBT); 10 behavioural interventions; three integrative therapies; three humanist; five other psychologically oriented interventions; and seven other psychosocial interventions. Delivery involved 1 to 20 (median 11) sessions of traditional face‐to‐face (41) or other individual formats (four); groups (nine); or involved computer‐only interaction (six). Most studies were conducted in the USA (n = 26); two were from South Africa; two from the Democratic Republic of the Congo; with single studies from Australia, Canada, the Netherlands, Spain, Sweden and the UK. Five studies did not disclose a funding source, and all disclosed sources were public funding.
Participants were invited from a range of settings: from the community, through the media, from universities and in places where people might seek help for their mental health (e.g. war veterans), in the aftermath of sexual trauma (sexual assault centres and emergency departments) or for problems that accompany the experience of sexual violence (e.g. sexual health/primary care clinics). Participants randomised were 99% women (3965 participants) with just 27 men. Half were Black, African or African‐American (1889 participants); 40% White/Caucasian (1530 participants); and 10% represented a range of other ethnic backgrounds (396 participants). The weighted mean age was 35.9 years (standard deviation (SD) 9.6). Eighty‐two per cent had experienced rape or sexual assault in adulthood (3260/3992). Twenty‐two studies (61%) required fulfilling a measured PTSD diagnostic threshold for inclusion; however, 94% of participants (2239/2370) were reported as having clinically relevant PTSD symptoms at entry.
The comparison of psychosocial interventions with inactive controls detected that there may be a beneficial effect at post‐treatment favouring psychosocial interventions in reducing PTSD (standardised mean difference (SMD) ‐0.83, 95% confidence interval (CI) ‐1.22 to ‐0.44; 16 studies, 1130 participants; low‐certainty evidence; large effect size based on Cohen’s D); and depression (SMD ‐0.82, 95% CI ‐1.17 to ‐0.48; 12 studies, 901 participants; low‐certainty evidence; large effect size). Psychosocial interventions, however, may not increase the risk of dropout from treatment compared to controls, with a risk ratio of 0.85 (95% CI 0.51 to 1.44; 5 studies, 242 participants; low‐certainty evidence). Seven of the 23 studies (with 801 participants) comparing a psychosocial intervention to an inactive control reported on adverse events, with 21 events indicated. Psychosocial interventions may not increase the risk of adverse events compared to controls, with a risk ratio of 1.92 (95% CI 0.30 to 12.41; 6 studies; 622 participants; very low‐certainty evidence).
We conducted an assessment of risk of bias using the RoB 2 tool on a total of 49 reported results. A high risk of bias affected 43% of PTSD results; 59% for depression symptoms; 40% for treatment dropout; and one‐third for adverse events. The greatest sources of bias were problems with randomisation and missing outcome data. Heterogeneity was also high, ranging from I² = 30% (adverse events) to I² = 87% (PTSD).
Authors' conclusions
Our review suggests that survivors of rape, sexual violence and sexual abuse during adulthood may experience a large reduction in post‐treatment PTSD symptoms and depressive symptoms after experiencing a psychosocial intervention, relative to comparison groups. Psychosocial interventions do not seem to increase dropout from treatment or adverse events/effects compared to controls. However, the number of dropouts and study attrition were generally high, potentially missing harms of exposure to interventions and/or research participation. Also, the differential effects of specific intervention types needs further investigation.
We conclude that a range of behavioural and CBT‐based interventions may improve the mental health of survivors of rape, sexual assault and sexual abuse in the short term. Therefore, the needs and preferences of individuals must be considered in selecting suitable approaches to therapy and support. The primary outcome in this review focused on the post‐treatment period and the question about whether benefits are sustained over time persists. However, attaining such evidence from studies that lack an active comparison may be impractical and even unethical. Thus, we suggest that studies undertake head‐to‐head comparisons of different intervention types; in particular, of novel, emerging therapies, with one‐year plus follow‐up periods. Additionally, researchers should focus on the therapeutic benefits and costs for subpopulations such as male survivors and those living with complex PTSD.
Interest in studying relevant events in psychotherapy has gained increasing importance, causing significant growth in theoretical and empirical conceptualizations. However, the diversity of theoretical perspectives, the multiple ways of defining, understanding and analyzing these events has often been confusing and ambiguous. The aim of this article is to provide an organizing perspective of the main approaches that identify and work with relevant events in the context of change process research. Six lines of research using relevant events or episodes are reviewed - Significant Events; Key Change Events; Change Episodes; Innovative Moments; Episodes of Rupture and Resolution, and Moments of Meeting- analyzing their definitions of relevant events or episodes, their different theoretical frame- works and conceptual models, their understanding of change and the consequent methodologies for observation and analysis. The similarities and differences of the different approaches and their con- tributions to the study of the psychotherapeutic process and its results are discussed.
Key words: Relevant Episodes in Psychotherapy, Significant events, Moments of meeting, Psychotherapy Process Research.
The author recommends a systematic, context-sensitive method for using observation to increase understanding of how change actually occurs in couples and family therapy. In this method, a task analysis of in-session performances on a specific task leads to the building of a model of the change process. This approach is exemplified in the process of in-session conflict resolution in couples therapy.
Integrative behavioral couple therapy (IBCT), developed by Andrew Christensen and Neil Jacobson in the 1990s, represents a departure from traditional behavioral couple therapy in its emphasis on acceptance and contingency-shaped change over traditional direct change strategies. Similar to “third wave” therapies for individual clients that promote a willingness to let go of the struggle to change one's own experience, acceptance in the context of couple therapy means a willingness to let go of the struggle to change the other partner; this is brought about through interventions that promote greater intimacy and nonblaming discussions of the couple's issues. This chapter discusses the IBCT model of couple distress and treatment, illustrates acceptance-based strategies with a case example, compares IBCT to other behavioral couple therapies and to third wave therapies for individuals, presents research on its efficacy, and provides suggestions for future research.
Emotion focused couples therapy or Emotionally focused therapy for couples (EFTC) is short-term 8 to 20 sessions, structured therapy originally developed in 1980's by Leslie Greenberg and Sue Johnson. It is one of the most empirically based types of couple therapy. Research has found that 70-75% of couples who undergo EFTC, will recover from distress, and these results are tested as stable over time by follow-up. All together with other research findings, EFTC meets the criteria for evidence based treatment. Study outlines the theoretical background of this couple therapy, which is relatively little known to Slovak and Czech therapists, and its differences comparing to other marital therapies. The contribution discusses the various phases and steps of the therapeutic process and explains the different kinds of dyadic cycles and process of change. In conclusion, it provides an overview of current research findings regarding EFTC that summarize effect size research, meta-analyzes, studies of costeffectiveness research and change process in therapy, research of the effectiveness of the therapy for different samples of the population and people in specific situations.
The author discusses how the Johnson and Gottman approaches are compatible and how they can be wed into a more comprehensive model of couple therapy. This discussion is divided into two parts. The first part covers the amalgamation of these two approaches and shows how they can be restructured into an integrated couple therapy (ICT) model. The second part shows how the different practices and methods of these two approaches can be systematically incorporated into five stages of treatment in the ICT model.
Objective:
Empirically based couple therapy results in significant improvements in relationship satisfaction for the average couple; however, further research is needed to identify mediators that lead to change and to ensure that improvements in mediators predict subsequent-not just concurrent-relationship satisfaction. In addition, given that much of the current literature on couple therapy examines outcomes in a research environment, it is important to examine mediators in a treatment-as-usual setting.
Method:
To address these questions, 161 heterosexual couples (322 individuals) received treatment-as-usual couple therapy at one of two Veteran Administration Medical Centers (M = 5.0 and 13.0 sessions at the two sites) and were assessed before every session. The majority of couples were married (85%) and had been together for a median of 7.8 years (SD = 13). Participants were primarily White, non-Hispanic (69%), African American (21%), and White, Hispanic/Latino (8%).
Results:
Individuals' own self-reported improvements in communication, emotional closeness, and psychological distress (but not frequency of behaviors targeted in treatment) mediated the effect of treatment on their subsequent relationship satisfaction. When all significant mediators were examined simultaneously, improvements in men's and women's emotional closeness and men's psychological distress independently mediated subsequent relationship satisfaction. In contrast, improvements in earlier relationship satisfaction mediated the effect of treatment only on subsequent psychological distress.
Conclusion:
This study identifies unique mediators of treatment effects and shows that gains in mechanisms predict subsequent relationship satisfaction. Future investigations should focus on the role of emotional closeness and psychological distress-constructs that have often been neglected-in couple therapy. (PsycINFO Database Record
Drawing on marriage and family therapy ( MFT ), this paper introduces the concept of we‐ness to new product development ( NPD ). We‐ness is the shared sense of togetherness family members feel toward each other. We apply we‐ness to NPD as the construct through which people share knowledge at the team, between‐team, and between‐organization levels. The results support the hypotheses that we‐ness increases knowledge sharing and that knowledge sharing increases product performance. In this study, we used regressions to analyze the hypotheses. We found that the greater in‐team we‐ness ( H 1, t = 3.786, p = .000), between‐team we‐ness ( H 2, t = 5.411, p = .000), and between‐organization we‐ness ( H 3, t = 2.940, p = .004) activities there were, the more knowledge sharing in NPD . Results also indicate that knowledge sharing is related to better NPD performance.
This paper contrasts team and family as the foundation metaphor to organize people engaged in product development. We argue the team metaphor can be counterproductive in settings where difficult decisions must be made. Teams can lead to individual members suppressing their opinions to “help” the team achieve its goal. Members are expected to sacrifice for the good of the team. That can be adaptive when the task is straightforward.
The family metaphor suggests that the group sacrifices for the individual. In a family environment, members protect minority opinions, and in cases where complex, ambiguous decisions must be made individual expertise and insight may come from one person. High‐trust family‐like settings can facilitate sharing sensitive information and norms that can be challenged. The family metaphor suggests a more flexible and tolerant approach to new ideas. At the same time, it is recognized that families can have dysfunctions that can detract from performance. Therefore, managers must carefully apply the use of family‐like settings.
The importance for family‐like approaches across organizations seems to be more important as technology complexity increases. Between‐team we‐ness was revealed significantly higher in goods manufacturers than service firms in this study. Small companies need to make extra effort to increase between‐team we‐ness.
The idea of approaching product development from a family relations perspective opens up new alternatives for managing people in teams, between teams, and even between organizations. MFT tools to address behaviors and individual performance issues increase the number and nature of managerial tools to increase product performance.
Several approaches to couple therapy produce large and clinically significant reductions in relationship distress. However, 25 to 30 per cent of couples show no benefit from couple therapy. Adapted forms of couple therapy can effectively treat some psychological disorders and enhance adjustment to physical health problems. The specific mechanisms underlying the effects of couple therapy on relationship distress are unclear. Current attempts to enhance the efficacy of couple therapy have three foci: (1) identifying the common factors that might account for change across approaches, (2) integrating different approaches to address specific needs of particular partners and couples and (3) monitoring the progress of couples during therapy and using that information to modify couple therapy as required. Given the high prevalence of relationship distress and its association with other problems, clinicians should routinely screen for relationship distress in adults. Couple therapy needs to be considered as the focus, or part of the focus, of treatment for a wide range of adult emotional and behavioural problems.
This study examined how the revealing of underlying vulnerable emotion relates to session and final outcome in the context of emotion‐focused therapy for couples. Segments of videotaped therapy sessions were rated on a measure of underlying vulnerable emotional expression for twenty‐five couples. Results indicated that partners rated sessions in which underlying vulnerable emotion was expressed significantly more positively than control sessions on a measure of session outcome. Moreover, from pre to post, couples who were found to have expressed underlying vulnerable emotion at least once improved significantly more on a measure of trust, and marginally significantly more on a measure of unfinished business, than couples who were not found to have expressed underlying vulnerable emotion. Recommendations for treatment are provided in light of the findings.
Practitioner points
It is recommended that couple therapists help partners to access and express underlying vulnerable emotion, because this appears to be associated with better session and final outcomes.
When an underlying vulnerable emotion begins to emerge, it is recommended that the therapist maintain the focus on this emotion and help to facilitate its full expression.
Observed positive and negative spouse behavior during sessions of Traditional (TBCT) and Integrative Behavioral Couples Therapy (IBCT) were compared for couples with successful outcomes and their unsuccessful counterparts. One hundred and thirty-four married chronically and seriously distressed couples (on average in their forties and 80% Caucasian) were randomly assigned to TBCT or IBCT. Trained observers made ratings of 1224 segments from approximately 956 sessions sampled from the course of up to 26 sessions. Multilevel modeling was used to examine change over time. TBCT treatment responders demonstrated a boost-drop pattern, increasing in constructive behaviors early (more positive behaviors and less negative behaviors) but decreasing later. IBCT responders demonstrated an opposite, drop-boost pattern, decreasing in constructive behaviors early and increasing later. Patterns were significant for positive behaviors (p < .05) and approached significance for negative behaviors (p = .05). In both treatments, nonresponders showed a significant pattern of decline in positive and increase in negative behaviors over time, although a trend (p = .05) indicates that TBCT nonresponders initially declined in negative behaviors. This study helps clarify the different process of change in two behavioral couple therapies, which may assist in treatment development and provide a guide for therapists in considering behavioral markers of change during treatment.
Attachment-Based Family Therapy is a treatment model designed specifically for depressed and suicidal adolescents. The primary goal of the treatment is to promote developmentally appropriate adolescent-parent attachment. Three core interventions are discussed: relational reframes; focusing on primary emotions and unmet attachment needs; and facilitating corrective attachment episodes. For each intervention, the theoretical/clinical rationale is presented followed by a brief illustration and relevant research findings. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Across nearly all cultures, sharing a lifelong committed relationship with an intimate partner comprises an almost universal and strongly held ambition. Nevertheless, cross-national data reliably indicate a high prevalence of relationship distress and dissolution, with adverse emotional and physical health consequences for adult partners and their children. This introduction to the special section summarizes findings regarding the effectiveness of couple therapy for treating general relationship distress, couple-based interventions for individual mental or physical health problems, and couple relationship education programs aimed at helping couples sustain a healthy committed relationship. Within each of these approaches, evidence regarding potential mediators of interventions’ effectiveness is reviewed, and critical unanswered questions are highlighted. Discussion concludes with a brief introduction to each of the articles comprising this special section on universal processes in couple therapy and relationship education.
Incorporating the pair-bond attachment relationship into recovery from addiction represents a contextually inclusive perspective on the dynamics and consequences of addiction and the scope of influence and involvement that supports and strengthens an enduring recovery. Nevertheless, organizing the pair-bond attachment relationship to sponsor recovery requires attending to the unique vulnerability of this relationship to interactional volatility and emotional reactivity—in consequence of partners' reciprocal experience of addiction. The advent and refinement of relationship therapies and interventions has recently produced a developmental model for successfully engaging the pair-bond attachment relationship for recovery and relationship healing while circumnavigating its vulnerabilities to emotional reactivity and destructive interaction. We present an approach to relationships in recovery from addiction that focuses on successfully engaging the attachment relationship through a five-stage, three-component model of enactments—therapist-facilitated couple interaction that promotes softened, mutually supportive, and self-reliant couple interaction. Enacting the pair-bond attachment relationship, recovery from addiction, and partner and relationship healing are simultaneously and reciprocally pursued.
This study aims to evaluate the attachment style of authors of domestic violence and to determine its influence on emotional and instrumental aggressiveness. Fifty subjects were selected from a jail population. Gender, nationality, age, anxiety, depression, personality disorders and psychotic disorders were controlled. The data were collected using the questionnaire sur la résolution des conflits conjugaux (CTS2), the questionnaire d’attachement amoureux (QEAA) and the questionnaire d’agressivité instrumentale et émotionnelle (QAIE). The results indicate that the vast majority (94.7%) of the authors of domestic violence present an “insecure” attachment style (p
Emotion focused therapy for couples (EFT; Johnson, 200421.
Johnson , S. M. 2004. The practice of emotionally focused couple therapy: Creating connection, , 2nd ed, New York: Brunner-Routledge. View all references) is an empirically supported model of couple therapy that is continuing to develop and mature. Excellent published resources exist for the therapist desiring to learn the EFT model yet sometimes uncertainty remains about exactly how to conduct an initial session. Questions also arise about how to integrate EFT-specific questioning with more general aspects of conducting a couple assessment. An outline of an initial session is offered that can be adapted depending on therapist preferences and client needs. Suggested elements include: joining/alliance building, eliciting presenting complaints, tracking the negative interactional cycle, obtaining relational and other history, asking about goals, assessing commitment, presenting a reframe, contracting for therapy, and assigning simple strategic “homework.”
Romantic couples (N = 127) engaged in a relationship conflict interaction during which their autonomic physiology, emotional experience, and emotional behavior were recorded. Couples were assigned randomly to one of two interventions, or to a control condition: In the affective suppression condition, one partner was instructed to refrain from expressing emotions. In the positive mindset condition, one partner was instructed to think about the positive aspects of the relationship. Results revealed that emotion regulation interventions influenced the physiology, emotional behavior, and emotional experience of both the manipulated person and his or her partner, who was oblivious to regulation manipulations. Specifically, suppression increased, and positive mindset decreased cardiovascular arousal and negative affect. These effects were generally exacerbated among those high on attachment anxiety and attenuated among those high on attachment avoidance. The results of this research corroborate and extend the Temporal Interpersonal Emotion Systems model (Butler, 2011) in the context of relationship conflict interactions.
In this paper we introduce the reader to our recent developments of an emotion-focused approach to couple therapy. We identify three core motivations that need to be attended to in facilitating conflict resolution in intimate relationships—the need for attachment, the need to have identity validated by the other, and attraction to the other. These motives, we suggest, are governed by the feelings they engender, making couple relationships a key means of emotion regulation. We describe different categories of feelings, distinguishing between primary emotions that are directly related to satisfaction of our core motivations and those emotions that are influenced by other factors in our psychological make-up. A five-stage model of an emotion-focused way of working with couples is outlined. These steps are designed to help partners gain awareness of and constructively express their different emotions. We emphasize that in order to resolve couple conflict it is not only important to develop the capacity to empathize with and soothe the other in a relationship but also to be able to soothe one's own anxieties and sense of shame and to tolerate disappointments.
Presents a brief review of the literature on structural analysis of interpersonal behavior followed by a proposal which draws heavily from prior models, especially those of E. S. Schaefer (1965) and T. Leary (1957). The proposed model goes beyond previous ones in that it has a highly explicit structure which defines behavioral opposites, complements, and antidotes. Built on 2 axes named affiliation and interdependence, the model describes dyadic social interactions in terms of complementary proportions of those underlying dimensions. Opposite behaviors appear at 180. angles whereas complementary behaviors appear at topologically similar positions on 2 separate planes. Antidotes are defined as opposites of complements. The proposed structure was tested using the questionnaire responses of normal as well as psychiatric Ss. Analysis of these data by the techniques of autocorrelation, circumplex analysis, and factor analysis supports the model. (39 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A previously described coefficient of agreement for nominal scales, kappa, treats all disagreements equally. A generalization to weighted kappa (Kw) is presented. The Kw provides for the incorpation of ratio-scaled degrees of disagreement (or agreement) to each of the cells of the k * k table of joint nominal scale assignments such that disagreements of varying gravity (or agreements of varying degree) are weighted accordingly. Although providing for partial credit, Kw is fully chance corrected. Its sampling characteristics and procedures for hypothesis testing and setting confidence limits are given. Under certain conditions, Kw equals product-moment r. The use of unequal weights for symmetrical cells makes Kw suitable as a measure of validity.
This paper explores some of the principles involved in the shift toward the study of change events in psychotherapy. A process-analytic approach to the study of change is suggested aimed at the development of micro-theory to explain the change processes that occur in specific in therapy contexts. It is suggested that designs which relate these complex change process to outcome will help determine which factors within a treatment model explain the obtained outcomes.
Contrasting conceptual paradigms describing the nature of intimate relationships are discussed. In particular, relationships may be viewed in terms of a rational bargain or as an emotional bond. The implications of each paradigm for the process of marital therapy are delineated, and the role of bonding and attachment in adult intimacy is considered. Some general conclusions are then drawn as to future directions for the marital therapy field.
Argues that research on change processes is needed to help explain how psychotherapy produces change. To explain processes of change, it will be important to measure 3 types of outcomes—immediate, intermediate, and final—and 3 levels of process—speech act, episode, and relationship. Emphasis will need to be placed on specifying different types of in-session change episodes and the intermediate outcomes they produce. The assumption that all processes have the same meaning (regardless of context) needs to be dropped, and a context-sensitive process research needs to be developed. Speech acts need to be viewed in the context of the types of episodes in which they occur, and episodes need to be viewed in their relationship context. This approach would result in the use of a battery of process instruments to measure process patterns in context and to relate these to outcome. (52 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Compared the relative effectiveness of 2 interventions in the treatment of marital discord: a cognitive-behavioral intervention that focused on teaching problem-solving skills and an experiential intervention that focused on emotional experiences underlying interaction patterns. 45 couples seeking therapy were randomly assigned to 1 of these treatments or to a wait-list control group. Each treatment was administered in 8 sessions by 6 experienced therapists whose interventions were monitored and rated to ensure treatment fidelity. Assessment measures included the Dyadic Adjustment Scale; Couples Therapy Alliance Scale; and tests of emotional style, target complaints, goal attainment, and intimacy. Results indicate that the perceived strength of the working alliance between couples and therapists and of general therapists effectiveness were equivalent across treatment groups and that both treatment groups made significant gains over untreated controls on measures of goal attainment, marital adjustment, intimacy levels, and target complaint reduction. The effects of the emotionally focused treatment were superior to those of the problem-solving treatment on marital adjustment, intimacy, and target complaint level. At follow-up, marital adjustment scores in the emotionally focused group were still significantly higher than those in the problem-solving group. (36 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)