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Strengthening attachment bonds: Emotionally focused therapy for couples.
Abstract
Mounting empirical evidence suggests that adult love represents an attachment process, in which the emotional bond forged between partners reflects an innate human tendency to seek out close relationships that provide safety and security. Emotionally Focused Therapy (EFT) for couples is an empirically supported psychological intervention based on the premise that chronic problems in intimate relationships in adulthood result from underlying attachment difficulties. From an EFT perspective, the resolution of problems in couple relationships therefore necessitates the strengthening of the emotional bond between partners. The principle goals of this presentation are to explain the 9 steps of EFT for couples and to illustrate the effects of EFT on specific aspects of attachment in couples, including trust, relationship satisfaction (Judy, stuff from course & book) and affect regulation (made to measure). This brief review of relevant research on EFT and attachment will lead into a discussion of preliminary findings from a study of the direct effects of EFT on adult attachment that our research term is currently conducting. Empirical research and clinical experience both indicate that healthy emotional dependency is an integral component of satisfying couple relationships, and EFT for couples can help solidify the attachment bonds that foster such emotional closeness.
... Uzmanlar dünya çapında bütün çiftlerin benzer sorunlar yaşadığına dikkat çekmektedir (Fisher, Languilaire, Lawthom, Nieuwenhuis, Petts, Runswick-Cole, & Yerkes, 2020). Beklenmedik durumların yaşandığı olağan dışı dönemlerde daha önceden travma sonrası stres bozukluğu (TSSB) gibi travması olan bireyler (yas ve kayıp, aile içi şiddet, uzun süre kapalı mekânda kalma, bağlanma ve diğer ilişki sorunları gibi) daha çok risk altındadır; kırılgan ve riskli ilişkiler bu tür dönemlerde yara almaktadırlar (Johnson, 2002). ...
... Geri çekilen partnerin ilişkide yeniden bağlılık geliştirebilmesi için gerekli makul bir evre vardır. Böylece, ilişkide yeniden yumuşama yaşanması mümkün olur (Johnson, 2002;Johnson & Whiffen, 2003). ...
... Duygu odaklı çalışan bir aile danışmanı öncelikli olarak çiftlerin duygusal yaşamlarında önemli anahtar tecrübelere yeniden erişimi sağlayıp, onların açılımını yaparak, bunları yeniden organize eder (duygusal kopuşlara ilişkin geçmiş yaşantılar gibi). Böylece, terapi sürecinde çiftlerin tepkilerini yeniden 'şimdi ve burada' deneyimlemeleri sağlanmaktadır (Johnson, 2002;Johnson, & Whiffen, 2003). ...
The number of COVID-19 reported cases by October 12, 2020 globally was 37,782,595 and in Turkey335,533, while deaths were 1,081,800 world-wide and 8,837 people in Turkey (Worldometer, 2020). Whenthe virus outbreak started to spread the world from Wuhan, China later in 2019, it appeared that socialrestriction and quarantine periods influenced couples’ relationships and family dynamics. For couples,relationship this period is characterized as requiring adaption to new changes, toleration of ambiguities andrestrictions where couples need to have the skills managing emotion regulation, stress and anxiety. Skillslike recognizing, defining and normalizing emotions when faced crisis became very important. Especiallycouples who experience hardship in their relationships during COVID-19 period emotionally focusedapproaches would strengthen couples’ relationships and increase their resilience as it offers ideal counselingframework. In this literature review, authors provide framework for counseling processes, principles andtechniques regarding couples who experience hardship in their relationships during COVID-19 period,using emotionally-focused approaches to family counseling.
... EFCT is an effective couples therapy designed to change inappropriate emotional responses and existing patterns. Greenberg 1988, Palmer andJohnson 2002). Utilizing humanistic and systemic principles, EFCT aims to create a more secure attachment pattern between couples (Johnson 2004, Wiebe andJohnson 2016). ...
... Such a bond is associated with mental and physical resilience even in the face of depression and the burden of challenging experiences (Johnson 2008). Such bonds provide couples with a safe haven and a secure foundation, an opportunity for a relationship that can "stand boldly against challenging life events" (Johnson 2002). ...
... When examining potential reactions after trauma, it is seen that there are symptoms such as generalization of stimuli about the traumatic event, re-experiencing, emotional emptiness and emotional regulation difficulties, or hyperarousal (Johnson 2002). Certain relationship activities, such as sexuality, which have the potential to soothe or calm other distressed couples, can also become at least a threat or, at worst, a new source of traumatization in the partnerships of trauma survivors. ...
Emotion-Focused Couple Therapy is a relatively short-term and effective couples therapy developed to change the negative interaction cycles and emotional reactions of couples experiencing difficulties in their relationships. While laying the foundations of this approach, which focuses on emotions, humanist and systemic principles were used. In this article, it is aimed to present a compilation study that includes the theoretical and practical processes of emotion-focused couple therapy for mental health professionals. The basic assumptions of emotion-focused therapy and how these affect couple therapy practice are examined. Various themes are outlined, including working with emotion types, the role of the therapist, therapy phases, and case formulation. Types of emotion-focused couples therapy developed for specific groups of couples with a particular background have also been discussed. Finally, the strengths and limitations of the approach, its place in couples therapy, and suggestions for future research are presented.
... Shame is related to these working models because when people feel shame, they experience the painful feeling of believing they are flawed and therefore unworthy of acceptance and belonging (Brown, 2006). According to attachment-based approaches, feeling unworthy of acceptance and belonging is inextricably tied to relationships and connection (Johnson, 2002). One feels unworthy of acceptance and belonging in relation to another person ("I feel unworthy of your love"), and thus, shame has both an inward focus (model of self: "I fear that I am unworthy") and outward focus ("I fear that you might see or discover that I am unworthy of your love"). ...
... This interpretation can also explain why in couple therapy with trauma survivors, therapists often see heightened shame at the very moment when the partner tries to reach out and gain emotional closeness (Johnson, 2002). It makes sense that trauma survivors would experience this fear of being seen, as the survivor's sense of self is often ingrained with self-denigration (Johnson, 2002). ...
... This interpretation can also explain why in couple therapy with trauma survivors, therapists often see heightened shame at the very moment when the partner tries to reach out and gain emotional closeness (Johnson, 2002). It makes sense that trauma survivors would experience this fear of being seen, as the survivor's sense of self is often ingrained with self-denigration (Johnson, 2002). Many survivors have never experienced an accepting and validating attachment figure to mirror a lovable sense of self (Johnson, 2002, p.57). ...
Research shows that shame can have a severe negative impact on intimate relationships, leading to negative shame loops between partners. In this article, we aim to provide a theoretical analysis of how attachment theory can help us understand that shame loops within couple relationships may not only be triggered by negative cues, such as criticism from a partner but can also innocently be triggered by a partner seeking connection or even offering comfort. We also elaborate on how therapists may unexpectedly trigger and intensify a client's shame. We conclude by providing a case description and discussing the therapeutic implications that can be helpful when working with the paradoxes of shame in couple therapy.
... During the last few decades Emotion-Focused therapy (EFT), based on research by Greenberg and Johnson (1988) and Johnson (1994Johnson ( , 2012, has become increasingly well-recognised within the field of couple therapy, and an EFT training program has been developed for couple therapists. Johnson and Brubacher write: ...
... This is particularly challenging at the beginning of the therapeutic process, when building a trustworthy working relationship, and it is described as a phenomenon in the fourth domain of the GMoD. The RPM is created to support the therapist to ensure a balanced therapeutic relationship and to be aware of the potential of forming a therapeutic alliance with one of the partners, which, in turn, will have negative consequences for the therapeutic relationship and outcome itself (Johnson, 2012). ...
... I object to how causal paradigms that use "co-s", as in co-dependency and co-addiction, imply that one participant is a responsible perpetuator and the other a victim. I find this predominant in the works of Johnson (2012). Many a psychological theory stigmatise and diagnose these relationships, and the common advice is for the "victim" to get away. ...
This is a theory-building, qualitative case study in the field of couple therapy, based on a Gestalt phenomenological and relational methodology. I propose a new Gestalt Model of Domains in Couple’s Work (GMoD) to develop and improve clinical practice. The research explores the co-created stagnation in couples’ relationships and how the GMoD can be used to grade therapeutic interventions in order to support the couple to attempt new ways of contacting and being with each other.
Six Gestalt therapists each conducted couple’s therapy with two couples. These therapists were supervised by the researcher supervisor. The supervision sessions were videoed after the first and third couple’s therapy session. After the fifth and final couple’s therapy session of the research project, the therapists met with the researcher in a videoed focus group dialogue. All videos were transcribed and analysed using Relational Thematic Analysis and NVivo. The outcome of the analysis and the focus group dialogue helped to build the theoretical frame for implementing the GMoD within the relational Gestalt method for couple’s therapy. The planned products include an advanced training program at the Norwegian Gestalt Institute, a book on Gestalt couple’s therapy, publications of articles and presentations at research seminars and post-doctorate research using a single-case timed series efficacy study and a longitudinal qualitative case study.
... Developers of these models describe them as integrative, de-pathologizing, evidencebased, brief therapies that rely on built-in healing processes that humans share (Johnson, 2004;Shapiro, 2017). In addition, both models have been used to heal the aftermath of traumatic events (Greenman & Johnson, 2013;Johnson, 2002Johnson, , 2004Johnson, , 2019MacIntosh & Johnson, 2008;Shapiro, 2017). ...
... When inadequately processed and stored, salient attachment events can become activated in the dyadic context, causing distortions and blocks (Moses, 2007), which manifest in the negative cycles that are targeted in EFT. The premise that contact with a loving partner can function as a safeguard against the stress and pain from upsetting traumatic memories (Capps et al., 2005;Capps, 2006;Coan et al., 2006;Johnson, 2002Johnson, , 2004Johnson, , 2019Moses, 2007) aligns with the results of this study. Whereas trauma physiologically dysregulates, secure bonds physiologically regulate (Coan et al., 2006). ...
... Whereas trauma physiologically dysregulates, secure bonds physiologically regulate (Coan et al., 2006). Likewise, whereas trauma induces helplessness and fear, secure attachment offers a sense of safety and protection (Johnson, 2002). With clinical examples, participants illustrated how, because EFT facilitates (in the present) the corrective emotional experiences that were likely lacking during the traumatic events reprocessed in EMDR, clients' partners' supportive responsiveness was helpful in solidifying their gains in therapy. ...
In this article, we present partial findings from a thematic analysis study that examined integrating emotionally focused therapy (EFT) and eye‐movement desensitization and reprocessing (EMDR) as clinical frameworks in couple therapy. The purpose of the study is to better understand how therapists integrate EFT and EMDR therapy in their clinical work. Thirteen licensed therapists (n = 13) trained in EFT and EMDR were interviewed about their experiences integrating these two models in their couple therapy practice. The findings included in this article are related to how these models complement each other as well as the clinical benefits associated with their integration. Findings provide preliminary evidence that there are benefits and challenges when integrating both models, although we emphasize complementarity in this article. Limitations and implications for future research on the integration and efficacy of these two models are also discussed.
... Couple therapy is a valuable avenue through which a single treatment can increase relationship satisfaction while simultaneously decreasing PTSD and depression symptoms (Erbes et al., 2008;Ikin et al., 2010;Johnson, 2002). Emotionally Focused Couple Therapy (EFT; Johnson, 2005) is well-positioned to treat PTSD in veterans and their partners (Blow et al., 2015), and preliminary evidence suggests EFT shows promise treating relationship distress and PTSD symptoms in a veteran population (Weissman et al., 2018). ...
... Researchers have developed a number of conceptual models depicting the interpersonal nature of PTSD, including individual and couple factors that impact the ways in which trauma reverberates through romantic relationships (the Dyadic Relationship Model; Gerlock et al., 2014; the Dyadic Responses to Trauma Model; Marshall & Kuijer, 2017; the Cognitive-Behavioral Interpersonal Theory of PTSD; Monson et al., 2010; the Couple Adaptation to Traumatic Stress; Nelson Goff & Smith, 2005;Oseland et al., 2016). Research demonstrates that PTSD symptoms undermine multiple components of couple functioning by reducing intimacy and safety, and increasing conflict in the relationship (Goff et al., 2006;Johnson, 2002;Monson et al., 2009;Solomon, Dekel, & Mikulincer, 2008). ...
... the exposure-based techniques that are the hallmark of many trauma-focused treatments. Further, for many partners, ongoing relationship distress may take a greater psychological toll than concomitant PTSD and depressive symptoms as relationship security is a fundamental need (Johnson, 2002). Consequently, improving relational health may be a more pressing concern for coupled individuals with PTSD or depression. ...
Emotionally Focused Couple Therapy (EFT) is a well-established, attachment-based treatment for relationship distress. This study seeks to further previous research by examining the impact of EFT on veterans’ and their partners’ symptoms of posttraumatic stress disorder (PTSD), depression, and relationship distress, in a real-life clinical setting. The present study uses dyadic data analyses to test three hypotheses: from pre to posttherapy veterans and their partners would report (a) increases in relationship satisfaction and decreases in (b) PTSD and (c) depression symptoms. In addition, we tested whether diagnostic status at the start of therapy, that is, meeting clinical criteria for that outcome, moderated the changes. Data were collected as part of routine care at an outpatient clinic at a Veterans Affairs (VA) Hospital. The sample consisted of 29 couples. Pre and postmeasures were obtained at the first and final sessions (Msessions = 15.52 SD = 7.19). Multilevel models examining changes across time for all partners found that the difference between pre and posttherapy scores for relationship satisfaction (b = 10.85, p < .01) and depression symptoms (b = −1.61, p < .05) was significant. Moreover, diagnostic status moderated treatment effects for all outcomes: the difference between pre and posttherapy scores was significant for partners who met clinical criteria for relationship distress (b = 13.93, p < .001), PTSD (b = −12.39, p < .01), and depression (b = −7.64, p < .001). Although PTSD and depression are not the focus of treatment, results indicate EFT is effective at reducing relationship distress and individual symptomatology in veterans and their partners.
... Best, 2003;Johnson u. Whiffen, 2003) sowie eine Reihe von daraus abgeleiteten integrativen systemischbindungsorientierten -oft auch manualisierten -Interventionen wie der Emotionsfokussierten Paartherapie (EFT; Johnson, 2005;Holzberg u. Seiferth, 2018), der systemischen Gruppentherapie bei komplexen Traumafolgestörungen (Sydow u. ...
... Orientiert an einem traumasensiblen systemisch-bindungstheoretischen Ansatz (Sydow, 2002(Sydow, , 2008(Sydow, , 2015(Sydow, , 2018 (Johnson, 2005;Johnson et al., 2001). Aber auch die Auseinandersetzung mit »ererbten Traumata« bzw. ...
... Wöller, 2017;Wöller et al., 2020) oder auf verhaltenstherapeutisch-integrative Ansätze (Cloitre, Cohen u. Koenen, 2006/2014 zurückzugreifen sowie auf spezielle Ansätze wie die Emotionsfokussierte Paartherapie mit »trauma suvivors« (Johnson, 2005) oder das Kopenhagener Manual zur systemischen Gruppentherapie für Frauen nach innerfamiliärem sexuellem Missbrauch (Sydow u. Lau, 2018). ...
... Herman (2015) referred to traumatic events as those that challenge our basic ideas of the world and others, and evoke powerlessness. Trauma can strip people of connection, purpose, control, and meaning (Herman, 2015;Johnson, 2002;Shapiro, 2017;Van der Kolk, 2015). Increasingly, researchers and clinicians are noting the major role contextual and relational factors, such as how one's community reacts to a traumatic event or the strength of one's social support network, play in symptom development following trauma (Herman, 2015;Johnson, 2002;Parnell, 2010;Shapiro, 2017). ...
... Trauma can strip people of connection, purpose, control, and meaning (Herman, 2015;Johnson, 2002;Shapiro, 2017;Van der Kolk, 2015). Increasingly, researchers and clinicians are noting the major role contextual and relational factors, such as how one's community reacts to a traumatic event or the strength of one's social support network, play in symptom development following trauma (Herman, 2015;Johnson, 2002;Parnell, 2010;Shapiro, 2017). Trauma-related symptoms such as intrusion symptoms, avoidance, trouble concentrating, sleep disturbances, and hypervigilance can become so upsetting that they create major social, emotional, and occupational impairment for most sufferers (Herman, 2015). ...
... When there is conflict in our most important relationships, we become reactive emotionally because we perceive that our attachment bonds may be threatened. For example, when partners sense that the other is not accessible or responsive (Johnson, 2002(Johnson, , 2004(Johnson, , 2019, they become preoccupied with threats to their bond, rendering them unable to function effectively and be present (Johnson, 2002). In addition to attachment theory, EFT is also rooted in systems theory and addressing couples' relational patterns using experiential/humanistic techniques. ...
In this paper, we present a literature review on integrating Eye Movement Desensitization and Reprocessing (EMDR) and Emotionally Focused Therapy (EFT) to treat trauma in couple therapy. Both are highly effective therapeutic models (one mainly used for individual trauma treatment and the other for strengthening attachment bonds in couples) that have gained significant traction and ample empirical support in the last three decades. Mental health therapists are increasingly experimenting with integrating these two models and have found that they can complement each other well; however, their integration is not well understood due to scant literature. Thus, we include research findings, clinical case examples, and theoretical discussions to provide readers with a comprehensive overview of the state of affairs on integrating these two models. We hope that this paper will highlight prior and existing practices and inspire clinicians to consider the clinical potential of integrating EFT and EMDR to increase effective therapy for couples affected by trauma.
... The amygdala is one part of an individual's brain that could show changes in functioning as a result of trauma. The amygdala forms emotional memories based on experiences (Johnson, 2005). When traumatic memories are formed, an individual is more likely to experience activations in their nervous system, which leads to frequent responses to real or perceived threats. ...
... When an individual's nervous system is constantly activated, it leads to symptoms of emotional dysregulation in clients that have experienced trauma (Briere, Hodges, & Godbout, 2010). Trauma has a powerful negative impact on an individual's life and relationships (Johnson, 2005). ...
... The nature of trauma is multidimensional and survivors of trauma report feeling helpless with their complex symptoms (Johnson, 2005). Instances that could impact normal functioning through emotional dysregulation are, for example, being confronted with physical danger, significant loss, or another distressing situation (Briere et al, 2010). ...
Emotionally Focused Individual Therapy (EFIT) is an evidence-based and empirically supported therapy (Wiebe & Johnson, 2016). Although there is significant research on EFT for couples with trauma, there is limited research on the effect of the treatment for trauma of individuals. The study models change in trauma-related symptoms and emotional dysregulation over the course of 12-15 sessions of EFIT treatment with 40 individuals. HLM results confirmed a significant change demonstrating a decrease in trauma-related symptoms of depression, attachment difficulties, and impaired self-reference. The findings did not show any significant decrease in emotional dysregulation across therapy sessions. It should be noted that the Covid-19 pandemic impacted the study results and lead to limitations, such as incomplete data. The findings support the theoretic assumption that EFIT helps alleviate symptoms of trauma for individuals engaged in therapy.
Keywords: attachment theory, emotionally-focused, emotional dysregulation, and trauma
... Uzmanlar dünya çapında bütün çiftlerin benzer sorunlar yaşadığına dikkat çekmektedir (Fisher, Languilaire, Lawthom, Nieuwenhuis, Petts, Runswick-Cole, & Yerkes, 2020). Beklenmedik durumların yaşandığı olağan dışı dönemlerde daha önceden travma sonrası stres bozukluğu (TSSB) gibi travması olan bireyler (yas ve kayıp, aile içi şiddet, uzun süre kapalı mekânda kalma, bağlanma ve diğer ilişki sorunları gibi) daha çok risk altındadır; kırılgan ve riskli ilişkiler bu tür dönemlerde yara almaktadırlar (Johnson, 2002). ...
... Geri çekilen partnerin ilişkide yeniden bağlılık geliştirebilmesi için gerekli makul bir evre vardır. Böylece, ilişkide yeniden yumuşama yaşanması mümkün olur (Johnson, 2002;Johnson & Whiffen, 2003). ...
... Duygu odaklı çalışan bir aile danışmanı öncelikli olarak çiftlerin duygusal yaşamlarında önemli anahtar tecrübelere yeniden erişimi sağlayıp, onların açılımını yaparak, bunları yeniden organize eder (duygusal kopuşlara ilişkin geçmiş yaşantılar gibi). Böylece, terapi sürecinde çiftlerin tepkilerini yeniden 'şimdi ve burada' deneyimlemeleri sağlanmaktadır (Johnson, 2002;Johnson, & Whiffen, 2003). ...
22 Haziran 2020 itibarı ile dünya çapında Covid-19 vaka sayısı 9,072,642; ölüm sayısı 471,176 kişi olup, Türkiye’de vaka sayısı 187,685; ölüm sayısı 4,950’dir (Worldometer, 2020). Çin’in Wuhan kentinde 2019 yılının sonlarında ortaya çıkarak dünyaya yayılan corona virüs sonucu yaşanan kısıtlama ve karantina süreçleri aile dinamiklerini ve çift ilişkilerini de olumsuz yönde etkilemiştir. Çin’de Covid-19 karantina sürecinde kalan çiftlerde boşanma başvuruları ve aile içi şiddet oranlarında artış gözlemlendi. Çift ilişkileri açısından bu dönem değişime adaptasyon, belirsizlikleri tölere edebilme ve kısıtlamalara uyum sağlama yanında özellikle de duygu düzenleme, stres ve kaygı yönetimi gibi becerilerin etkili bir şekilde kullanımını gerektiren dünya çapında bütün çiftler için kritik bir dönem oldu. Olası krizlere karşı duyguları fark etme, tanımlama, normalleştirme ve dönüştürme gibi beceriler aşırı derecede önem taşır. Özellikle de ilişkilerinde sorun yaşayan çiftler arasında zorluklarla başa çıkmayı gerektiren bu Covid-19 döneminde duygu odaklı yaklaşım hem ilişki bağlarını güçlendirecek hem de dayanıklılığı arttıracak bir yaklaşım olup, ideal bir danışmanlık çerçevesi sunar. Bu çalışmada, Covid-19 sürecinde, ilişkilerinde sorun yaşayan çiftlere yönelik duygu odaklı aile danışmanlığı görüşme süreci, ilke ve teknikleri konusunda literatür bilgisi sunulacaktır.
... Birçok çalışmada (Calhoun, Beckham ve Bosworth, 2002;Dekel ve Goldblatt, 2008;Dekel, Goldblatt, Keidar, Solomon ve Polliack, 2005;Dekel ve Solomon, 2006;Galovskia ve Lynosa, 2004) travmatik yaşantıların sadece travmaya birebir maruz kalan bireyleri değil bireylerin yakın çevresini de (eşi, çocuğu, arkadaşı) etkilediği dile getirilmektedir. Kısacası travmatik yaşantıların bulunduğu sistemde bulaşıcı bir etkisi Turkish Studies -Social, 15(3) vardır (Bride ve Figley, 2009;Johnson, 2002;Nelson-Goff ve Smith, 2005). Travmatik yaşantılar yaşayan bireylerle yaşayan yakınlarında da uyku sorunu, nefes almada güçlük, bedende uyuşma, baş ağrısı, diğerlerine güvenmede zorluk, zihne gelen istemsiz düşünceler görülebilmektedir (Mansfield, Kaufman, Marshall, Gaynes, Morrissey ve Engel, 2010). ...
... Bu çalışmalarda gazi eşlerinin ikincil travma yaşaması birçok teori ile açıklanmaktadır. Bu teoriler; bağlanma teorisi (Johnson, 2002), bilişsel davranışçı terapi (Monson vd., 2011), aile sistem teorisi (Nelson-Goff ve Smith, 2005), aile bağlanma teorileridir (Riggs ve Riggs, 2011). ...
... Bağlanma teorisine göre travma sonrası stres sorunu ilişkisel bağlamda oluşmakta ve travma sonrası stres sorununun sonuçları ilişkilere bulaşmaktadır (Johnson, 2002). Johnson'a göre (2002) ilişki; travma sonrası stres yaşayan bireyin travmasıyla başa çıkmasına olumlu etki etmiyorsa bireyin travmayı yeniden yaşamasına yol açabilmektedir. ...
... Interpersonal emotion regulation is important in the context of mental health, for example in stress-and trauma-response disorders. A sense of security supports effective stress management and adds to a person's ability to tolerate the effects evoked by a traumatic experience (Johnson, 2002). According to the sociointer-personal model, the importance of the context is accentuated not only in the aftermath of traumatic events but also in adjusting to severe stressful events that may provoke adjustment disorder (Maercker & Horn, 2013). ...
... An ability to maintain contact with other people protects people from trauma. People who can talk about their experience and thus deal with it by getting support from others while seeking meaning for their experience will cope better (Johnson, 2002). In this study, the verbal interaction between the parents appeared as an important source of support, comfort, and soothing and as a means of communicating and structuring information. ...
... The significance of emotions, and in particular of dyadic emotion regulation, for the coping of parents can be understood through SBT and resilience research. The comfort and protection obtained from the closest ones can be seen as an evolution-induced pathway to resilience and recovery (Johnson, 2002). In this study, parents of seriously ill children experienced each other as a significant resource and source of resilience. ...
... These fears, while understandable, reinforce conditions for emotional cut-off, miscommunication, and misunderstanding. Couples then lose the same connection they have been fighting for their whole lives (Johnson, 2002). ...
... In doing so, partners can begin to feel safe articulating their core "The Commitment of a Lifetime": The Role of Emotionally Focused Couple Therapy in Strengthening Attachment Bonds and Improving Relationship Health in Later-Life Couples-The Teletherapy Case of "Alice" and "Steve" D. Mendelson Pragmatic Case Studies in Psychotherapy, http://pcsp.nationalregister.org/ Volume 20, Module 1, Article 1, pp. 1-80, 01-23-24 [copyright by author] 21 attachment needs, as these needs no longer threaten to invite abuse, neglect, or exploitation as they did in the past (Johnson, 2002). ...
A healthy marriage is a crucial protective factor for adapting to the challenges of late life. Emotionally Focused Couple Therapy (EFCT) is an attachment-based model of psychotherapy that emphasizes here-and-now processing of emotion in a safe holding environment; enhanced understanding of the patterned interactions between self and other; and a non-pathologizing, growth-oriented approach toward couples’ difficulties. This case study examines the benefits of EFCT for addressing issues specific to late life, including existential concerns such as aging, illness, and mortality; caregiving burdens and stress; cumulative relational trauma over the lifespan; and forgiveness and healing from emotional injuries. The case study involved a 20-session, teletherapy treatment of a couple named "Alice" and "Steve," aged 74 and 75, respectively, with Steve suffering from advanced Parkinson’s Disease. The couple presented with hopelessness and resentment about their caregiving situation, unresolved traumas from early childhood fueling their relationship’s sore spots, and unprocessed grief and fears concerning losses at the end stage of life. The EFCT-guided treatment focused on promoting transformational and corrective experiences of secure attachment bonding. Throughout therapy, Alice and Steve cultivated coherent, positive perspectives of their marriage and related hardships by engaging in reminiscence; embraced their longings for each other by relinquishing their defenses against loss and mourning; and strengthened the legacy of their marriage by exploring their shared values and vision of family life. At the end of therapy, the clients retrospectively completed several standardized, quantitative measures assessing aspects of emotional and relational health. Their responses evidenced their heightened emotional awareness and acceptance, increased marital adjustment and satisfaction, and improved attachment security over the course of the therapy. This case study highlights EFCT as a potent therapeutic intervention for fostering relationship health in later-life individuals to reduce the public health risks associated with social disconnection and loneliness in the aging population.
... Attachment theory provides a useful framework for understanding adjustment to trauma while assessing, conceptualizing, and intervening with veterans and their partners impacted by deployment-related trauma (Clark & Owens, 2012;Currier et al., 2012). From an attachment theoretical framework, veterans dealing with psychological trauma and its related effects, principally recover when they can form and maintain supportive, accepting intimate relationships (Johnson, 2002). For some veterans, having a supportive relational base with a partner, functions as a "protective factor" to limit or prevent trauma responses (Renaud, 2008). ...
... In this section, the researchers will situate these findings in the literature, offer recommendations for clinical practice, note the limitations, and provide direction for future research. These findings are consistent with prior research, which found that forming and maintaining supportive relationships with intimate partners can function as a protective factor for previously deployed veterans (Johnson, 2002;Renaud, 2008;Vest et al., 2017). They also point to the benefits that these relationships provide for non-deployed veterans. ...
... Couple relational dynamics and normative functioning have been predominately conceptualized as couples with no trauma exposure (Johnson, 2002;Ruhlmann et al., 2018). Couples affected by traumatic stress are generally typified as primary and secondary trauma survivors (referred to as "single-trauma couples" [STC]; Nelson Goff & Smith, 2005, p. 154). ...
... Results of this study delineate processes found within DTC and provide insight into the perceptions, behaviors, dyadic interactions, and past experience that may foster or hinder effective resilience in DTC. Oftentimes trauma exposure can result in a severance of interpersonal connection and attachment that exacerbates trauma-related symptoms and sense of hopelessness (Johnson, 2002;Monson et al., 2010). However, our findings corroborated previously created systemic resiliency processes (i.e., Walsh, 1996Walsh, , 2006 and literature that supports a balanced (inclusion of adaptive and maladaptive interactions) conceptualization of DTC relational dynamics (Blalock-Henry et al., 2011;Nelson Goff et al., 2014;Ruhlmann et al., 2018;Whisman, 2014). ...
Objective: Empirical knowledge about "dual-trauma couples" (DTC), characterized by both partners with a history of trauma exposure and presentation of trauma-related symptoms, is especially deficient. We analyzed DTC partners' qualitative data culled from the Relationship Evaluation Questionnaire (Busby et al., 2001) to ascertain dyadic resiliency processes within dual-trauma couples.
Method: A data-reductive thematic analysis on short-answer responses of reported relational strengths and weaknesses from female (n = 822) and male partners' (n = 831) yielded several processes that provide insight into individual perceptions, behaviors, and past experiences, and dyadic interactions that may foster or hinder effective resilience in DTC.
Results: Participant responses highlighted existing dyadic strengths that fostered effective couple adaptative processes: shared beliefs and goals, mutual collaboration and psychological flexibility, and dyadic connectedness. Barriers to couple resiliency included individual perceptions, behaviors, and past experiences, and dyadic interactions that exacerbated relational instability, emotional unsafety, contentious communication, and difficulties with distress tolerance.
Conclusions: Results promote a balanced conceptualization (i.e., inclusion of both adaptive and maladaptive interactions) of couples affected by trauma exposure. Implications for clinical treatment and several areas for future research are discussed.
... For instance, as CFT represents a plurality of welldefined strategies there exist interventions that have the potential to alleviate the distress caused by relational injuries due to trauma (Carr, 2018), such as increasing the empathetic capacity toward the partner suffering from childhood trauma and thereby reducing mutual criticism, blame, and hostility. Targeting the partners' vulnerability and basic needs for nurturing and protection, CFT has the potential of facilitating their relationship to become a safe harbor for both partners (Johnson, 2002). On the contrary, it is also possible to further hypothesize that the burden of trauma could even complicate to what extent the couple or family may benefit from relational therapy. ...
... Participants with a history of childhood trauma who showed less progress on the system level could suggest that they either need longer hospitalization or a higher frequency of sessions to fully benefit from the treatment. The latter would be in line with the recommendations proposed by Johnson (2002) that couples who have experienced trauma need more therapy sessions than couples who have not experienced trauma. ...
This study aimed to examine if survivors of childhood abuse responded differently to couple and family therapy compared with patients without such experiences. The study included 36 couples and nine individuals (N = 81). Of these participants, 30.3% had disclosed being exposed to and/or physical or sexual abuse during childhood. All participants of this study had attended a 6–12-week residential couple and family treatment program at a specialized treatment facility in Norway. The t-tests showed that significant improvements occurred on measures assessing symptoms of anxiety and depression, as well as relationship satisfaction and family functioning, from admission to discharge (effect sizes ranged from .31 to .92). The mixed model analyses showed that persons with a history of childhood trauma have greater symptoms of anxiety and depression at intake compared to persons without such experiences. Further, the mixed model analyses indicated that those who had been exposed to childhood abuse responded less to treatment measured weekly on family functioning than a person without a history of childhood abuse. Generalizability of this study is limited due to the relatively small sample size which has been drawn from a psychiatric population. Even so these findings imply that couple and family therapy is a suitable treatment of individual symptoms for both those who have and those who have not suffered childhood trauma. These results should motivate future research on the impact of trauma
... Given that childhood maltreatment is an act of omission (e.g., neglect) or commission (e.g., abuse) that is perpetrated by figures who are entrusted with the child's safety and wellbeing, it has been proposed that healing from childhood maltreatment occurs within the context of safe, secure relationships (Johnson, 2002). Attachment theorists would suggest that early caregiving experiences create internalizing representations of relationships. ...
... On the other hand, romantic relationships can be a tremendous source of healing. Formation of high-quality romantic relationships can diminish the underlying feelings of devaluation, powerless, worthlessness, guilt, shame, isolation, and rejection inherent in maltreatment (Finkelhor & Browen, 1985;Johnson, 2002). Relationships characterized by companionship, support, and effective conflict resolution can offer behavioral guidance to reduce maladaptive coping strategies (e.g., substance use), enhance self-esteem, and promote a sense of importance (Flett et al., 2016;Thoits, 2011). ...
Childhood maltreatment is associated with mental health problems across the life course and depression and social anxiety are two of the more common problems. Given the interpersonal nature of childhood maltreatment, adult romantic relationships have also been a keen interest. It has been suggested the interpersonal relationships may mediate the relationship between maltreatment and adult mental health; however, little research has examined the mediating role of adult romantic relationships. This omission misses an opportunity to advance empirical understanding as well as clinical intervention. To address this gap, the current study utilized a sample of 785 adults using two waves of data from the study of Midlife of Development in the United States to examine relationship quality as a mediator linking childhood maltreatment to adult depressive and social anxiety symptoms. Interpretation of structural equation models indicated that there were significant indirect effects from childhood maltreatment to both symptoms of depressive and social anxiety through relationship quality. Results of post-hoc analysis suggested that gender did not moderate any direct or indirect paths. In light of the significant indirect effects, relationship quality may be a point of intervention. Having a high-quality romantic relationship can provide a corrective experience for adults who were maltreated in childhood, thereby decreasing symptoms of depression and social anxiety.
... Gangguan kelekatan (attachment disruptions) didefinisikan sebagai ancaman yang berat dan berkepanjangan terhadap ketersediaan atau responsifitas pengasuh (caregiver) yang menciptakan ketakutan dan ketidakyakinan terhadap ketersediaan pengasuh atau kapasitas untuk merespon dalam momen yang berbahaya (Kobak, Zajac, & Madsen, 2016). Padahal, ketika seorang anak atau orang dewasa mengalami sebuah ketakutan tetapi percaya bahwa figur kelekatan tersedia dan responsif, akan terdapat sebuah harapan terhadap pertolongan dan dukungan (Johnson, 2002). ...
... Ketika ancaman terhadap ketersediaan partner dikomunikasikan secara terbuka, level konflik yang tinggi dan pelepasan ikatan dapat diperkecil. Selain itu, penyesuaian emosi (emotional attainment), responsifitas, serta menghadapi "bahaya", bersama akan menguatkan ikatan kelekatan yang aman (Johnson, 2002). Bowlby (Bowlby, 1973) mengusulkan bahwa fear system diaktifkan oleh tanda bahaya yang "natural", termasuk sesuatu yang asing/tidak biasa, stimulasi perubahan secara mendadak,ketinggian dan kesendirian. ...
Penelitian ini bertujuan untuk menghasilkan suatu media berupa buku bantuan diri untuk membantu remaja SMA di DKI Jakarta yang orangtuanya bercerai memelihara ikatan kelekatan. Buku bantuan diri dapat digunakan secara individual maupun oleh guru bimbingan dan konseling dalam proses konseling. Buku bantuan diri yang dikembangkan terdiri dari tujuh bab. Bab 1 sampai dengan 4 merupakan pemahaman diri konseli mengenai perceraian dan perasaan peserta didik. Membantu peserta didik untuk menyadari, menerima, dan mengekpresikan perasaan. Pada bab 5 dan 6 merupakan treatment dalam buku. Membantu peserta didik memiliki harapan yang aman terhadap orangtua. Pada bab 7 yaitu mengenai pemeliharaan yang merupakan kesimpulan dan refleksi diri setelah merampungkan buku bantuan diri. Metode penelitian yang digunakan adalah Research and Development (RnD) model ADDIE (Analyze, Design, Develop, Implement, Evaluate). Tahapan model pengembangan yang dilakukan adalah analisis, desain, dan pengembangan. Alat pengumpulan data yang digunakan berupa angket dan pedoman wawancara. Penilaian media dilakukan oleh validator yang terdiri dari ahli media, ahli materi dan peserta didik. Dari hasil uji validasi tersebut diperoleh rata-rata persentase dengan validasi ahli media 93,26%, validasi ahli materi 93,75%, peserta didik 91,77%, dan guru bimbingan dan konseling 92,04%. Hasil pengembangan buku bantuan diri untuk memelihara ikatan kelekatan bagi remaja yang orangtuanya bercerai dikategorikan layak. Kata Kunci : Ikatan Kelekatan (Attachment Bond), Buku Bantuan Diri, Model ADDIE, Perceraian ABSTRACT This study aims to develop a media that is a self help book to help high school adolescents in DKI Jakarta maintain attachment bond after their parents' divorce. The book can be used individually or by school counselors in the counseling process. The book consists of seven chapters. Chapters 1 to 4 discuss student's self-understanding of the divorce and their feelings. They help students realize, accept, and express their feelings. While chapters 5 and 6 are about treatments. They help students have secure expectancies to their parents. Chapter 7 is about self maintenance which is a conclusion and a self reflection after completing a self-help book. The method is Research and Development (RnD) with ADDIE model (Analyze, Design, Develop, Implement, Evaluate). The stages of the development model are analysis, design, and development. The technique of data collections is utilizing forms of questionnaires and interview. The evaluation of media was done by validators from the expert of media, the expert of material, students, and school counselors. Based on the validation test, it was obtained that the average percentage 93.75% of media expert, 93.75% of material expert, 91.77% of students, and 92.04% of school counselors. The result of the development of self help book is to help adolescents maintain attachment bond after their parents' divorce was categorized as appropriate. Keywords: Attachment Bond, Self Help Book, ADDIE Model, Divorce
... Emosjonsfokusert parterapi har hittil vist seg å vaere effektiv i møte med mange ulike klienter, både fra ulike kulturer og sosioøkonomisk bakgrunn (Denton et al., 2000), samkjønnede par (Josephson, 2003), eldre par (Bradley & Palmer, 2003), par med kroniske lidelser (Kowal et al., 2003) eller med depressive lidelser (Wittenborn et al., 2019) og angstlidelser som posttraumatisk stresslidelse (Ganz et al., 2022;Johnson, 2002). Den tradisjonelle «tause mannen» har også vist seg å respondere godt på emosjonsfokusert parterapi (Ceniza & Allan, 2021). ...
Developed in the 1980s, emotionally focused couples therapy has been a well-documented model for treating couples from different cultural backgrounds where one or both partners may be experiencing mental health problems. The method is based on attachment theory and aims to strengthen the attachment bond between partners through a set of different interventions. The article presents the theoretical framework of the method, an understanding of what triggers and maintains difficulties between couples and mental health issues, as well as key goals and processes for changing couples' interaction patterns that have proven effective in addressing various mental disorders. The article also presents a clinical case that demonstrates how emotionally focused couples therapy utilises the attachment bond between partners as a resource in treating old attachment wounds.
... Some of the issues that are most in evidence are the development of trustworthy relationships and intimacy, sexual functioning, parenting, career and other life decisions, ongoing decisions/ discussions with abusive others, and so forth. Specific resources are available for many of these issues (Basham & Miehls, 2004;Bass & Davis, 1994;Davis, 1991;Davis, 2002;Johnson, 2002;Maltz, 2001). In this stage, as in the others, the clinician continues to provide the secure base from which the client does the work and provides ongoing facilitation of relational learning. ...
Complex trauma occurs repeatedly and escalates over its duration. In families, it is exemplified by domestic violence and child abuse and in other situations by war, prisoner of war or refugee status, and human trafficking. Complex trauma also refers to situations such as acute/chronic illness that requires intensive medical intervention or a single traumatic event that is calamitous. Complex trauma generates complex reactions, in addition to those currently included in the DSM–IV (American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD). This article examines the criteria contained in the diagnostic conceptualization of complex PTSD (CPTSD). It reviews newly available assessment tools and outlines a sequenced treatment based on accumulated clinical observation and emerging empirical substantiation.
... They may learn from experience that interpersonal relationships are unstable and chaotic, characterized by loss and victimization (Pearlman & Courtois, 2005). Seeking what is familiar, they often form relationships with others who have unresolved loss or trauma, who may be abusive or re-enact trauma from the past, reinforcing distrust in others and cementing feelings of being unloveable (Basham & Miehls, 2004;Johnson, 2002). ...
While research continues to establish a connection between shame and complex trauma, there is a lack of understanding on how this is addressed in therapeutic practice. The current research employed a qualitative exploratory research methodology to answer the question, how do counsellors perceive and treat shame in adult survivors of complex trauma? Seven counsellors were recruited to engage in a virtual semi-structured interview. The data was analyzed using thematic analysis resulting in three main themes, each containing various sub-themes. The three themes are emotional landscape, which pertains to the emotional effects of shame and how they can be treated in therapy; self-concept, which explores the negative beliefs and thinking patterns clients develop and suggests techniques for diffusing shame; and attachment and the therapeutic relationship, which highlights interpersonal difficulties faced by clients and the impact of the therapeutic alliance, along with exploring the personal experience of counsellors in the therapeutic relationship.
... This has led researchers to explore whether attachment-based treatments focused on increasing felt-security in adults could help to improve their emotional-wellbeing (Bucci, Roberts, Danquah, & Berry, 2015;Facompré, Bernard, & Waters, 2018). Attachment-focused treatments have taken on different forms such as using attachment theory to tailor treatment to the individuals' attachment style (e.g., Shorey & Snyder, 2006), therapy to enhance attachment security (e.g., Davila, 2003), couple therapy to resolve relationship conflict and to enable partners to address life traumas constructively together (Johnson, 2002). Other attachment-based treatments are child and parent intervention programmes (e.g., the circle of security, Hoffman et al., 2006;attachment and biobehavioural catch-up, Dozier, Lindhiem, & Ackerman, 2005). ...
Attachment security priming (ASP) techniques have resulted in many positive outcomes including increased felt-security, an affective attachment state associated with optimal emotional regulation and relationship functioning. To date, however, ASP studies have almost exclusively been conducted with adult samples. This randomised experimental study investigated whether ASP could increase felt-security in adolescents with social, emotional and mental health (SEMH) difficulties. We further examined the security-related themes of the written protocols produced as part of the ASP procedure, allowing for the observation of the cognitions activated by the primes. Two prime groups (N = 100, Mage = 14.5) completed a mental imagery and written priming task; the experimental group visualised a security-inducing attachment figure, whilst the control group visualised a shopping trip. The experimental group reported significantly higher felt-security (ηp2 = 0.252) and wrote significantly more words related to attachment-relevant themes in their written protocols, compared to the control group. Findings demonstrate the potential of using ASP techniques to improve felt-security and associated outcomes in adolescents with SEMH difficulties.
... From an Emotionally Focused Therapy perspective, there are effective or ineffective dependency styles (Johnson, 2002). One notion of EFT posits that autonomy is formed when an individual is nurtured in a secure environment. ...
Emotionally Focused Therapy (EFT) is a theoretical approach that is considered widely effective in decreasing relationship distress among couples. Emotionally Focused Therapy uses deepening of the clients’ emotions to facilitate change to break negative interactional patterns within couple relationships. However, African American men have developed some behaviors and attitudes about emotions that may present challenges to them receiving Emotionally Focused Therapy. Some of those behaviors and beliefs include alexithymia and emotion ideologies which include restricting emotion based on their experience with societal stressors (e.g., race-based trauma, system racism). Given this emotional discrepancy, there are social and cultural considerations that need to be addressed between African American individuals in order to conduct effective couple work. This paper discusses emotional expressiveness and culturally sensitive approaches that EFT therapists will need to consider when counseling African American men in couples therapy.
... EFT has also been used extensively for couples in which one partner has posttraumatic stress disorder (PTSD) resulting from physical illness, violent crime, war trauma, or childhood sexual abuse (Johnson, 2002). EFT appears to be particularly appropriate for traumatized couples, perhaps because it focuses on emotional responses and attachment. ...
Emotionally focused couple therapy (EFT) has contributed substantially to the field of couple interventions. In particular, it has led the way in developing interventions that change emotion regulation and responses in ways that lead to increased emotional responsiveness and bonding interactions.
... [bodyni]Based on an extensive review of research, EFT is considered to be an evidence-based treatment for couple distress (Snyder, Castellani, & Whisman, 2006), and it has been successfully adapted to clinical populations in which relational distress was either comorbid with or exacerbated by other stressful couple or family concerns, including parenting chronically ill children (Walker, Johnson, Manion, & Cloutier, 1996), facing postpartum depression (Whiffen & Johnson, 1998), or dealing with posttraumatic stress disorder (PTSD) (Johnson, 2002). Here we review recent evidence relevant to empirical validation of EFT for couples as a treatment for comorbid depression, chronic illness, and trauma/PTSD. ...
... This article presents partial findings of a thematic analysis on the experiences of licensed clinicians integrating EFT and EMDR in couple therapy, with a focus on its practical aspects. In agreement with other authors (e.g., Negash et al., 2018;, participants recognized that integrating EMDR and EFT could be helpful for couples as it not only aligned with, but also facilitated, the goals of creating secure bonds and helping partners meet each other's attachment needs (Johnson, 2019(Johnson, , 2002. However, participants stated integration is not always recommended, were rightly cautious about possible pitfalls, and mentioned strategies they have used to reduce risks. ...
In this paper, we present and discuss partial findings of a thematic analysis on the experiences of 13 licensed clinicians who integrate Emotionally Focused Therapy (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) in couple therapy. We cover five of the seven themes that emerged from the data. These themes refer to practical factors of implementation, such as identifying and assessing the conditions necessary for effective integration, risks of integrating, and timing of integration in couple therapy. One additional theme refers to the institutional and training factors that might hinder model integration. After presenting the findings, we contrast them with available literature. We conclude by discussing clinical and research implications.
... CT refers to a broad range of therapeutic approaches which seek to alleviate relational and mental distress (Carr, 2019). One potential source of distress is childhood trauma creating relational injuries that further impact on these individuals' ability to build and maintain healthy relationships as adults with their partner and family (Chapman et al., 2004;Johnson, 2002). Thus, survivors of trauma have heightened risk of experiencing intimate relational distress (Colman & Widom, 2004;Taft et al., 2011), including disturbed parental capacities (Suardi et al., 2017). ...
In the present study we aim to increase our knowledge of the relationship between childhood trauma and outcome in couple therapy. We sampled participants based on their sub-optimal responses to treatment as well as one member of the dyad having reported experiences of childhood trauma. Six participants constituting three couples were included. All data was analyzed using thematic analysis. Our main finding was that when couples are not able to agree on the goal of their therapy and this is not handled adequately by the therapist, the alliance tends to split. The therapy thus becomes more individually focused at the expense of the couple relationship. Generally, participants did not themselves assess their past traumas as having negatively impacted therapy giving instead credence as to how it has impacted their self-knowledge. In the future, longitudinal studies should be conducted to explore if there is an association across treatment between trauma and the therapeutic relationship, and the influence it might have on outcome. The findings of this study further support the already existing literature on the importance of alliance and elaborates upon how split alliances occur, develops, and constrains therapy.
... There are different ways through which attachment security can be simulated and enhanced. For example, clinicians use therapeutic approaches in which the therapist acts as a security-providing figure, thereby increasing one's sense of security while providing a model for future relationships (e.g., S. M. Johnson, 2002;Johnson, 2019). However, here we focus on experimental methods that can be used to enhance security, which has a long tradition in social psychology. ...
Attachment security priming has important theoretical and practical implications. We review security priming theory and research and the recent concerns raised regarding priming. We then report the results of a meta-analysis of 120 studies ( N = 18,949) across 97 published and unpublished articles (initial pool was 1,642 articles) investigating the affective, cognitive, and behavioral effects of security priming. A large overall positive effect size ( d = .51, p < .001) was found across all affective, cognitive, and behavioral domains. The largest effect was found for affect-related outcomes ( d =.62, p < .001), followed by behavioral ( d = .44, p < .001), and cognitive ( d = .45, p < .001). Trait attachment anxiety and avoidance moderated the effects of subliminal security priming for behavioral outcomes—security priming effects were larger among people higher on attachment anxiety and avoidance. Assessment of publication bias revealed mixed evidence for the possible presence of asymmetry.
... Partners may be caught in negative cycles of interaction (e.g., pursuer-distancer) leading to relational distress and higher levels of affective symptoms, emotional reactivity, and aggression. Replacing negative sequences of interaction (e.g., criticism and withdrawal) with more positive ones (e.g., intimacy and support) can allow couples to cope with stress, successfully navigate individual differences, and inject positive emotions into their marriage (Johnson, 2002). We recommend emotion-focused therapy for use where one or both partners have a history of abuse, as it has been found to be an effective treatment for such couples (Dalton et al., 2013), and may help address both marital problems and mental health issues. ...
Childhood abuse has been widely associated with mental health problems in adulthood and marital quality may be one possible mediator. We examine marital quality as a mediator linking childhood abuse to positive affect, negative affect, emotionally reactivity, and aggression. Using data from Midlife Development in the United States (MIDUS), results of structural equation modeling indicate that the indirect effects from childhood abuse to each of the mental health outcomes were significant. Marital quality may be a source of resilience among adults who were abused in childhood and could be a point of intervention for clinicians.
... Resilience to trauma exposure and other challenges, even for those directly impacted by a pandemic, may be underestimated (PeConga et al., 2020). When these responders form and maintain supportive accepting connections with partners and others, these relationships can provide a key means of recovery from trauma and major challenges (Fagan, 2015;Johnson, 2002;Steele, 2020). Although attachment security diminishes the experience of fear, fear of loss of such relationships due to death, like what is occurring due to COVID-19, also represents a primary source of anxiety (Steele, 2020). ...
COVID-19 continues to have a deleterious impact on vulnerable populations in our society, and unfortunately, first responders are often overlooked in this conversation. To address that gap, we retrospectively compared routinely collected baseline assessment data from 69 treatment-seeking first responders who presented for treatment before COVID-19 to data collected from 75 similar first responders at the same agency during the pandemic. Data assessments gauged first responders’ attachment avoidance, attachment anxiety, resilience, depression, generalized anxiety, PTSD, and suicidality. Findings indicate that the strength of correlations between resilience, depression, generalized anxiety, and PTSD increased for these responders during the COVID-19 pandemic. They further highlight the role that attachment anxiety plays for first responder ability to cope during the pandemic. Practitioners can use these findings to create a conversation early in the treatment process and guide a collaborative treatment plan.
... The current finding that a sense of stigma continued to infiltrate intimate relationships, resulting in the covering up of the enucleation site is opposed to previous research reporting facial prosthesis wearers did not feel the need to cover up in the presence of partners and family members (Yaron et al., 2018). In this regard, therapeutic consideration of interpersonally orientated interventions where traumatic disfigurement interrupts intimate interpersonal processes may be helpfully considered (Johnson, 2002). ...
This study aims to explore the psychosocial factors and challenges affecting the lives of those who wear an ocular prosthesis following a traumatic eye injury. Thematic analysis of semi-structured interviews with eight individuals resulted in five themes: emotional devastation in the aftermath; moving forward; fear of negative social evaluation; keeping it normal - protecting self and close others; and threat of injury & blindness. Enucleation or evisceration of an eye causes significant emotional stress. Despite successful prosthetic restoration, many individuals continue to experience ongoing psychosocial challenges, as a consequence of their experiences of visible difference and visual impairment.
... There are also a number of family-inclusive treatments for PTSD (Johnson, 2002;Monson et al., 2012;Sautter et al., 2015), but all of the existing protocols require multiple conjoint sessions over several months, posing a significant barrier to treatment access. The most well-known and commonly used family-inclusive treatment is cognitive behavioral conjoint therapy for PTSD (CBCT; Monson et al., 2012), a 15-session, fully dyadic intervention based on the cognitive behavioral interpersonal theory of PTSD (Monson et al., 2010); an 8-session CBCT protocol (Morland et al., 2019) and an intensive multicouple CBCT protocol (Fredman et al., 2020) have also been tested. ...
Dropout from trauma-focused treatment for posttraumatic stress disorder (PTSD) represents a daunting challenge for the field, particularly among military and veteran samples. Family involvement may help to increase the effectiveness of PTSD treatment while also improving retention. We tested a two-session brief family intervention (BFI) protocol delivered as an adjunct to individual trauma-focused treatment among a sample of 20 veteran-family member dyads (N = 40). Willingness to participate in the family-inclusive protocol was high, with over 85% of veterans and family members who were screened agreeing to take part. All enrolled veterans were beginning a course of either cognitive processing therapy (CPT) or prolonged exposure (PE), delivered in outpatient Veterans Affairs clinics. Family members were randomized to either receive or not receive the BFI from study clinicians. In the BFI condition, 20.0% of veterans dropped out of CPT/PE before the 16-week study end; the remainder were either still attending on-protocol sessions or had completed the full protocol. In the control condition, 40.0% of veterans dropped out of CPT/PE before the end of the study. Observed significant, large-magnitude decreases in PTSD symptoms over time did not differ by condition, ESsg range = -1.12 to -2.04. Accommodation did not significantly decrease over time in either condition, ESsg range = 0.18 to -0.98. The BFI represents a promising option for veterans, family members, and clinicians who are seeking a brief, feasible, narrowly focused method for incorporating families into veterans' individual trauma-focused therapy and potentially reducing the rate of dropout.
... Trust and contentment are other elements of attachment theory that become apparent in relationships later in life. Attachment theory is therefore part and parcel of engagement and the ability to connect with others (Fraley & Shaver, 2008;Johnson, 2002;L'Abate et al., 2010). ...
The field of child welfare continues to search for effective ways to mitigate risks foster youth often encounter. Research discoveries about the importance of attachments and relational competence for foster youth support greater well-being. However, little is known about the use of smartphone technology and companion software in foster care as a method in promoting relational competence. This qualitative implementation study sought to explore the perceptions of child welfare providers and other stakeholders regarding how smartphone technology facilitated the ability of foster youth to become more connected with trusted adults. Research results reveal challenges associated with child welfare officials’ purposeful issuance and utilisation of smartphones. Stakeholders and providers viewed these challenges as learning opportunities. Three critical themes uncovered—relationship building, youth empowerment, and normalcy—provide direction for how smartphone technology might be more efficiently tapped relative to future child welfare initiatives.
... These findings provide additional support for the application of attachment theory as a principal means of comprehending the primary mechanisms describing how these programs help veterans with PTSD (Esposito, McCune, Griffin, & Maholmes, 2011;O'Haire et al., 2015;Scotland-Coogan, 2019;Vitztum & Urbanik, 2016). From an attachment theory perspective, individuals and those connected to them can begin to heal from primary and secondary trauma in the context of close, supportive, accepting relationships (Johnson, 2002). As identified in the conceptual model, when veterans form close bonds with their service dog, with others in these programs, and strengthen bonds with their partners, this provides them with a relational bridge to aid them in managing their PTSD responses. ...
This article details findings from an investigation to understand the experiences of partners of veterans with posttraumatic stress disorder (PTSD) participating in a service dog program. Fifteen partners of veterans with PTSD participating in a service dog training program responded to an online survey assessing their own trauma symptoms as well as their current relationship satisfaction. Twelve of the survey participants also took part in in-depth interviews. The researchers propose a conceptual model based on participant responses that centers on the significance of veterans building a three-part relational bridge when they take part in these programs that foster reductions in PTSD symptoms, increased resiliency, and improved relational functioning. A clinical social worker providing counseling services to veterans and their partners at the service dog agency involved in the study plays a central role as part of this relational bridge. Social workers may consider supporting and advocating for veteran clients to have access to qualified service dog agencies as complementary or alternative treatment options.
... In recognition of the association between PTSD symptoms and family functioning, a handful of family-inclusive treatments for PTSD have been developed. Some of these are specifically designed for spouses or romantic partners (e.g., Emotionally Focused Couple Therapy for Trauma (Johnson, 2002), Structured Approach Therapy (Sautter, Glynn, Cretu, Senturk, & Vaught, 2015)), while others are open to a broader range of family members (e.g., Cognitive-Behavioral Conjoint Therapy (CBCT; Monson & Fredman, 2012); REACH (Fischer, Sherman, Han, & Owen, 2013)). These protocols are intended to be standalone treatments; with the exception of REACH, all contain elements that focus directly on treating the PTSD symptoms (such as exposure) while also providing psychoeducation and elements targeting relationship enhancement (such as communication skills training). ...
Family involvement in the treatment of posttraumatic stress disorder (PTSD) among veterans has the potential to improve treatment retention and outcomes. Current protocols that incorporate family members into treatment tend to involve at least 15 sessions, and none are designed to complement Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE), the two most widely used and heavily promoted evidence-based PTSD therapies in the Veterans Affairs (VA) healthcare system. The current paper describes the development and initial feasibility and acceptability of a Brief Family Intervention (the BFI) designed to be delivered as an adjunct to veterans' individual CPT/PE. The BFI focuses on providing psychoeducation about PTSD and treatment, building family member support for treatment, and reducing family symptom accommodation. A detailed review of the treatment structure and activities is provided, and qualitative data from four dyads (veterans and their spouses/significant others) at baseline and post-intervention are presented. Veterans and partners reported positive responses to the program and were enthusiastic about its utility. Larger randomized controlled studies will be needed to determine the protocol's efficacy and effectiveness.
... Clinicians may also want to encourage partners to be involved with therapy, employing models such as Emotionally Focused Couple therapy (EFT). The work of Sue Johnson on EFT and trauma suggests that greater relational intimacy, trust, and healing emerges when couples work through painful individual experiences, such as FOO adversity, together (Johnson 2002). ...
Because adverse childhood and family of origin experiences may have implications for adult relationships, the current study was designed to understand the associations between childhood family of origin adversities, and adult romantic relationship quality for individual African Americans in relationships (N = 1286) considering the potential intermediary role of coming to terms, self-esteem and depression symptoms. A structural equation model was conducted using a selection of data from the RELATE assessment (see www.relate-institute.org). Results revealed no direct effect between family of origin adversity and relationship quality, however there were several indirect effects carried through coming to terms, self-esteem, and depression symptoms. Results also suggested that coming to terms associated with higher self-esteem and lower levels of depressive symptoms for the African Americans in the current study sample. Clinicians may find it useful to focus on assisting African American individuals in coming to terms with childhood family of origin adversity as part of treatment for depression, self-esteem issues, and adult romantic relationship problems. Additional clinical implications and directions for future research are discussed.
... Paralleling our conceptualization of the relationship between maltreatment and provisions of emotional support is an attachment process, we recommend attachment-based interventions, such as Emotion Focused Therapy (EFT; Diamond, Shahar, Sabo, & Tsvieli, 2016;Johnson, 2002). EFT may be helpful because it aims to evoke maladaptive negative emotions rooted in maltreatment such as dejection, shame, fear, terror, and guilt, and transform them into positive and adaptive emotional responses such as compassion, confidence, connection, and assertiveness (Diamond et al., 2016). ...
Background: Research has established that childhood maltreatment is associated with
interpersonal problems across the life course. Less is known regarding how maltreatment is
linked with adult’s provision of emotional support to their family members, friends, and
romantic partners. Objective: To examine how maltreatment severity is associated with adult’s provisions of emotional support to family members, friends, and romantic partners and examine differences between men and women.Participants and Setting: A sample of 1,255 adults (56% women) was collected between 2005 and 2009. Methods: Data are from the National Survey of Midlife Development in the United States (MIDUS). Participants completed retrospective survey reports of childhood maltreatment and current provision of emotional support provided to family members, friends, and romantic partners. Results: Using hierarchical regression analysis, childhood maltreatment was negatively associated with provisions of emotional support provided to family members (b = -0.013, p < .05), friends (b = -0.013, p < .05), and romantic partners (b = -0.016, p < .05) above and beyond other childhood adversities, current mental health symptomology, and current stress. Gender moderated the relationship for friends (b = 0.012, p <. 05) and romantic partners (b = 0.015, p < .05) where women provided more emotional support than men while no gender differences in support provided to family members (b = 0.009, p > .05.)
Conclusion: Childhood maltreatment contributes to less provision of emotional support to
family members, friends, and spouses for both men and women and is particularly detrimental for men. Clinical Implications are discussed.
Family-only interventions provide a unique opportunity to engage families in what may be a more feasible or appealing model compared to fully inclusive family or couple approaches. I present both theoretical and research-informed justifications for intervening with family members alone, while also describing potential clinical pitfalls. A particular focus will be on a brief intervention for the family members of adults with posttraumatic stress disorder (the Brief Family Intervention for PTSD, or BFI). I will review the components of the BFI and discuss the rationale for various choices regarding its structure and content. This chapter includes a case vignette to illustrate the clinical approach.
This chapter will consider some psychological, psychoanalytical and psychodynamic perspectives of formulation. The words are essentially interchangeable depending upon your theoretical frame of reference. In this chapter the focus is upon theories of identity and emotional development; systemic and relational influences; and the act of doing formulation as a reflexive group process. Formulation is a framework to invite evidence-based hypothesis and thinking that can challenge assumptions and invite new ideas and knowledge and focus our conversations, assessments and interventions. The utility of group formulation and discussion affords our thinking and about the person’s experience of distress. The chapter asserts that one perspective is not enough to understand the whole story. The focus is on developing knowledge and use of case formulation as a means of collaboratively understanding a person’s experience of mental and or physical distress and illness, whether in crisis or longer-term situations: from cognitive behavioural, medical, psychological and social perspectives. Some authors may differ in the way they name the different domains of formulation as CBT, Psychodynamic, Systemic and Integrative (Johnson & Dallos, 2014) and as a consequence favour different influences; but the process, i.e. the act of doing formulation is what is foregrounded; the process of exploration is the same regardless of your theoretical or professional position. I have used this approach in my own clinical practice, in the teaching of undergraduate and postgraduate students and continued professional development of clinicians in practice to frame discussions in group supervision for many years. I never fail to be impressed and captivated by the level of critical thinking and compassionate willingness of students and clinicians to be self-effacing about the theoretical models we feel wedded to, and a readiness to consider assumptions we all hold about personhood, illness and expected outcomes. This chapter may be of use to new and experienced clinicians. It may not offer new theoretical knowledge to experienced clinicians but prompt each to consider ways of working—using formulation as a structure to think together, assess and work with individuals and families referred with mental and physical health difficulties. I have been inspired by, and learnt from, those with whom I have had the privilege to work with: colleagues, students and people with lived and living experience. I could not have done my job without involving the thinking of others. There is a case example of a family’s story which is shared to illustrate the ideas offered in this chapter.
This process–outcome study was conducted within a naturalistic setting at the Family Unit, Modum Bad, Norway. The aim of the study was fourfold: 1) To evaluate the Family Unit’s treatment program by assessing the participants’ degree of mental and relational distress from intake to discharge and changes in distress taking place during treatment. 2) To investigate the predictive association of therapists’ reports of patients’ histories of childhood trauma on weekly patient-reported outcome.
3) To retrospectively explore a subsample of those patients with histories of childhood trauma about their experiences of receiving treatment at the Family Unit.
4) Apply dyadic analyses (Kenny et al., 2020) as a method of analyses to investigate actor–partner effects related to a) how the actor’s (i.e., the individual) alliance to the therapist predicts his or her relationship satisfaction, b) how the actor’s alliance to the therapist predicts his or her partner’s relationship satisfaction, c) how the actor’s relationship satisfaction predicts his or her alliance to the therapist, and d) how the actor’s relationship satisfaction predicts his or her partner’s alliance to the therapist.
In conclusion, our study has contributed to the literature by identifying and exploring how couples with histories of trauma experience relational challenges (i.e., split alliances) in residential therapy and how such challenges are related to poorer outcomes. Furthermore, the application of dyadic analyses as conceptualized within the actor–partner interdependence model presented novel results pertaining to working alliances. Our findings strengthened our conviction that mixed method research designs with the application of dyadic analysis are necessary when studying complex relational phenomena.
Aim: The aim of this study was to predict psychological helplessness based on initial maladaptive schemas and coping strategies in women affected by marital infidelity. Method: The present study is descriptive-correlational in terms of method. The statistical population included all women involved in the issue of marital infidelity (spouse) who referred to counseling centers in District 5 of Tehran in 2021. 210 people were selected by convenience sampling method. Data collection tools included the Yeniseri and Kokdemir (2006) Marital Infidelity Questionnaire, the Lovibond & Lovibond (1995) Psychological Assistance Questionnaire, Lazarus Folkman (2001), and Young's Early maladaptive Schema Questionnaire (2000). Statistical analysis was performed using Pearson correlation coefficient and multiple regression method. Results: The results of the study showed that based on the initial maladaptive schema and coping strategies, psychological helplessness in women affected by marital infidelity can be predicted. Conclusion: The study of these predictor variables in premarital and family counseling is necessary to identify people at risk.
Posttraumatic stress disorder (PTSD) is bidirectionally associated with couple distress and dysfunction, as well as mental health difficulties in partners and children. PTSD can elicit responses from friends and family that are well-meaning but may maintain the symptoms of PTSD. Negative family interactions have been linked to poorer individual therapy outcomes, and individual evidence-based treatments for PTSD do not consistently improve relational functioning. Consequently, there have been efforts to develop and test dyadic treatments that improve relational functioning and PTSD and, in some cases, also improve the health and well-being of partners. The current chapter describes different ways to conceptualize couple treatment of PTSD and reviews the efficacy of these interventions.
The purpose of this systematic review is to evaluate the effectiveness of couple therapy from different therapeutic approaches on the variables of depression, anxiety, stress, and relational factors in couples with infertility. It also aims to identify whether couple therapy increases the likelihood of pregnancy. A search protocol was entered into specific databases (PsycINFO, EMBASE, PubMed, and CINAHL) and a total of 12 interventional studies are included in this review. The results show that couple therapy of six or more sessions is effective in reducing depression, anxiety, stress, and relational complaints in couples who present with a lengthier infertility history. Couple therapy also increases the likelihood of pregnancy but only in couples with idiopathic infertility rather than medical and structural infertility. An explorative comparison of the effectiveness of different therapeutic approaches shows superior results with emotionally focused couple therapy, cognitive behavioural couple therapy, and behavioural couple therapy. This review adds to the evidence base for couple therapy and reinforces the need for this modality because of the interpersonal nature of infertility.
Childhood maltreatment can leave adults vulnerable to relationship problems. Relationship mindfulness has been shown to promote relational wellbeing increasing the positive relationship quality and decrease negative relationship and may be a mediator. Using a sample of 106 adults, results of the structural equation modeling indicate that the indirect (mediated) effects from childhood maltreatment to both positive and negative relationship quality through relationship mindfulness were significant. Direct effects from maltreatment to positive and negative relationship quality were both non-significant. Based on the results of the study, clinicians are encouraged to use couple-based mindfulness interventions among adults with a history of maltreatment.
The abuse of older people by family members is an issue that is gaining attention in Australia. There are a number of factors that have been reported to increase the vulnerability of victims and thereby the risk of experiencing elder abuse. Cognitive impairment is one risk factor that has consistently been reported (Chen & Dong, 2017). Despite this, there has been little research into whether abuse experienced by older people with a cognitive impairment differs from that of victims who do not have a cognitive impairment. This study used 12 months of data from an elder abuse helpline to examine whether: individual risk factors; relational risk factors; abuse types and behaviours; barriers to addressing abuse; and the impact of abuse on victims differed as a function of whether the victim was reported to have a cognitive impairment.
Between-group differences regarding individual and relational factors were found. Victims who were identified as having a cognitive impairment (CI Group) had more complex support needs and were more likely to be dependent on perpetrators than victims who had no cognitive impairment (NCI Group). Victims in the CI Group were more likely to experience neglect and social abuse and less likely to experience physical or psychological abuse than victims in the NCI Group. The types of abuse behaviours used by perpetrators were also found to differ, as were the methods used to facilitate financial abuse. Further differences related to the reported impact of abuse and the barriers for victims in addressing abuse. The findings from this study may inform practice when working with victims of elder abuse and provide a basis for further research to be undertaken.
Trauma affects individuals deeply and symptoms of trauma create numerous difficulties in intimate committed relationships. In spite of this, too few couple therapy interventions have been systematically evaluated for couples where one or both members are trauma survivors. There is promising evidence demonstrating that there is a strong association between trauma and poor couple functioning. There is also evidence from pilot studies showing that couple interventions (cognitive‐behavioral couple therapy and emotionally focused couple therapy, in particular) are effective in both reducing trauma symptoms and in improving the couple relationship. We provide an overview of this research and recommendations for the future.
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