Short-Term and Long-Term Effects of Training in EFT: A Multinational Study in Spanish-speaking Countries

This study seeks to validate the cross-cultural effectiveness of emotionally focused couple therapy (EFT) training in a sample of Spanish-speaking clinicians. The 28-hr formalized training for EFT was offered in six different Spanish-speaking countries, covering Europe, North America, Central America, and South America. Two hundred and seven therapists of 14 different Spanish-speaking nationalities completed pre-training assessments, 153 of them completed post-training assessments, and 92 therapists also completed the follow-up assessment. Using multilevel growth modeling (MLM), results indicated that therapists experienced significant and positive changes in terms of EFT competence (knowledge and skill acquisition), mature empathy, self-compassion, and attachment over time. Implications for transnational EFT training, specifically in Spanish-speaking countries, are discussed.     

The experience of learning Emotionally Focused Couples Therapy

This study examined the process of learning Emotionally Focused Couples Therapy (EFT) as reported by 122 EFT therapists and therapists-in-training. Participants completed an online questionnaire assessing their experiences of learning EFT, with particular emphasis on EFT theory, alliance, interventions, perceived impact on clients, and impact on self. Findings suggest that therapists are drawn to the attachment-based model of EFT, appreciate the EFT framework and structure, that clients endorse the usefulness of the model and that learning the model has contributed to personal healing and improved relationships for the trainees. Results also show that the transition to EFT from another model can be taxing and requires time, support, and additional supervision/training to increase comfort level and competency with EFT. Nevertheless, results also highlight that learning EFT can be a rewarding and worthwhile endeavor.     

Tapping your way to success: using Emotional Freedom Techniques (EFT) to reduce anxiety and improve communication skills in social work students

By the nature of their professional training and practice placements, social work students are prone to situations provoking the onset of anxiety. A programme of academic and placement support, termed the ‘Skills Lab’, provides help and support for students to develop their communication skills and prepare for their practice placements and transition into professional social work practice. Skills Lab evaluations indicated a high level of appreciation, linked with a strong sense of apprehension and anxiety, which some students report has negatively affected their performance. To address student anxiety, a pilot study using Emotional Freedom Techniques (EFT) was developed. EFT is an intervention, which may potentially be effective in reducing academic anxiety and enhancing public speaking. This mixed-methods pilot study measured participants’ (n = 45) subjective distress and anxiety before and after using EFT. Subjective distress/anxiety was invoked through a 15-min assignment lecture. Twelve of the 45 students also participated in one-one interviews to elaborate on their experiences of EFT. Quantitative findings indicated participants reported significantly less subjective distress and anxiety after using EFT. Qualitative findings indicated three themes whereby participants found EFT calming, relaxing and helpful; considered the transferability of EFT in other settings; and proposed some of the mechanisms of EFT’s action.     

Measuring the Effectiveness of the Emotionally Focused Therapy Externship Training in Hungary done through Translation

Our study adds to the rising field of dissemination and implementation research on Emotionally Focused Therapy. We evaluated the psychometric characteristics of the Hungarian EFT‐KACS, examined the impact of the EFT Externship training done through translation on Hungarian therapists, and we investigated how therapist background characteristics related to outcomes. A total of 340 Hungarian professionals completed the questionnaires (N = 152 in 2016; and N = 188 in 2018) at three data collecting points—prior to (N = 329), after the training (N = 254), and 6 months later (N = 101). Results suggest the Hungarian EFT‐KACS has similar psychometric properties as the original English version and shows high internal consistency. The 4‐day EFT Externship trainings done through translation provided significant, lasting increases in perceived EFT‐specific knowledge and competency, and in alliance, similar to findings in English‐ and Spanish‐speaking countries. Externship outcomes were also found to be related to specific therapist experience and background characteristics.     

Supervising emotionally focused therapists: a systematic research-based model

Emotionally Focused Therapy (EFT) is an empirically validated relational therapy that recognizes the complexity of couple's therapy and supports the need for specialized training of therapists. Until now, there has been little research on effective methods for EFT supervision and no systematic model for conducting EFT supervision. The findings of a qualitative study of certified EFT therapists' experiences with EFT supervision and training are presented in this study, along with a systematic model of EFT supervision. The model of EFT supervision is based on the findings of this study, relevant research regarding effective clinical supervision, and the authors' experiences with EFT supervision. This model of EFT supervision is isomorphic to the clinical practice of EFT, in that it is theoretically grounded in attachment theory and emphasizes experiential and emotionally based processes.     

The Impact of Blamer‐softening on Romantic Attachment in Emotionally Focused Couples Therapy

Emotionally Focused Couples Therapy (EFT; Johnson, 2004 ) treats relationship distress by targeting couples' relationship‐specific attachment insecurity. In this study, we used hierarchical linear modeling (Singer & Willett, 2003 ) to examine intercept and slope discontinuities in softened couples' trajectories of change in relationship satisfaction and relationship‐specific attachment over the course of therapy from a total sample of 32 couples. Softened couples (n = 16) reported a significant increase in relationship satisfaction and a significant decrease in attachment avoidance at the softening session. Although softened couples displayed an initial increase in relationship‐specific attachment anxiety at the softening session, their scores significantly decreased across post‐softening sessions. Results demonstrated the importance of the blamer‐softening change event in facilitating change in EFT.     

Randomized controlled trial of emotionally focused couple therapy compared to treatment as usual for depression: Outcomes and mechanisms of change

This randomized controlled trial examined the effectiveness of Emotionally Focused Therapy (EFT) for depression and relationship satisfaction versus usual care (i.e., couple therapy other than EFT), and explored mechanisms of change. Mixed model trajectory analyses of 16 couples indicated EFT was associated with greater improvement in relationship satisfaction among men and women. Men receiving EFT reported greater improvements in depressive symptoms compared to usual care. Unified structural equation modeling revealed changes in relationship satisfaction preceded changes in depressive symptoms in one cluster of partners, while changes in depression preceded changes in relationship satisfaction in a second cluster. Two other clusters reported simultaneous changes in satisfaction and depression. This study provides encouraging results on the effectiveness of EFT for depression, and insight into mechanisms of change.     

Challenges and opportunities to eLearning in social work education: perspectives from Spain and the United States

ABSTRACT

eLearning has become an academic tool used to provide access to education for multiple segments of the population, which otherwise would have little to no access to it. While other academic disciplines integrated it into their curricula early in the digital revolution, in many countries, social work education is just beginning to address the opportunities and challenges web-based learning may bring to these programmes [Blackmon, 2013. Social work and online education with all deliberate speed. Journal of Evidence-Based Social Work, 10(5), 509–521. doi:10.1080/15433714.2012.663672; Phelan, 2015. The use of eLearning in social work education. Social Work, 60(3), 257–264. doi:10.1093/sw/swv010]. This international collaborative research study seeks to better understand the challenges and opportunities faced by social work educators teaching at universities who are already using some form of eLearning in the United States and in Spain. A quantitative, non-experimental research design was employed. Results show that there are similarities as well as differences in the ways the two subsamples perceive the challenges and opportunities of eLearning. Findings reveal that there are some significant differences between the way the two subsample respondents perceived challenges and opportunities to eLearning. Recommendations for online social work educators and administrators are provided regarding overcoming challenges and capitalizing on opportunities applicable to the US, Spain, and the larger European and global contexts. Recommendations for further research and practice are also included.     

FACILITATING INTIMACY: INTERVENTIONS AND EFFECTS

The Present study investigated by effects of two sets of marital interventions taken from Emotionally Focused Therapy (EFT) and Cognitive Marital Therapy (CMT) on level of marital intimacy, dyadic trust, and dyadic adjustment. It was hypothesized that both EFT and CMT would have a positive effect on levels of intimacy, trust, and adjustment as compared to a wait-list control group and that there would be a differential effect in favor of EFT as compared to CMT. Thirty-six couples free of marital distress and seeking to enhance theor intimate relationship were randomaly assigned to EFT, CMT, or a wai-list control group. Therapists' interventions were monitored and found to be faithfully implemented. Groups were equivalent on demographic variables and the quality of the therapeutic alliance. Both EFT and CMT group posttest means were found to be significantly higher than controls on the self-report measures of intimacy, Observational measures of intimacy revealed differential effects in favor of EFT as comopared to CMT at posttest. At a 10-week follow-up, EFT group means were significantly higher than CMT on self-reported intimacy and adjustment.     

The Impact of Behavioral Couple Therapy on Attachment in Distressed Couples

Emotion‐focused therapy (EFT; Greenberg & Johnson, 1988 Emotionally focused therapy for couples. New York: Guilford Press) is anchored in attachment theory (Johnson, 2003 Attachment processes in couples and families. New York: Guilford) and considers change in attachment schemas essential in the process of improving satisfaction in relationships (Johnson, 1999, Research and couples therapy: Where do we go from here? American Family Therapy Academy Newsletter). However, there are little data on how measures of attachment change over the course of EFT or any other couple therapy. The current study examines whether increases in attachment security predict improvements in marital satisfaction during behavioral couple therapy, which would suggest that change in attachment style is a key process variable even for a non‐attachment‐focused treatment. Multilevel models of data from 134 couples participating in a randomized clinical trial of integrative behavioral couple therapy and traditional behavioral couple therapy (Christensen et al. Journal of Consulting and Clinical Psychology, 72, 2004, 176) indicate that although there is a trend for early change in attachment‐related anxiety and avoidance to predict later change in marital satisfaction, early change in marital satisfaction strongly predicts change in attachment‐related anxiety through the end of treatment and 2‐year follow‐up. These findings suggest that changes in satisfaction may lead to changes in attachment rather than the reverse and that change in attachment may not be the mechanism of change in all efficacious couple therapy.     

Deactivating the Buttons: Integrating Radical Exposure Tapping with a Family Therapy Framework

The purpose of this paper is to describe and illustrate with case examples a brief intervention termed Radical Exposure Tapping (RET). RET can be integrated with family therapy to address stuck points where the therapy is hindered by a family member's affective block, an intense and unchangeable emotional reactivity to a specific trigger. RET draws from the methodology of Eye Movement Desensitization and Reprocessing (EMDR) and combines it with the tapping sequence of the Emotional Freedom Technique (EFT) to produce an intervention that is more flexible than EMDR, provides greater rigor than using the EFT technique alone and can be effective in a single session within the context of family therapy. The paper puts this work into context by first over viewing definitions of trauma and Post‐Traumatic Stress Disorder, arguing that family members' emotional reactivity may be a symptom of PTSD even when they would not qualify for the diagnosis because they had not experienced a life threatening event.     

Prompting Depression Treatment Seeking among Smokers: A Comparison of Participants from Six Countries in an Internet Stop Smoking RCT

Websites containing information and advice about health are increasingly common and popular. It is important to understand whether the material these sites contain can positively influence individual behavior, and whether populations differ in their response to that material. Participants in an international web-based stop smoking randomized controlled trial (RCT) were screened for major depression; participants whose history and/or depression symptoms were deemed of concern were offered one of two prompts (Strong and Mild) to seek treatment, depending on depression history. Participants from 3 predominantly English-speaking and 3 predominantly Spanish-speaking countries were analyzed. Individuals given a Strong prompt were more likely to seek treatment for depression than those given a weak prompt (16.6% vs. 10.2% of previously untreated individuals reported seeking treatment), controlling for symptom level and other variables. Country-specific differences were observed, with participants from South Africa and Spain departing from the common pattern of Strong prompt leading to higher likelihood of treatment seeking. Older age and female gender, but not symptom level predicted higher likelihood of seeking treatment following a prompt. The results suggest that information provided by the health websites can promote help seeking in affected individuals.     

EFFECTS OF A COMMUNICATION TRAINING COMPONENT ADDED TO AN EMOTIONALLY FOCUSED COUPLES THERAPY

In this study a 4-session communication skills training component was added to an 8-session Emotionally Focused couples therapy package. This treatment (EFT + CT) was compared to 12 sessions of Emotionally Focused therapy (EFT) to investigate whether the communication training component enhanced the effectiveness of EFT, and both treatments were compared to a wait-list control. Both treatments achieved superior gains at posttest compared to the control group on measures of marital adjustment and target complaint improvement (but not on intimacy and passionate love), with EFT + CT being superior on communication. The only differential treatment effect was EFT's superiority on target complaints at follow-up.     

Augmenting antidepressant medication treatment of depressed women with emotionally focused therapy for couples: a randomized pilot study

This is the first study to evaluate adding emotionally focused therapy for couples (EFT) to antidepressant medication in the treatment of women with major depressive disorder and comorbid relationship discord. Twenty-four women and their male partners were randomized to 6 months of medication management alone (MM) or MM augmented with EFT (MM + EFT). MM followed the Texas Medication Algorithm Project guidelines. Fifteen EFT sessions were delivered following the EFT treatment manual. The primary outcome was severity of depressive symptoms (assessed by the 30-item Inventory of Depressive Symptomatology-Clinician Rated version [IDS-C(30) ] administrated by evaluators blinded to cell assignment). Secondary outcome was relationship quality as assessed by the Quality of Marriage Index. Results from assessments at intake, termination, and two posttreatment follow-ups were analyzed using growth analysis techniques. IDS-C(30) scores improved over 6 months of treatment, regardless of the treatment assignment, and women receiving MM + EFT experienced significantly more improvement in relationship quality compared with women in MM. Because relationship discord after depression treatment predicts worse outcome, interventions improving relationship quality may reduce depression relapse and recurrence. Testing this hypothesis in larger samples with longer follow-up could contribute to knowledge on the mechanisms involved in determining the course of depressive illness.     

New research findings on emotionally focused therapy: introduction to special section

This article introduces the special section "New Research Findings on Emotionally Focused Therapy." Emotionally focused couple therapy researchers have a strong tradition of outcome and process research and this special section presents new findings from three recent studies. The first study furthers the goal of determining the kinds of clients for which EFT is effective (Denton, Wittenborn, & Golden, this issue) and the next two studies (Furrow, Edwards, Choi, & Bradley, this issue; Wittenborn, this issue) focus on the person of the therapist and provide some implications for EFT intervention and training. Together, these three studies provide valuable lessons on how to deepen our knowledge of the application of EFT for different populations and therapists.     

Predicting Change in Marital Satisfaction Throughout Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. EFT is recognized as one of the most effective approaches to couple therapy, but to guide therapists in their use of EFT, a theoretically based model to predict change is needed. This study tested such a model by recruiting 32 couples, and 14 therapists who provided approximately 21 sessions of EFT. Couples completed self‐report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre‐ and posttherapy and after each therapy session. Results of hierarchical linear modeling suggested that individuals higher on self‐report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction across EFT sessions. Assessing attachment security at the start of therapy will inform therapists of the emotion regulating strategies used by couples and may help couples achieve positive outcomes from EFT.     

Forgiveness and Reconciliation in Emotionally Focused Therapy for Couples: The Client Change Process and Therapist Interventions

This article presents psychotherapy process research findings related to the forgiveness and reconciliation model, known as the Attachment Injury Resolution Model (AIRM), within the context of emotionally focused therapy for couples (EFT). Outcomes for EFT as an intervention for general relationship distress and AIRM have been successfully tested. Audiotapes of nine resolved and nine nonresolved EFT couple cases were used to study the client change process, the validity of AIRM, and EFT interventions used at each stage of the model. Study findings suggest resolved couple clients engaged deeply with their internal experience were more deliberate and controlled in their processing and more affiliative in their interpersonal responses in comparison with nonresolved couples. Resolved versus nonresolved client in‐session performances were discriminated on the basis of four model components. These were associated with significant shifts from secondary reactive emotions to primary attachment–related emotional processing of the injurious incident and with interactions that focus on shaping emotional responsiveness. Key EFT interventions employed in successful attachment injury resolution are also identified.     

Couple Therapy and Attachment: An Interview with Susan Johnson

Susan M. Johnson is an international expert in Emotionally Focused Couple Therapy (EFT). She is a Professor of Psychology and Psychiatry at the University of Ottawa and Director of the Marital and Family Therapy Clinic at Ottawa Civic Hospital. She is the author of The Practice of Emotionally Focused Marital Therapy – Creating Connection (Brunner/Mazel, 1996) and the co‐author of Emotionally Focused Therapy for Couples: The Heart of the Matter. EFT is now one of the most empirically validated couples therapies and is accepted as such by the American Psychological Association. On sabbatical in 1999, she went to New Zealand and then visited Australia in April, conducting workshops in Sydney and Perth.     

Enactments in Emotionally Focused Couple Therapy: Shaping Moments of Contact and Change

Emotionally focused couple therapy (EFT) uses enactments to shape responsive attachment‐significant contact and to change couple interaction. In this article, we show how EFT enactments differ from enactments in other therapy approaches, present a theory of EFT enactments, a model for creating EFT enactments, and an extended case example of an EFT enactment. Video Abstract