Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up

Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.     

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.     

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.     

CREATING HEALING RELATIONSHIPS FOR COUPLES DEALING WITH TRAUMA: THE USE OF EMOTIONALLY FOCUSED MARITAL THERAPY

Emotionally focused marital therapy (EFT), a marital therapy that particularly focuses on the creation of secure attachment, has proven in empirical studies to be effective for distressed couples. This paper discusses the application of EFT in couples where one or both of the partners have experienced significant trauma. EFT, in this context of trauma, incorporates the nine steps of conventional EFT and also encompasses the three stages of the "constructivist" self development theory of trauma treatment. This paper illustrates how the integration of EFT and trauma treatement can prove effective in treating not only relationsip distress but also the individual symptoms of posttraumatic stress disorder (PTSD).     

The Intersection of Multiple Minority Identities: Perspectives of White Lesbian Couples Adopting Racial/Ethnic Minority Children

In order to analyse the salience of race/ethnicity, sexual orientation, and adoptive status for lesbian adoptive parents, this study examined the challenges and strengths described by 20 White lesbian couples (40 women) who were adopting racial/ethnic minority children from within the United States. Data from two time points (pre‐ and post‐adoptive placement) were analysed qualitatively. Results indicated that the majority of women voiced concerns about raising racial/ethnic minority children in a ‘White privileged’ society. Many women reported facing a lack of understanding from others and were aware of multiple layers of stigma. However, having faced discrimination themselves as sexual minorities, many also perceived themselves as possessing unique strengths (e.g., experience coping with stigma). Many women expressed feeling that by drawing on support from their communities as well as their own awareness of and experience with diversity issues, they could prepare their children for the challenges they might face.     

“We will never be normal”: The Experience of Discovering a Partner Has Autism Spectrum Disorder

Online forums and lay literature suggest that partners of individuals with Autism Spectrum Disorder (ASD) experience depression, distress, and trauma in their everyday lives, exacerbated during the time surrounding diagnosis. In this content analysis, 29 participants were provided with an online open‐ended statement asking them to describe in writing their experiences of discovering that their partners had ASD during their relationships. Six themes emerged, including: facing unique challenges within relationships; insisting partners seek diagnosis; initial shock and relief; losing hope for normalcy; making accommodations within relationships; and wishing for professional support. Marriage and family therapists should help couples minimize blaming and promote self‐awareness, appropriate relationship expectations, and mutual understanding. Future research should explore the overall experience of neuro‐mixed relationships for both partners.     

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.     

Establishing Safety in Emotionally Focused Couple Therapy: A Single‐Case Process Study

Emotionally Focused Couple Therapy (EFT) is an effective approach to working with distressed couples. It is not only effective in reducing relationship distress, but also in successfully maintaining gains over time. In the current study, we sought to understand the therapy processes that result in the creation of safety during stage one of EFT. Safety is a key ingredient in stage one, setting the stage for deeper interpersonal and intrapsychic work in later stages of treatment. In order to achieve the study aim, we analyzed video recordings of the first six sessions of a single couple case from an EFT randomized controlled trial. Using a theory building case study approach, results reveal that all expected components related to the creation of safety were achieved. Additional findings from our analyses indicate that the therapist was highly active, especially in seizing key moments in the therapy provided by this particular case, which shifted the couple in the direction of safety and deescalated their interactional cycle. Implications of key findings are discussed.     

Predicting Follow‐up Outcomes in Emotionally Focused Couple Therapy: The Role of Change in Trust,Relationship‐Specific Attachment,and Emotional Engagement

Emotionally Focused Couple Therapy (EFT), an evidence‐based couple therapy (Johnson, Hunsley, Greenberg, & Schindler, 1999), strives to foster lasting change through the creation of secure attachment bonds in distressed couples. Although studies have demonstrated lasting change in follow‐up (Wiebe et al., in press), research is needed to investigate predictors of long‐term outcomes. Our goal was to investigate predictors of long‐term outcomes in relationship satisfaction. Relationship satisfaction was assessed across 24 months in a sample of 32 couples who received an average of 21 EFT sessions. Decreases in attachment avoidance were most predictive of higher relationship satisfaction across follow‐up. These findings support the theoretical assumption that EFT helps couples foster lasting change in relationship satisfaction through the facilitation of secure attachment bonds.     

Parent–Caregiver Experiences With the Autism Spectrum Disorder Service Delivery System

Autism spectrum disorder (ASD) diagnoses are increasing, leading to growing demands on the service delivery system to meet the needs of children and families. Further understanding individual enabling components such as perceptions of parents/caregivers and personnel, as well as community-level enabling components such as the availability of and quality of services, may help inform system improvements. In this qualitative study, 19 parents/caregivers of children with ASD in one state in the United States were interviewed regarding their experiences with the ASD service delivery system, as well as their individual responses in relation to these experiences. Emergent themes point to the importance of individual coping strategies such as social support, collaboration with service providers, advocacy and empowerment, determination, and luck. Characteristics of the service delivery system, positive and negative, also were described. Findings can inform the design of future programs, services, and policies to support parent/caregiver coping and improved service delivery.     

Exploring Parents' Experiences and Reactions to Adolescents' Hyperactivity,Impulsivity, and Attention Problems

Adolescents' hyperactivity, impulsivity, and attention problems (HIA) have been shown to make parents feel powerless. In this study, the authors examined whether these feelings were dependent on parents' experiences with their older children. Two models that offer different predictions of how parents make use of their earlier experiences when raising their later‐born children were explored: the learning‐from‐experience model and the spillover model. The authors used reports from 372 parents with 1 child (M_age = 11.92) and 198 parents with 2 children (M_age = 11.89 and 14.35) from a small town in a European country. The results did not support a learning‐from‐experience process. Instead, consistent with a spillover process, parents felt particularly powerless about their younger children with HIA if they also felt powerless about their older children. This study suggests that parents' experiences of raising their older children are important for their reactions to HIA in their younger children     

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.     

Exploring Partner Intimacy Among Couples Raising Children on the Autism Spectrum: A Grounded Theory Investigation

In this study, we explored how couples raising children with autism spectrum disorder negotiate intimacy, including what contextual and temporal factors influence these processes. We conducted conjoint interviews with 12 couples, employing grounded theory methodology to collect and analyze the data. Our results indicated that fostering intimacy in these couples' relationships involves partners working together to make key cognitive and relational shifts. Couples are aided or hindered in making these shifts by the degree to which they experience various contextual and environmental factors as resources or roadblocks. We also found that intimacy is not a fixed point at which couples one day arrive, but is an iterative process taking place over time and requiring work to develop and maintain.     

Trajectories of Conflict Over Raising Adolescent Children and Marital Satisfaction

The present study examined trajectories of marital satisfaction among couples with adolescent children and evaluated how changes in parents' conflict over raising adolescent children were associated with changes in marital satisfaction over 4 years. Using a prospective, longitudinal research design and controlling for family socioeconomic status, dyadic growth curve analysis from a sample of 431 couples with adolescent children indicated that marital satisfaction decreased over time for parents with adolescent children and that the trajectories for mothers and fathers were substantially linked. More importantly, the study demonstrated that increases or decreases in parents' marital conflict over raising adolescent children were associated with corresponding decreases or increases in marital satisfaction for both mothers and fathers.     

Understanding Grandfamilies: Characteristics of Grandparents,Nonresident Parents,and Children

Using data from the Year 9 Fragile Families and Child Wellbeing Study (N ～ 3,182), we investigated the characteristics grandfamilies (grandparents raising their grandchildren with no parent present, N = 84) and compared them to other key groups, including children's nonresident parents and other economically disadvantaged families with children. Results show that grandparents raising their grandchildren were generally better off in terms of educational attainment, marital status, and economic well‐being than the child's parents. Grandparents raising their grandchildren also had characteristics very similar to other disadvantaged mothers. Academic and socioemotional well‐being were poorer among children in grandfamilies compared with those living with their mothers, but parenting practices were very similar. These findings suggest that although children in grandfamilies may be at a disadvantage academically and socioemotionally, grandparent caregivers are in many ways similar to other fragile‐family mothers. Overall, this study enhances our knowledge of an important yet understudied family type.     

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.     

Young Adult Romantic Couples’ Conflict Resolution and Satisfaction Varies with Partner's Attention–Deficit/Hyperactivity Disorder Type

Attention‐deficit/hyperactivity disorder (ADHD) has previously been associated with less satisfaction and success in romantic relationships. This study compares conflict resolution and problem‐solving behaviors in young adult romantic couples either having one partner with ADHD combined type (C‐couples), having one partner identified with ADHD inattentive type (IA‐couples), or in which neither partner has an ADHD diagnosis (nondiagnosed [ND] couples). Self‐reports of current and childhood ADHD symptoms corroborated diagnostic status and speaker and listener behaviors, coded via the Rapid Couples Interaction Scoring System (Gottman, 1996), were the primary dependent variables. Analyses revealed greater negativity and less positivity in C‐couples’ behavior during a conflict resolution task, relative to IA and ND couples, and this corresponded with couples’ relational satisfaction. IA‐couples emitted relational behavior that was largely similar to ND couples. Findings support that relational impairment exists in C‐couples, and to some degree, contrast with previous research suggesting that individuals with predominant inattention experience greater social impairment in adulthood than those with other types of ADHD.     

Toward a mini-theory of the blamer softening event: tracking the moment-by-moment process

In this article we present the results of a discovery-oriented task analysis research study identifying specific therapist behaviors that facilitate softening events in emotionally focused therapy (EFT) for couples. Therapy sessions conducted by an expert EFT therapist were examined. Six therapist content theme shifts were identified and specific interventions were delineated within each using an EFT coding scheme (EFT-CS) created for this study. This study extends the theoretical understanding of the softening process--a key change event in an empirically validated couples therapy approach--and provides a detailed clinical map for the training of therapists.     

A Comparison of High‐ and Low‐Distress Marriages That End in Divorce

We used data from Waves 1 and 2 of the National Survey of Families and Households to study high‐ and low‐distress marriages that end in divorce. A cluster analysis of 509 couples who divorced between waves revealed that about half were in high‐distress relationships and the rest in low‐distress relationships. These 2 groups were not artifacts of the timing of the interview or of measurement error. Irrespective of marital quality, couples who divorced shared many risk characteristics, such as having divorced parents. Individuals in high‐distress marriages reported increases in happiness following divorce, whereas those in low‐distress marriages reported declines in happiness. These results suggest two basic motivations to divorce: poor relationship quality and a weak commitment to marriage.     

Predicting Key Change Events in Emotionally Focused Couple Therapy

In emotionally focused couple therapy (EFT), the blamer‐softening event helps individuals express and respond to partners’ unmet attachment needs. This study examined the impact of this event in relation to attachment at intake and changes in marital satisfaction from pre‐ to posttherapy. Thirty‐two couples were provided an average of 21 sessions of EFT. Hierarchical linear modeling revealed that the occurrence of a softening event significantly predicted increased marital satisfaction. Furthermore, the occurrence of a softening event significantly moderated the relationship between attachment avoidance at intake and change in marital satisfaction from pre‐ to posttherapy. For couples who had a softening event, partners with higher levels of attachment avoidance were less likely to have positive changes in marital satisfaction.