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.     

Two‐Year Follow‐up Outcomes in Emotionally Focused Couple Therapy: An Investigation of Relationship Satisfaction and Attachment Trajectories

Emotionally Focused Couple Therapy (EFT; The practice of emotionally focused couple therapy: Creating connection. New York, NY: Brunner‐Routledge) is an evidence‐based couple therapy that aims to create lasting change for couples (Clinical Psychology: Science and Practice, 6(1), 67–79). Although studies have demonstrated strong results in follow‐up (Journal of Marital and Family Therapy, 28(4), 391–398), less is known about relationship functioning across time after therapy has ended. We modelled change in relationship satisfaction and attachment from pre‐therapy through 24 months follow‐up in 32 couples. HLM results confirmed a significant growth pattern demonstrating increases in relationship satisfaction and secure base behaviour and decreases in relationship specific attachment anxiety over the course of therapy and across follow‐up at a decelerated rate. These findings support the theoretical assumption that EFT helps couples engaged in therapy create lasting relationship satisfaction and attachment change.     

Couple Longevity in the Era of Same‐Sex Marriage in the United States

The author used a new longitudinal data set, the How Couples Meet and Stay Together surveys (N = 3,009), to generate the first nationally representative comparison of same‐sex couple stability and heterosexual couple stability in the United States. He measured the association between marriage (by several definitions of marriage) and couple longevity for same‐sex couples in the United States. Reports of same‐sex relationship instability in the past were due in part to the low rate of marriages among same‐sex couples. After controlling for marriage and marriage‐like commitments, the break‐up rate for same‐sex couples was comparable to (and not statistically distinguishable from) the break‐up rate for heterosexual couples. The results revealed that same‐sex couples who had a marriage‐like commitment had stable unions regardless of government recognition. A variety of predictors of relationship dissolution for heterosexual and for same‐sex couples are explored.     

The Development and Implementation of a Multi‐Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo

In this article, we present development and feasibility of implementation of a multi‐couple group for use with torture‐surviving couples. The model was developed in the Democratic Republic of the Congo in a community that experienced widespread torture during the wars from 1998 to 2004. The Torture‐Surviving Couple Group model is a short‐term intervention designed to use few human resources to address relational difficulties resulting from exposure to traumatic stressors. The model was guided by critical and feminist epistemologies and employed an ecological lens to incorporate neurobiology and attachment processes along with narrative therapy techniques. An existing multi‐couple group model for addressing violence (Stith, Rosen, McCollum, & Thomsen, 2004 ), and a stage model for healing trauma (Herman, 1992 ) also informed the structural development of the Torture‐Surviving Couple Group model. Couple groups were conducted using a 10‐session program with 13 couples who met weekly. Session themes were incorporated into four phases emphasizing: (a) preparation; (b) safety and stabilization; (c) processing the relationship effects of trauma and grief; and (d) reintegration and rebuilding couple and family life. Couples reported and showed remarkable progress in their relationships after participating in the groups. Clinical and research implications and discussed along with the feasibility of developing and testing the model in a post‐conflict low income setting.     

Changes in Relationship‐Specific Attachment in Emotionally Focused Couple Therapy

Emotionally focused couple therapy (EFT; Johnson, The practice of emotionally focused couple therapy (1st/2nd edition). Brunner‐Routledge, New York, 2004) is an effective treatment of relationship distress (Johnson et al., Clinical Psychology: Science and Practice, 1999; 6, 67). However, less is known about EFT's impact on couples' relationship‐specific attachment bond. Using hierarchical linear modeling with a sample of 32 couples, we examined session‐by‐session changes in couples' relationship‐specific attachment anxiety and avoidance and pre‐ to posttherapy changes in their relationship‐specific attachment behaviors. Couples significantly decreased in relationship‐specific attachment avoidance, and those who completed a blamer softening significantly decreased in relationship‐specific attachment anxiety. Couples' attachment behavior significantly increased toward security. Finally, session‐by‐session decreases in relationship‐specific attachment anxiety and avoidance were significant associated with increases in relationship satisfaction across sessions. These results provide empirical support for the attachment‐based assumptions of EFT. Video abstract accessible by clicking here     

Couples relationship standards and satisfaction in Pakistani couples

Relationship standards are beliefs about what is important in a satisfying couple relationship, which vary considerably between cultures, and might mean that what couples seek from couple therapy differs across cultures. We assessed the standards of n = 49 Pakistani couples and whether those standards predicted couple satisfaction. To provide referents for the Pakistani standards, we also assessed selfreported relationship standards in n = 33 Western couples and n = 30 Chinese couples. Pakistani couples endorsed couple bond standards (e.g., expressions of love) as similarly important, and family responsibility (e.g., extended family relations) standards as more important, than Western or Chinese couples. In Pakistani couples, Couple Bond predicted couples' relationship satisfaction, but family responsibility and Religion predicted only wives' satisfaction. Modest sample sizes necessitate caution in interpreting results but suggest existing couple therapies might need modification to address the distinctive relationship standards of Pakistani couples.     

The Association Between Partner Enhancement and Self‐Enhancement and Relationship Quality Outcomes

The purpose of this research was to understand in greater detail, using 2 samples (Study 1 N = 4,881 heterosexual couples; Study 2 N = 335 heterosexual couples who completed the Relationship Evaluation Questionnaire), how partner or self‐enhancement patterns differentially influence relationship outcomes. A multivariate analysis of covariance was conducted comparing 4 outcome measures for different couple types in which individuals rated the partner higher, the same, or lower than they rated themselves on affability. Couples in which both individuals perceived themselves as more affable than the partner experienced poorer results on the relationship outcome measures, whereas couples in which both individuals perceived the partner's personality as more affable than their own experienced more positive relationship outcomes. Additional analyses with structural equation models demonstrated the consistent influence of enhancement measures on relationship outcomes for cross‐sectional and longitudinal samples.     

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.     

Independent Comment on Audio‐Visual and Print Materials

Book reviewed in this article: 101 Healing Stories for Kids and Teens: Using Metaphors in Therapy. George W. Burns Attachment Processes in Couple and Family Therapy. Susan Johnson and Valerie Whiffen (Eds) An Introduction to Marriage and Family Therapy. Lorna L. Hecker and Joseph L. Wetchler (Eds) Experiential Psychotherapy with Couples — A Guide for the Creative Pragmatist. Rob Fisher The Practical Practice of Marriage and Family Therapy: Things My Training Supervisor Never Told Me. Mark Odell & Charles E. Campbell Using Workbooks in Mental Health: Resources in Prevention, Psychotherapy and Rehabilitation for Clinicians and Researchers. Luciano L'Abate (Ed.) The Therapy Triangle: Empowering You with the Knowledge to Heal Emotional Cutoff: Bowen Family Systems Theory Perspectives. Peter Titelman (Ed.) Clinical Applications of Bowen Family Systems Theory. Peter Titelman (Ed.)     

Independent comment on audio-visual and print materials

Marta Lohyn Vietnamese Parents and Teenagers Seeking Harmony Peter ChurvenShe Won't Be Right, Mate! Jim CrawleyThe Therapeutic Relationship In Systemic Therapy Maria ScicchitanoEating Disorders: A Survival Guide For Family And Friends Nora HuppertConscious Marriage; A New Model For Making Marriages Work. Sherry WrightCouples Therapy: Feminist Perspectives. Carol BolandViolence In Gay And Lesbian Domestic Relationships. Penny RoughanSexual Coercion In Dating Relation-Ships.     

Independent Comment on Audio‐visual and Print Materials: The Graduate Diploma in Family Centred Practice,Monash University

Book reviewed in this article: Brief Therapy for Couples: W. Kim Halford NY Domestic Violence in Australia: The Legal Response, 3rd edn.: Renata Alexander Intimacy & Solitude: Balancing Closeness and Independence.: Stephanie Dowrick Clinical Epiphanies in Marital and Family Therapy: A Practitioner's Casebook of Therapeutic Insights, Perceptions, and Breakthroughs: David A. Bastiste Jr. (Ed.). Comparative Treatments for Relationship Dysfunction: Frank M. Dattilio Women's Stories of Divorce at Childbirth: When the Baby Rocks the Cradle: Hilary Hodge Recreating Partnership: A Solution Oriented, Collaborative Approach to Couples Therapy.: Phillip Ziegler and Tobey Hiller But Facts Exist: An Enquiry into Psychoanalytic Theorizing: Thomas Freeman Refugees: Living on the Margins: Helen Pavlin     

Clinicians Play with Mud,and It's the Best Thing for Us: An Interview With Alistair Campbell

Alistair Campbell is Research Editor for the ANZJFT. He is a Senior Lecturer in Clinical Psychology and Director of the Psychology Clinic at James Cook University in Townsville. He speaks provocatively with Ben Hansen about research and training in family therapy, about accountability to our clients, and about practice.     

Relationship Education in Community Settings: Effectiveness with Distressed and Non‐Distressed Low‐Income Racial Minority Couples

Couple relationship education (CRE) programs are intended to prevent negative couple outcomes, however, some evidence suggests couples in greater distress may still benefit. The current study examined pre‐ and postchanges in relationship functioning of 362 low‐income African American and Hispanic couples. Outcomes (dedication and communication) were assessed by examining differences between two distinct groupings of couples; distressed (both partners reporting clinically significant distress) and nondistressed (neither partner reporting clinically significant distress) couples. Distressed couples at predemonstrated large‐sized gains in all outcome variables, as compared to nondistressed couples. Those who participated in the single‐couple format demonstrated lower gains in positive communication as compared to those in the group format. Implications for distressed couples in CRE programs are offered.     

THE LONG-TERM EFFECTS OF THE COUPLE COMMUNICATION PROGRAM

The immediate and long-term impact of the Couple Communication Program was assessed. Seventeen married couples were assigned to training groups. Change was assessed using self-report measures of marital adjustment and communication quality along with behavioral ratings of couple verbal interaction. Couples increased significantly on all measures at immediate posttest. Marital adjustment returned to pretest levels by five month follow-up. Couple perceived communication quality and rater judged communication quality maintained posttest levels. The findings suggest a need for more skills training in the program, an increase in length of the program, and consideration of program improvements designed to enhance generalization.     

Developmental Patterns in Marital Satisfaction: Another Look at Covenant Marriage

This study investigated differences in the trajectory of marital satisfaction in the first 7 years between couples in covenant versus standard marriages. The authors analyzed data on 707 Louisiana marriages from the Marriage Matters Panel Survey of Newlywed Couples, 1998–2004, using multivariate longitudinal growth modeling. When the sample was restricted to couples who remained married over the duration of the study, a marginal benefit of covenant status was found for husbands. This effect was largely accounted for by covenant husbands' more extensive exposure to premarital counseling. The linear decline in marital satisfaction over time that obtained for both husbands and wives was not, however, any different for covenant marriages versus standard marriages. Couples characterized by more traditional attitudes toward gender roles were significantly less satisfied than others. High premarital risk factors, initial uncertainty about marrying the spouse, and the presence of preschool‐age children in the household were all corrosive of marital satisfaction at any given time.     

The Norway Couple Project: Lessons Learned

Couple therapists in routine practice may find it difficult to apply findings from an increasingly expanding and complex body of couple therapy research. Meanwhile, concerns have been raised that competency in evidence‐based treatments is insufficient to inform many practice decisions or ensure positive treatment outcomes (American Psychological Association Presidential Task Force on Evidence‐Based Practice, American Psychologist, 2006, 271). This article aims to narrow the research/practice gap in couple therapy. Results from a large, randomized naturalistic couple trial (Anker, Duncan, & Sparks, Journal of Consulting and Clinical Psychology, 2009, 693) and four companion studies are translated into specific guidelines for routine, eclectic practice. Client feedback, the therapeutic alliance, couple goals assessment, and therapist experience in couple therapy provide a research‐informed template for improving couple therapy outcomes.     

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.     

Abstracts

Avery, A., Ridley, C, Leslie, L., and Milholland, T. Relationship Enhancement with Premarital Dyads: A Six-Month Followup. American Journal of Family Therapy , 1980, 8 , 3, 23–31.
Bader, E., Microys, G., Sinclair, C, Willett, E. and Conway, B. Do Marriage Preparation Programs Really Work: A Canadian Experiment. Journal of Marital and Family Therapy , 1980, 6 , 2, 171–179.
Hof, L., Epstein, N., and Miller, W. Integrating Attitudinal and Behavioral Change in Marital Enrichment. Family Relations , 1980, 29 , 241–248.
L'Abate, L. Screening Couples for Marital Enrichment Programs. American Journal of Family Therapy , 1980, 8 , 3, 74–77.
Nelson, R. C. and Friest, W. P. Marital Enrichment through Choice Awareness. Journal of Marital and Family Therapy , 1980, 6, 4, 399–407.
Wagner, V, Weeks, G. and L'Abate, L. Enrichment and Written Message with Couples. American Journal of Family Therapy , 1980, 8 , 3, 36–45.
Wampler, K. S., and Sprenkle, D. H., The Minnesota Couple Communication Program: A Follow-Up Study, Journal of Marriage and the Family, August , 1980, 42 , 3, 577–584.     

The effectiveness of PREP with lower-income racial/ethnic minority couples

The current study examined the effectiveness of the Prevention and Relationship Enhancement Program (PREP) with lower-income and racial/ethnic minority (African American and Latino/a) couples. Additionally, we tested whether relationship outcomes varied based on the delivery format (i.e., group format vs. couple format). The sample included 321 unmarried couples expecting a child or who have a child 3 month old or younger. The couples participated in 16 hr of PREP via a group or a couple format over the course of 2-3 months. Couples relationship quality was assessed prior to and directly after the program. The results showed that men and women demonstrated significant gains in their communication skills, relationship functioning, friendship, dedication, and relationship confidence. Couples who participated in PREP via the couple format had better outcomes on three of the seven relational outcomes as compared to couples who participated in PREP via the group format.     

‘Therapy Doesn't Exist in a Vacuum’: An Interview With Max Cornwell

Max Cornwell is a psychologist and social worker in Sydney. He edited ANZJFT from 1985 until 1996 and is a former editor of Australian Social Work. He has taught in hundreds of venues in Australia and abroad. In 1980 he co‐founded the Family Therapy Institute, a major influence on the training of family therapists in New South Wales until the mid‐90s. He is an Honorary Life Member of VAFT and has received the Journal Award for services to family therapy.