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.     

Examining Attachment Avoidance and Attachment Anxiety Across Eight Sessions of Couple Therapy

This study examined initial levels of attachment anxiety and avoidance, as well as their patterns of change, across eight sessions of couple therapy. Participants were 461 couples in a treatment‐as‐usual setting. Dyadic latent growth modeling was used to determine whether couples started therapy at similar levels of attachment anxiety and avoidance and whether attachment anxiety and avoidance changed. An actor partner interdependence model was used to see whether partner attachment anxiety was related to avoidance. Results showed relative stability of attachment anxiety and avoidance over the course of therapy, with the only change being a slight decline in attachment anxiety among women. Results showed that a person's attachment anxiety was not related to their partner's avoidance and vice versa.     

Inviting Autonomy Back to the Table: The Importance of Autonomy for Healthy Relationship Functioning

Autonomy, or self-determination, is a key ingredient in promoting relationship flourishing. Although autonomy has long been an important concept in the family therapy field (labeled differentiation; Family therapy in clinical practice, 1978), definitional confusions and the ascendency of attachment theory and attachment-based clinical approaches to treating couples have relegated autonomy to a minor role at best and a caricature of rugged individualism and antirelational separateness at worst. Given recent research showing the importance of autonomy for the development of secure attachment in children and the key role autonomy plays in healthy intimate partner functioning, the concept of autonomy needs to take a more central role in our research and clinical practice with couples.     

Attachment insecurities and under-commitment in distressed couples: The role of positive and negative partner behaviors

Research has rarely considered intermediate variables in the association between attachment insecurities and relationship commitment. Based on attachment theory and Rusbult's Investment Model, we tested whether positive and negative partner behaviors explain this association in 91 distressed couples undergoing therapy. Path analyses based on the Actor–Partner Interdependence Model revealed that individuals with attachment avoidance reported perceiving fewer positive behaviors from their partner, which was associated with their own higher under-commitment. Partners of individuals with avoidance also reported perceiving fewer positive partner behaviors, which was in turn associated with their own higher under-commitment. Partners of individuals with attachment anxiety perceived more positive behaviors from their partner, which was associated to their own lower under-commitment. Perceived negative partner behaviors were only directly associated with higher under-commitment. These findings imply that perceived positive partner behaviors may be a key aspect to target in relationship therapy in couples who present with high attachment insecurities.     

Using Difference Scores to Inform Therapy Practice: Differences in Perceptions of Attachment Behaviors between Partners in a Clinical Sample

Using clinically relevant research methodology, this study focuses on differences (cross‐partner difference scores) in perceptions of attachment behaviors (emotional accessibility, responsiveness, and engagement) between partners in couples therapy. In general, findings suggest that higher levels of self‐enhancement attachment behaviors (participant perceives self as demonstrating more attachment behaviors than the partner's ratings of the participant) are associated with lower relationship satisfaction and greater relationship instability. The association between attachment behavior difference scores and measures of relationship health is mediated through partner perceived positive communication. These results suggest that differences in perceptions between partners’ level of attachment behaviors are an important clinical construct for therapy. As such, clinical recommendations for addressing self‐enhancing attachment behaviors, and the mediating role of positive communication, are discussed with recommendations for researchers.     

Attachment Perspective on Marital Dissolution and Relational Family Therapy

Divorce or dissolution of a long-term intimate relationship is an event on the continuum of an individual’s experience of attachment injury that is reawakened and played out again in this process. An attachment injury means the experience of rejection and betrayal of trust at a critical time of distress when one is in need of support. By means of the case study method, the article presents a case of a female client dealing with divorce. The history of traumatic relations through a lens of attachment theory is presented, along with divorce as the reawakening of an attachment injury and its processing in a relational family therapy model.     

Discernment Counseling for “Mixed‐Agenda” Couples

This article describes discernment counseling, an approach to working with couples where one partner is leaning toward divorce and the other wants to preserve the relationship and work on it in couples therapy. These “mixed‐agenda” couples are common in clinical practice but have been neglected in the literature. The goal of discernment counseling is clarity and confidence regarding the next steps for the relationship, based on a deeper understanding of each partner's contributions. Sessions emphasize individual conversations with each partner. An analysis of 100 consecutive cases found that about half of the couples chose to start couples therapy in order to reconcile, with most of the rest choosing the divorce path. Longer term follow‐up information is also presented.     

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.     

A Dyadic Analysis of Attachment Insecurities and Romantic Disengagement among Couples Seeking Relationship Therapy

This study sought to assess the role of attachment insecurities on romantic disengagement among couples seeking relationship therapy. Dyadic associations were examined between attachment insecurities and romantic disengagement, accounting for depression, relationship satisfaction, and commitment, using a sample of 171 couples. Partners completed the Experiences in Close Relationships Scale and the Romantic Disengagement Scale. Path analysis revealed that attachment-related avoidance, but not anxiety, was associated with romantic disengagement. Men's attachment-related anxiety was related to greater disengagement in their partner. The combination of men's attachment-related avoidance and women's attachment-related anxiety was also significantly associated with women's romantic disengagement. Although attachment insecurities were associated with romantic disengagement, contextual and intrapersonal factors also contributed to our understanding of disengagement. Findings are discussed in light of clinical interventions for couple therapy.     

Relationship satisfaction of Mexican American and non-Hispanic white American interethnic couples: issues of acculturation and clinical intervention

Despite the increasing prevalence of interethnic marriages, remarkably little empirical literature exists for guiding clinical interventions offered to these couples. This study compared the marriages of 72 couples with one Mexican-American partner and one non-Hispanic White American partner, 75 Mexican-American couples, and 66 non-Hispanic White couples. Overall, the interethnic couples were more similar to non-Hispanic White couples than they were to Mexican-American couples across multiple domains, with the latter group indicating modestly higher levels of relationship distress. Among interethnic couples, Mexican-American wives' level of acculturation related significantly to both their own marital- and parental-role orientation and to distress in their relationships with children, as well as to their husbands' marital distress regarding child rearing and the couple's interactions regarding finances. Implications for clinical interventions with Mexican- and White-American interethnic couples are discussed.     

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.     

Attachment styles, alcohol, and childhood experiences of abuse: an analysis of physical violence in dating couples

This study examined individual and partner characteristics that contribute to the propensity for physical violence in couples. In a sample of 171 heterosexual dating couples, each partner completed measures assessing experienced childhood abuse, alcohol use, alcohol expectancies, attachment, and relationship length. Physically violent men reported more abuse from each parent, greater alcohol use, anxious attachment, and a longer relationship. Their female partner reported more childhood abuse by the father and reciprocal perpetrated violence. Physically violent women reported more abuse from the father, greater alcohol use, aggressive alcohol expectancies, and a longer relationship. Their male partner reported greater abuse from the mother, greater alcohol use, and reciprocal perpetrated violence. This study demonstrates the importance of considering how each individual's characteristics within a dyad contribute to increased propensity for dating violence.     

Patterns of intimate partner violence in young adult couples: nonviolent, unilaterally violent, and mutually violent couples

This study examined nonviolent (NV), unilaterally violent (UV), and mutually violent (MV) patterns of perpetrated intimate partner violence in relation to dyadic relationship quality and partner injury. The respondents were 1,294 young adult, Add Health partners (AHP) and their non-Add Health partners (NAHP), in dating, engaged, or in marital relationships, who were participants in Wave III of the National Longitudinal Study of Adolescent Health (Add Health). Using both partner reports of perpetration to classify intimate partner violence (IPV) patterns resulted in 25% of couples with a MV pattern, and 75% of couples with a UV pattern; among those couples (41%) reporting any perpetrated IPV. Results also showed poorer relationship quality and higher partner sensation-seeking scores among MV and UV couples when contrasted with NV couples. Those couples with MV patterns were more likely to contain partner injury than those with UV patterns.     

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.     

Attachment Change in the Beginning Stages of Therapy: Examining Change Trajectories for Avoidance and Anxiety

The purpose of this study was to investigate the nature of self‐reported attachment change (avoidance and anxiety) in the context of six sessions of couple therapy designed to emphasize both therapist‐centered and couple‐centered (i.e., enactment‐based) clinical process during the beginning stages of therapy. A total of 48 couples with at least one partner who reported clinically significant relationship dissatisfaction participated in this study. Findings confirmed that some couples experience positive attachment‐related change (anxiety or avoidance), while also identifying a subset of individuals who may not experience optimal levels of attachment‐related change. In addition, findings point toward both differences and similarities between change trajectories for avoidance and anxiety. Finally, there was evidence that socio‐demographic factors may be associated with attachment change.     

The Brief Accessibility,Responsiveness, and Engagement Scale: A Tool for Measuring Attachment Behaviors in Clinical Couples

Measuring attachment behaviors is relevant to creating secure couple relationships. This article seeks to test and examine the reliability and validity of the Brief Accessibility, Responsiveness, and Engagement (BARE) Scale—a practical measure of couple attachment–in a clinical sample. Couples took the BARE and other assessments measuring relationship functioning (self and partner reports of relationship satisfaction, relationship stability, positive and negative communication, and attachment styles). Results suggest that the BARE appears to be a reliable and valid tool for assessing couple attachment and can accurately predict and classify whether the couples belong in the clinical or nonclinical group, as well as their level of relationship satisfaction. Results also indicate attachment behaviors are related to relationship outcomes.     

Emotionally Focused Therapy for Couples and Attachment Theory

Emotionally focused therapy for couples (EFTC) is an important framework for couples therapy. It provides an integrative model, drawing upon experiential, systems and attachment theory to understand the dynamics of the couple relationship and to describe the therapeutic process. The aim of this paper is to ask how EFTC uses attachment theory, and whether it draws as fully as it can upon the richness of that theory to inform the process of therapy. This is set in the context of the evolving importance of attachment theory for therapeutic work.     

Insecure Attachment Behavior and Partner Violence: Incorporating Couple Perceptions of Insecure Attachment and Relational Aggression

Intimate partner violence and insecure attachment are therapeutically relevant concepts when working with couples. The link between attachment and intimate partner violence has been examined in the literature, but an area of aggression that often goes unexamined is relational aggression, or using third parties as a means of being aggressive toward a partner. We asked how participants' attachment behaviors were related to their own and partners' relational and physical aggression. We used structural equation modeling to estimate actor–partner interdependence among these relationships in 644 heterosexual couples. Results indicated significant partner paths from attachment to relational aggression, as well as significant actor paths between relational aggression and physical aggression. Implications were discussed. Data for this study were collected from the RELATE assessment.     

Sexual Distress Mediates the Associations Between Sexual Contingent Self-Worth and Well-Being in Women With Genitopelvic Pain: A Dyadic Daily Experience Study

Provoked vestibulodynia (PVD), a common cause of women’s genitopelvic pain, is associated with poorer psychological and sexual well-being in affected couples. Greater sexual contingent self-worth (CSW)—defined as self-esteem that is dependent on the perceived success or failure of a sexual relationship—has been linked to poorer well-being in a cross-sectional study of couples coping with PVD. This study aimed to examine whether daily sexual distress mediated the associations between greater sexual CSW and lower sexual satisfaction and greater anxiety, depressed mood, and women’s pain in affected couples. Women (N = 125) diagnosed with PVD and their partners completed the Sexual CSW Scale and then online daily surveys for eight weeks measuring sexual distress, sexual satisfaction, anxiety, depressed mood, and women’s pain during intercourse. Multilevel analyses were based on the actor–partner interdependence model (APIM). For women who had higher sexual CSW (compared to lower sexual CSW), on sexual activity days when their sexual distress was higher, they reported lower sexual satisfaction and greater anxiety, depressed mood, and pain (compared to their average level across all sexual activity days). Findings suggest that daily sexual distress may be one pathway between greater sexual CSW and poorer day-to-day well-being in women with PVD.