The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study

The current study is a pilot project conducted at Baltimore VA Medical Center investigating the use of emotionally focused couples therapy (EFT) for couples in which one partner is a veteran who has been diagnosed with posttraumatic stress disorder (PTSD). Fifteen couples enrolled in the study and seven of these couples completed treatment (26 to 36 weekly sessions of EFT). Both partners were assessed on measures of relationship satisfaction, psychological distress, depression, and quality of life, and veterans were assessed on measures of PTSD symptoms at baseline and 2 weeks after the intervention. Paired t-tests were used to compare scores before and after EFT. In terms of results, the veterans' partners reported significant improvements in relationship and life satisfaction and in decreased depression and a decrease in psychological distress. Veterans demonstrated a significant decrease in self-reported symptoms of PTSD. These results provide preliminary evidence for the usefulness of EFT to help foster improved relationship satisfaction, and psychological well-being for veterans with PTSD and their partners who completed treatment.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

Emotionally Focused Couple Therapy with Couples Facing Terminal Illness

Research on effective therapeutic interventions for couples dealing with terminal illness is scant. Changes in daily routine, added responsibilities, role changes, and the grief process are all contributors to the enormous stress and emotional strain felt by these couples. Couples where one partner is terminally ill may experience anger, depression, guilt, and anxiety. The authors propose that emotionally focused couple therapy (EFT), originally developed by Greenberg and Johnson (Emotionally focused therapy for couples, Guilford Press, New York, NY, 1988) may be effective in addressing this distress and in facilitating the grieving and support process in couples dealing with terminal illness. EFT is a systemic, experiential form of therapy that builds upon Bowlby’s (Attachment and loss: Volume I: Attachment, Basic Books, New York, NY, 1969) attachment theory. By exploring the emotional experience of both partners it may be possible to re-structure the couple’s emotional partnership and support the grief process for both partners.     

EMDR and Emotionally Oriented Couples Therapy

When reviewing past and current research on the role of emotion in couples therapy, there appeared to be a lack of articulation concerning how emotional expressions and relational dynamics are affected by emotional trauma that has not been accessed. The authors demonstrate how emotionally and experientially oriented therapy with couples can be enhanced by accessing stored trauma through the use of Eye Movement Desensitization and Reprocessing (EMDR). This approach is called Eye Movement Relationship Enhancement (EMRE) therapy and includes key clinical areas such as accessing and tolerating previously disowned emotion, reprocessing emotional experiences, and amplifying couple intimacy. These key areas are discussed and illustrated with case examples.     

Core Energetic Couples Therapy

SUMMARY

Core energetics is a method of psychotherapy that seeks the integration of all aspects of humanity: the emotional, physical, mental, and spiritual. Based on a deep understanding of the ways in which energy and consciousness work together, the therapy, developed by John C. Pierrakos, MD, invites couples to experience their inner truth and to identify their universal life goals and core feelings. Core energetics emphasizes wholeness and unification without loss of individuation for the couple. This article describes core energetics as it is used in couples work; the theory, therapeutic stance, methods of diagnosis, and energetic techniques are discussed, as well as the focus on sexuality and Spirituality.     

Integrating Sex and Couples Therapy: A Multifaceted Case History

Traditionally, sexuality has not been a focus in couples therapy training, research, or practice, although it is an important, often complex issue for many couples. This article tells the story of a couple presenting for sex therapy due to their unconsummated marriage, and is told to exemplify how sex therapy and couples therapy can be integrated in order to best meet the needs of couples. As the story unfolds, the multilayered facets of the presenting issue are revealed. The therapy incorporates and weaves together family of origin history, intrapsychic and cognitive issues, relational dynamics, patterns of interaction, and physiological/medical concerns into a postmodern couples therapy with behavioral interventions. This combined approach recognizes the value of each method on its own and their greater usefulness when blended together.     

Emotionally Focused Couple Therapy

Abstract

Working with couples who are both survivors of emotional abuse and are currently in an emotionally abusive relationship can be particularly challenging for the clinician. This article focuses on Emotionally Focused Couple Therapy as a recommended practice approach for clients who are caught in emotionally abusive patterns with one another. The article reviews relevant literature on this approach and illustrates the specific interventions applied lo an emotionally abusive couple.     

A Caring Framework for Enhancing Couples Therapy

As couples move away from role oriented patterns of relating they enter a transitional phase where marital expectations are less clearly defined. Frequently couples seeking therapy complain of a lack of caring in their relationships. They also express confusion about the appropriateness of their desire for more caring. In this article the authors present a caring framework based on their research with couples in "vital-total" marriages. They also suggest several ways this caring framework can be used in clinical work with couples.     

Learning Emotionally Focused Couple Therapy: Four Clinicians' Perspectives

This study examined the experiences of four clinicians learning emotionally focused couple therapy (EFT). Two group interviews, separated by 6 years, explored topics that included emotion, gender, model differences, personal practitioner impact, and the long-term influence of EFT training on clinical work. Emotion emerged as a major theme, with three subthemes at each phase. Phase 1 results indicated an increase in personal awareness of emotions, a positive impact on close personal relationships, and challenges for males in learning to elicit and use emotion. Phase 2 results, 6 years later, revealed that focusing on emotions remained salient and that EFT continues to influence the work of each clinician to varying degrees. Limitations, future research suggestions, and clinical implications are discussed.     

The Effectiveness of Therapy with Couples Reporting a History of Childhood Sexual Abuse: An Exploratory Study

The purpose of this pilot study was to explore the impact of childhood sexual abuse (CSA) on couples therapy. Participants were couples seeking therapy who were screened for CSA prior to therapy. Groups were compared using self-report and therapist-rated measures of individual and relational distress. Results indicate that although therapists report significant differences between CSA couples and couples not reporting abuse at the onset of therapy, those differences do not translate into significant differences in the perceived effectiveness of therapy as measured by change scores on therapist rated levels of distress, questions regarding the effectiveness of therapy, dropout, and length of treatment.     

Emotionally Focused Family Therapy and Play Therapy Techniques

Emotionally Focused Family Therapy provides a framework for understanding children's behaviors in terms of attachment needs of comfort and support. However, when working with young children, play therapy is often developmentally preferred over “talk therapy.” By integrating play therapy techniques within an Emotionally Focused Family Therapy theoretical framework, therapists can help parents understand and meet their child's needs for affection and comfort. This article will discuss how play therapy techniques can be integrated with an Emotionally Focused Family Therapy theoretical framework for work with young children and their families.     

Commitment First,Communication Later: Dealing with Barriers to Effective Couples Therapy

Teaching communication techniques to couples is a common way for therapists to begin treatment. In many cases, couples then use these newly acquired skills to express negative or even hostile information to each other, sometimes doing more harm than good to the relationship. Based upon years of clinical experience with hundreds of couples in treatment, this article presents the idea that having the couple see themselves as an entity first, not as two individuals, may be necessary before clear communication can be maximally therapeutic. The article outlines the Couple Power model of treatment, suggesting that four basic tasks—commitment, cooperation, communication and community—need to be accomplished in that order, postponing the teaching of communication skills until later in therapy. Theory behind the tasks and suggestions for effective techniques to achieve the “Four C’s” of Couple Power are presented and discussed.     

Healing the Attachment Injury of Marital Infidelity Using Emotionally Focused Couples Therapy: A Case Illustration

This case illustration is a demonstration of a therapist handling the betrayal of infidelity through the application of Emotionally Focused Couples Therapy (EFT), specifically utilizing the attachment injury resolution model. An actual dialogue from a key couples session is included as it applies to the model, providing clinicians with an example for how EFT can be applied to the common clinical occurrence of infidelity.     

Male Emotional Intimacy: How Therapeutic Men's Groups Can Enhance Couples Therapy

Men's difficulty with emotional intimacy is a problem that therapists regularly encounter in working with heterosexual couples in therapy. The first part of this article describes historical and cultural factors that contribute to this dilemma in men's marriages and same-sex friendships. Therapeutic men's groups can provide a corrective experience for men, helping them to develop emotional intimacy skills while augmenting their work in couples therapy. A model for such groups is presented, including guidelines for referral, screening, and collaboration with other therapists. Our therapeutic approach encourages relationship-based learning through direct emotional expression and supportive feedback. We emphasize the development of friendship skills , core attributes of friendship ( connection, communication, commitment, and cooperation ) that contribute to emotional intimacy in men's relationships. Case examples are included to illustrate how this model works in clinical practice, as well as specific suggestions for further study that could lead to a more evidence-based practice.     

Phase-based Emotionally Focused Couple Therapy for Adults With Complex Posttraumatic Stress Disorder

Complex posttraumatic stress disorder (complex PTSD) presents unique challenges to treatment beyond that of posttraumatic stress disorder (PTSD). The expert consensus best practice for treatment of complex PTSD is a phase-based or sequenced approach that has typically been offered in individual or group therapy modalities. Emotionally focused couple therapy (EFCT) shows promise as a couple-based treatment for PTSD, but the standard protocol may inadequately incorporate best practice guidelines of phase-based treatment for complex PTSD. Integration of phase-based treatment of complex PTSD within an EFCT format is proposed, giving direction to EFCT providers on incorporating best practice guidelines into their work with survivors.     

The Drama of Couples Therapy

In the author's view, the intensity of couples/family treatment arises from a suppressed acknowledgment of reciprocity, of interconnectedness among family members, beyond the often familiar dynamics of blaming and deprivation. Eliciting a recognition of profound interdependence raises anxiety, and stands in opposition to culturally prescribed concepts of autonomy and independence. To this end, a dramaturgical model of couples/family is proposed and discussed, involving the therapist's participation as director, witness or audience, and protagonist.     

Treating Depression in Men: The Role of Emotionally Focused Couple Therapy

While initial treatment recommendations for depression in the context of relationship problems have been outlined, attention typically has been focused on females experiencing depression. Less is known about the assessment and treatment of men with depression and relationship distress. This article presents the current literature on depression and relationship problems, including what is currently known about the occurrence, expression, assessment, and treatment of depression in men. Theoretical and empirically based assessment and treatment recommendations are then provided for Emotionally Focused Couple Therapy with depressed men in distressed relationships.     

Emotion-focused Therapy: The Transforming Power of Affect

Emotion-focused therapy (EFT) is an empirically supported humanistic treatment that views emotion as fundamental to experience, as contributing to both adaptive and maladaptive functioning, and as essential to therapeutic change. EFT combines both following and guiding the client’s experiential process, emphasizing the importance of both relationship and intervention skills. Utilizing markers of particular emotional processing difficulties at the core of client problems, therapists intervene with matched interventions aimed to resolve the emotional processing difficulty. This process helps clients access new adaptive emotional resources, transform maladaptive emotional responses, address emotional interruption and regulation, make sense of experience, and construct new meaning and self-narrative.