Susan M. Johnson

Differential Effects of Experiential and Problem-Solving Interventions in Resolving Marital Conflict.

The present study compared the relative effectiveness of two interventions in the treatment of marital discord: a cognitive-behavioral intervention, teaching problemsolving skills, and an experiential intervention, focusing on emotional experiences underlying interaction patterns. Forty-five couples seeking therapy were randomly assigned to one of these treatments or to a wait-list control group. Each treatment was administered in eight sessions by six experienced therapists whose interventions were monitored and rated to ensure treatment fidelity. Results indicated that the perceived strength of the working alliance between couples and therapists and general therapist effectiveness were equivalent across treatment groups and that both treatment groups made significant gains over untreated controls on measures of goal attainment, marital adjustment, intimacy levels, and target complaint reduction. Furthermore, the effects of the emotionally focused treatment were superior to those of the problem-solving treatment on marital adjustment, intimacy, and target complaint level. At follow-up, marital adjustment scores in the emotionally focused group were still significantly higher than those in the problem-solving group.

RESEARCH ON THE TREATMENT OF COUPLE DISTRESS

This article reviews the research on couple therapy over the last decade. The research shows that couple therapy positively impacts 70% of couples receiving treatment. The effectiveness rates of couple therapy are comparable to the effectiveness rates of individual therapies and vastly superior to control groups not receiving treatment. The relationship between couple distress and individual disorders such as depression and anxiety has become well established over the past decade. Research also indicates that couple therapy clearly has an important role in the treatment of many disorders. Findings over the decade have been especially promising for integrative behavioral couples therapy and emotion-focused therapy, which are two evidence-based treatments for couples. Research has also begun to identify moderators and mediators of change in couple therapy. Finally, a new and exciting line of research has focused on delineating the principles of change in couple therapy that transcends approach.

Resolving attachment injuries in couples using emotionally focused therapy: steps toward forgiveness and reconciliation.

The goal of this study was to use task analysis to verify that the attachment injury resolution model described in this article discriminates resolved from nonresolved couples. Twenty-four couples with an attachment injury received, on average, 13 sessions of emotionally focused therapy (EFT). At the end of treatment, 15 of the 24 couples were identified as resolved. Segments of best sessions for all couples were transcribed and rated on 2 process measures. Resolved couples were found to be significantly more affiliative and achieved deeper levels of experiencing than nonresolved couples. They also showed significant improvements in dyadic satisfaction and forgiveness than nonresolved couples. The results support the attachment injury resolution model and suggest that resolution during EFT is beneficial to couples.

Emotion-Focused Therapy for Couples in the Treatment of Depression: A Pilot Study

Emotion-focused therapy (EFT) for couples was compared to pharmacotherapy in the treatment of major depressive disorder. Eighteen distressed couples in which the female partner met diagnostic criteria for major depressive disorder were randomly assigned to 16 weekly sessions of emotion-focused therapy or pharmacotherapy with desipramine, trimipramine, or trazadone. Twelve couples completed the study. Both interventions were equally effective in symptom reduction. There was some evidence that females receiving EFT made greater improvement after the conclusion of treatment than those receiving pharmacotherapy. The results suggest EFT might be useful in the treatment of comorbid major depressive disorder and relational distress.

Emotionally focused therapy for couples and childhood sexual abuse survivors

This study explored Emotionally Focused Therapy (EFT) for couples with childhood sexual abuse survivors (CSA) and their partners. Half of the couples in this study reported clinically significant increases in mean relationship satisfaction and clinically significant decreases in trauma symptoms, and thematic analyses identified numerous areas where trauma survivors were challenged in fully engaging in the therapy process. In particular, trauma symptoms such as affect dysregulation and hypervigilance were identified to play a role in the challenges that survivors experienced in fully engaging in the EFT process. Results of these thematic analyses yielded clinical recommendations for working with CSA survivors and their partners in EFT for traumatized couples. Recommendations for future study were articulated.

Process Research on Emotionally Focused Therapy (EFT) for Couples: Linking Theory to Practice

The focus of this article is on the link among theory, process, and outcome in the practice of Emotionally Focused Therapy (EFT) for couples. We describe the EFT model of change and the EFT perspective on adult love as the reflection of underlying attachment processes. We outline the manner in which theory and research inform EFT interventions. This leads into a detailed review of the literature on the processes of change in EFT. We highlight the client responses and therapist operations that have emerged from process research and their relation to treatment outcomes. We discuss the implications of this body of research for clinical practice and training.

Status of Psychological Trials in Breast Cancer Patients: A Report of Three Meta-Analyses

This systematic review reports the results of three meta-analyses addressing the clinical efficacy of psychological interventions in breast cancer patients. Three outcome variables were examined: anxiety, depression and quality of life. Several moderator variables were found to both account for inter-trial heterogeneity and interact with treatment efficacy; methodological quality, prognosis, treatment type, orientation and duration. A clinically moderate treatment effect was found for anxiety (−0.40, 95% CI, −0.72 to −0.08, N = 1278). This was not robust to study quality, but remained stable for patients with more advanced disease. Short-term group therapy was more effective than longer term intervention and individual ones. A clinically moderate-to-strong effect was found in trials assessing depression (−1.01, 95% CI, −1.48 to −0.54, N = 1324). A more robust finding of −0.47 (95% −0.69 to −0.24) was based on methodologically more reliable studies treating patients with high psychological morbidity. Intervention was shown to have moderate effects on improving QOL (0.74, 95% CI, 0.12 to 1.37, N = 623), though it was not robust to study quality. Findings suggest that short-term treatments with a focus on coping may be more suitable for early breast cancer patients. Patients with advanced breast disease appear to benefit more from longer term interventions which emphasize support. Recommendations are also made for future clinical trials.

Low sexual desire in women: The effects of marital therapy

A total of 49 couples, in which the women were experiencing inhibited sexual desire (ISD), received Emotionally Focused Therapy for Couples (EFT) or were assigned to a wait-list control group. An additional 15 couples were recruited as a non-ISD comparison sample. Only very modest treatment and control group differences were found after treatment. Females treated with marital therapy made significant gains on one measure of sexual desire and on level of depressive symptomatology. Overall, the marital treatment group seemed to make clinically significant gains from pre- to posttreatment which were largely maintained at follow-up. Lower levels of initial marital distress resulted in greater treatment gains, and better pretreatment marital adjustment predicted better posttreatment overall sexual adjustment. The main difference found between ISD and non-ISD couples was that ISD couples had significantly more sexual distress. Results are discussed in light of the unique features of this subject population, and suggestions are given for future research.

Integrating Sex and Attachment in Emotionally Focused Couple Therapy.

In this article, sexual functioning is placed in the context of love as an attachment bond. Attachment theory offers the most coherent and empirically validated theory of adult love and is summarized together with the implications of this theory for the practice of couple therapy in which sexual issues are often addressed. Recent research on attachment and sexuality is outlined and a model of healthy sexuality where attachment and sexuality are integrated is offered. The principles of an attachment-oriented approach to sex issues are set out and illustrated with reference to the process of emotionally focused couple therapy. Case descriptions and brief in-session transcripts are included.

Soothing the Threatened Brain: Leveraging Contact Comfort with Emotionally Focused Therapy

Social relationships are tightly linked to health and well-being. Recent work suggests that social relationships can even serve vital emotion regulation functions by minimizing threat-related neural activity. But relationship distress remains a significant public health problem in North America and elsewhere. A promising approach to helping couples both resolve relationship distress and nurture effective interpersonal functioning is Emotionally Focused Therapy for couples (EFT), a manualized, empirically supported therapy that is strongly focused on repairing adult attachment bonds. We sought to examine a neural index of social emotion regulation as a potential mediator of the effects of EFT. Specifically, we examined the effectiveness of EFT for modifying the social regulation of neural threat responding using an fMRI-based handholding procedure. Results suggest that EFT altered the brains representation of threat cues in the presence of a romantic partner. EFT-related changes during stranger handholding were also observed, but stranger effects were dependent upon self-reported relationship quality. EFT also appeared to increase threat-related brain activity in regions associated with self-regulation during the no-handholding condition. These findings provide a critical window into the regulatory mechanisms of close relationships in general and EFT in particular.