The Cognitive-affective and Behavioural Impact of Emotionally Focused Couple Therapy

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) understands and treats relationship distress using an attachment theory perspective. Although EFT has consistently demonstrated excellent relationship satisfaction outcomes (Johnson, Hunsley, Greenberg & Schindler, 1999) less is known about its influence on couples’ attachment functioning. The process of change within EFT suggests that couples should display increases in their relationship-specific models of attachment security over the course of therapy. The goal of this study was to examine these attachment-based assumptions of EFT with 32 heterosexual couples that completed an average of 21 sessions of therapy. Session-by-session changes in partners’ self-reported relationship satisfaction and relationship-specific attachment anxiety and avoidance were examined, along with changes in couples’ pre-post-therapy relationshipspecific attachment behaviours. Results indicated that couples’ relationship-specific attachment anxiety and avoidance significantly decreased over the course of therapy. Additionally, couples’ post-therapy secure base behaviour scores significantly increased towards security from pre-therapy levels. Results also demonstrated that changes in relationship-specific attachment anxiety were significantly associated with changes in relationship satisfaction. These findings provide support for the claim that EFT can facilitate increases in partners’ relationship-specific attachment security and that these increases are a key contributor to the relationship satisfaction gains seen within this approach. Changes in Romantic Attachment 40 Changes in Romantic Attachment in Emotionally Focused Couple Therapy Emotionally Focused Couple Therapy (EFT; Johnson, 2004) is an empirically validated approach to treat relationship distress. Within this approach, it is understood that relationship distress results from partners’ rigid engagement in negative interaction cycles (Johnson, 2004). These cycles are thought to result from partners’ unmet attachment needs for both security and care within their relationship (Johnson & Whiffen, 1999). During therapy, as partners experientially identify, experience, and express their unmet needs for security and care, they learn new patterns of engagement with their partner. The theory of EFT suggests that these new patterns of emotional engagement work to restructure partners’ relationship-specific models of attachment. While EFT has led to excellent relationship satisfaction outcomes at post-therapy and follow-up (Halchuck, Makinen & Johnson, 2010; Johnson et al., 1999), much less is known about the effects of EFT on partners’ relationship-specific attachment functioning. Accordingly, the goals of the current study are to investigate the impact of EFT on partners’ relationship-specific models of attachment. Results will allow for a test of the attachment theoretical assumptions of EFT and also help us to understand the usefulness of attachment theory to treat relationship distress (Davila, 2003). At the same time, these results will add to the growing body of literature on the clinical application of attachment theory in addressing a wide range of psychopathology (Shorey & Snyder, 2006). Emotionally Focused Couple Therapy EFT (Johnson, 1996/2004) uses experiential, systemic and attachment-based approaches to facilitate improvements in couples’ relationship functioning. Johnson and colleagues (1999) reviewed EFT research that demonstrated that 86% of couples reported Changes in Romantic Attachment 41 improvements in relationship satisfaction at therapy termination. Research has also illustrated that these relationship satisfaction gains are maintained at two and three years after therapy (Cloutier, Manion, Gordon-Walker & Johnson, 2002; Halchuk, Makinen, & Johnson, 2010). Further, couples who have completed EFT have reported higher levels of intimacy at post-therapy than couples who have completed a behavioural problem solving approach or who were assigned to a waitlist control group (Denton, Burleson, Clark, Rodrigues, & Hobbs, 2000; Johnson & Greenberg, 1985). Further, Makinen & Johnson (2006) demonstrated that EFT results in preto posttherapy increases in couples’ trust and forgiveness scores. EFT case conceptualizations and interventions are informed by attachment theory (Davila, 2003; Johnson & Whiffen, 1999). Specifically, EFT encourages partners to experientially identify and express their unmet attachment needs to one another in an effort to restructure their negative patterns of interaction. The following section provides a brief review of the key concepts of attachment theory that are used by EFT therapists to understand and treat relationship distress. Attachment Theory Attachment theory (Bowlby, 1969/1982) states that individuals are born with an innate desire to seek proximity to others, and to be soothed by them, in times of distress. Variations in early caregiving environments lead individuals to develop different models about the worthiness of self and about the availability of others to soothe their distress in times of need. The differences between these models are reflected in an individual’s level of attachment security, attachment anxiety, and attachment avoidance. According to attachment theory (Bowlby, 1988) individuals with attachment security were provided with sensitive and responsive emotional support by their primary caregivers. Changes in Romantic Attachment 42 This attuned support allows these individuals to develop an understanding of, and an ability to cope with, negative affect (Fonagy, 2001). These individuals also learned that others are a viable resource for comfort, reassurance, and guidance in times of need (Shaver & Mikulincer, 2002). Individuals with attachment security display more helpful and responsive caregiving with their partner during laboratory based caregiving tasks (Collins & Ford, 2010) and conflict resolution tasks (Bouthilier, Julien, Dubé, Bélanger & Hamelin, 2002) than do individuals with high levels of attachment anxiety or avoidance. Individuals with high levels of attachment anxiety were provided with inaccurate emotional mirroring and inconsistent support from their primary caregivers (Fonagy, 2001). As a result, these individuals learned to believe that they themselves must be unworthy of consistent care and that others are an unreliable source of comfort in times of need. Further, they learned that in order to have their attachment needs met they must hyperactivate their cries of distress (Shaver & Mikulincer, 2002). Hyperactivating affect regulation strategies include clinging behaviour, overdependence, and ‘most of all, a strongly held personal belief that negative affect cannot be managed independently’ (Shaver & Mikulincer, 2002). Individuals high in anxious attachment tend to display an overdependence on loved ones, a misattuned approach to caregiving, and a focus on negative affect during conflict resolution tasks (Collins & Feeney, 2001; Mallinckrodt & Wei, 2005; Shaver & Mikulincer, 2002). Individuals high in attachment avoidance faced rejection and hostility when they disclosed their attachment needs to their primary caregivers. Accordingly, these learned that they must engage in deactivation strategies to cope with their negative affect (Mikulincer & Shaver, 2002). These deactivating strategies include the avoidance of emotional involvement, the numbing of affect, and the denial of the need for intimacy. Individuals with attachment avoidance tend to engage in excessive self-reliance, to reject loved ones’ offers of Changes in Romantic Attachment 43 support, and to display a pattern of neglectful caregiving during laboratory-based caregiving tasks (Feeney, 1999; Mikulincer & Shaver, 2007; Simpson, Rholes, Orina, & Grich, 2002). Not surprisingly, couples comprised of two insecurely attached partners—most commonly anxious-avoidant or anxious-anxious pairings (Mikulincer & Shaver, 2007)— report the highest amount of marital conflict, the lowest amount of marital support and display patterns of negative interaction that reinforce their insecure attachment orientations (Davila & Kashy, 2009; Gallo & Smith, 2001). Based on this review, it can be seen that early attachment security is a protective factor for future individual and romantic relationship functioning (Mikulincer & Shaver, 2007). This suggests that models of attachment formed in childhood display some stability into and throughout adulthood. Although research has supported this claim (Fraley, 2002; Fraley, Vicary, Brumbaugh & Roisman, 2011), individuals have also demonstrated shifts in attachment orientations over time, especially in light of new caregiving experiences. For example, in adulthood, changes towards self-reported attachment security have been linked to positive changes in individuals’ perception of their partner’s availability and support in times of distress and changes in an individual’s own ability to seek support in times of need (Crowell, Treboux, & Waters, 2002; Davila & Kashy, 2009; Simpson, Rholes, Campbell & Wilson, 2003). Based on these research findings, EFT, and other similar attachment-based researchers and clinicians hold that models of attachment could also change from insecurity to security, over the course of therapy. Attachment Orientations as Therapeutic Outcomes Attachment theorists (Bowlby, 1988; Johnson & Whiffen, 1999; Mikulincer & Shaver, 2007; Shorey & Snyder, 2006) argue that therapists can facilitate change in clients’ models of attachment by providing them with a corrective emotional experience. This occurs Changes in Romantic Attachment 44 when therapists provide clients with a safe base from which to explore their attachment fears, and when therapists respond to these needs in a more attuned manner than the client had experienced from others in the past. However, only a few studies have systematically examined and reported results on attachment chang