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Guided by the Person-of-the Therapist Training (POTT) Model, the current qualitative study explores emotional experiences and emotion regulation strategies of emotionally focused trained therapists who work with high-conflict couples in Turkey. Twenty-one therapists who completed at least the externship in emotionally focused couple therapy (EFCT) and had prior or current clinical experience working with high-conflict couple(s) were recruited through various social media platforms and professional organizations' listservs. Semistructured individual interviews were conducted, audio-recorded, and transcribed verbatim. Thematic analysis of the qualitative data revealed five main themes: (1) Different Compelling Emotional Experiences of the Therapists, (2) Sun After Storm, (3) Triggers of Therapists' Emotions, (4) Perceived Adaptive Emotion Regulation Strategies, and (5) Positive Impact of the Therapist's Regulation Strategies on the Therapy Process. Overall, the findings supported the three phases of the POTT model: namely, knowledge of self, access to self, and use of self. Our study demonstrates the need for integrating self-of-the-therapist work into the clinical practice, training, and supervision of therapists working with distressed couples.

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BACKGROUND: Data from a two-arm randomized controlled trial of emotionally focused therapy (EFT) compared to usual care were used to examine whether baseline emotion regulation influences relationship satisfaction for female and male partners. This is clinically relevant as clinicians have debated whether clients' initial emotion regulation skills predict positive outcomes in EFT. METHODS: Dyadic multilevel modeling was used to determine whether baseline emotion regulation predicted both initial levels and change in relationship satisfaction and whether that relationship differed by treatment group (i.e., EFT or usual care). RESULTS: Baseline emotion regulation difficulties were associated with lower initial relationship satisfaction. However, baseline emotion regulation difficulties were not associated with change in relationship satisfaction over the course of treatment and this relationship did not differ by treatment group. CONCLUSIONS: Results demonstrate that partners with diverse presentations of emotion regulation at baseline may benefit from couple therapy.

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This is the first study to explore the effectiveness of emotionally focused couple therapy (EFT) for depressive symptoms and relationship distress among couples in Taiwan. This one-arm pragmatic trial assessed the clinical outcomes of 17 couples using multilevel modeling to investigate changes in depressive symptoms and relationship distress throughout treatment. Over half of the participants were moderately depressed and moderately distressed at baseline. Multilevel models revealed decreased depressive symptoms over time, with a small increase toward the end of treatment. However, no significant changes were observed in relationship distress over time. The study was limited by the low "dose" of EFT (M = 7 sessions) received by participants and the small sample size (n = 17). A comprehensive discussion of the findings from a cultural perspective was provided. Future research is needed to further examine the effectiveness of EFT for couples in Taiwan and Asia.

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Research shows that shame can have a severe negative impact on intimate relationships, leading to negative shame loops between partners. In this article, we aim to provide a theoretical analysis of how attachment theory can help us understand that shame loops within couple relationships may not only be triggered by negative cues, such as criticism from a partner but can also innocently be triggered by a partner seeking connection or even offering comfort. We also elaborate on how therapists may unexpectedly trigger and intensify a client's shame. We conclude by providing a case description and discussing the therapeutic implications that can be helpful when working with the paradoxes of shame in couple therapy.

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Romantic relationships are more satisfying and fulfilling when power is balanced relatively equally between partners (Leonhardt et al., Journal of Family Psychology, 34, 2020, and 1). Yet, few couples therapy models explicitly outline how to confront relational power issues (Knudson-Martin & Huenergardt, 2015, Socio-emotional relationship therapy: Bridging emotion, societal context, and couple interaction, Springer). Emotionally Focused Therapy (EFT; Johnson, 2020, The practice of emotionally focused couple therapy, Routledge) is a well-established, evidence-based therapy modality that many therapists use with couple clients, yet despite its effectiveness, it does not provide direction for explicitly addressing and treating power differentials in couple relationships. In this paper, we explore the integration of EFT with Socio-emotional Relationship Therapy (SERT), a model overlay that acknowledges the impact of social discourse on enactments of power in intimate couple relationships. We first address the importance of understanding power in couple relationships, addressing power in couples therapy, and provide a brief overview of SERT and EFT. We then introduce an integration of the models intended to help therapists balance power, increase connection, and secure attachment bonds between romantic partners.

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Approximately 5% of people in the United States engage in some form of consensual non-monogamy (CNM; Archives of Sexual Behavior, 2018, 47, 1439). Therapists are becoming increasingly aware of the need to treat members of CNM relationships, including polyamorous relationships. To date, no research has been conducted and little has been written about applying existing couple therapy models normed on heterosexual, cisgender, monogamous relationships to CNM or polyamorous relationships. Emotionally focused therapy (EFT) is an empirically supported treatment for relationship distress that offers promise for working with polyamorous relationships due to the model's systemic and attachment theoretical foundations. We propose EFT is an ideal model for working with polyamorous relationships because of the focus on externalizing, interpersonal and intrapersonal emotional and experiential coherence, and the attachment bond. Building and sustaining multiple attachment relationships allows for the fulfilment of a diverse range of relational needs and wants as well as provides a secure base for individual and relational exploration. In this article, we first provide general information about polyamory and discuss the research on attachment theory and polyamory. We then provide a step-by-step conceptualization of how EFT therapists can expand the model to include extra-dyadic attachment relationships. In addition, we include specific ways in which the model would need to be adapted when working with polyamorous clients. We conclude with recommendations for EFT therapists working with polyamorous relationships.

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Through the application of a discovery-oriented task analysis, this research delineated specific therapist behaviors that resulted in a successful caregiver openness event in emotionally focused family therapy (EFFT). EFFT experts were recruited via email and asked to submit family therapy recordings where they believed a caregiver openness event occurred. Ten family therapy recordings were submitted by three experts. Within these recordings, 12 caregiver openness events were discovered and critically analyzed. Nine themes were identified and interventions therapists applied to accomplish these themes were delineated using the emotionally focused therapy-coding scheme (EFT-CS). These themes included: (1) validating and reframing the child's protected stance, (2) processing the impact of the child's unmet attachment longings, (3) validating the caregiver's blocked relational stance, (4) expanding caregiving intentions, (5) enacting the caregiver's intentions to meet the child's attachment longings, (6) processing the enactment, (7) processing and promoting caregiver accessibility to the child's response, (8) heightening the caregiver's accessible stance, and (9) enhancing shifting family dynamics. Additional findings, implications for clinical practice, training, and future research are discussed.

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Attachment insecurity is a transdiagnostic marker of risk associated with interpersonal emotion dysregulation and adverse psychosocial outcomes across the lifespan. Few interventions target the enhancement of attachment security in late adolescence. Most programs focus on strengthening the adolescent-caregiver relationship; meanwhile, youth increasingly spend less time with their families and look to peer relationships as a source of connection, particularly as they transition to college. Drawing from the principles of Emotionally Focused Therapy, we developed a psychotherapeutic peer mentorship program to enhance attachment security for insecurely attached youth during the transition to college. We tested the preliminary efficacy of Emotionally Focused Mentorship (EFM) in an open pilot trial by pairing (N = 82) insecurely attached first-year college students (i.e., "mentees") with securely attached mentors. Across five weekly sessions, mentors helped mentees identify and express their emotions in close relationships by working through different relational scenarios. Attachment and mental health trajectories were self-reported three times over five weeks and analyzed using Bayesian growth curve models. Across five weeks, participants reported improvements in attachment anxiety and avoidance, emotion regulation difficulties, depressive symptoms, loneliness, and self-esteem. Participants who completed the intervention (n = 55) noted improvements in their psychological wellbeing and interpersonal relationships. Results are promising and highlight the need to conduct a randomized clinical trial to test if these effects are causal. Given rising mental health demands, trained peer mentors may be a cost-effective way to improve attachment and psychological outcomes for insecurely attached participants during the transition to college.

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BACKGROUND: Couple relationship distress is common and associated with poor physical, psychological, and relational outcomes for both partners. Emotionally Focused Therapy for couples (EFT) is a short-term structured approach based on attachment theory that integrates a humanistic, experiential approach to restructuring emotional experience and a systemic structural approach to restructuring interactions. This model has been shown to be an effective treatment for couple distress. The supporting research, however, has only been conducted with English-speaking couples. Despite Spanish being the second-most spoken language and meaningful cultural differences between English- and Spanish-speaking countries, the efficacy of EFT has not been examined in this cultural context. This study will examine the efficacy of EFT in this particular context and advance the understanding of potential mechanisms of change. METHODS: We will use a multicenter randomized wait-list controlled design to examine the efficacy of EFT in a Spanish-speaking sample of moderately distressed couples. One hundred forty individuals in 70 couples in Argentina, Costa Rica, Guatemala, Mexico, and Spain will be randomly assigned to receive 19-21 sessions of EFT or be placed on a waitlist. Outcomes on a range of relational and individual mental health variables will be assessed prior to random assignment, throughout treatment, and at the conclusion of treatment. Primary outcomes will include dyadic adjustment, couple satisfaction, and attachment. Secondary variables, such as loneliness, parenting, affective communication, and sexual satisfaction, will be included as potential mediators of the treatment effect. Couples in the treatment group will also be assessed at 3-, 6-, 12-, 18-, and 24-month follow-ups. Process variables such as the therapeutic alliance will also be assessed routinely in couples assigned to the treatment group. Couples in the waitlist will receive a psycho-educational program based on EFT after completing the study. DISCUSSION: This study will be the first RCT of Emotionally Focused Therapy in a Spanish-speaking context. The results of the study will inform researchers interested in whether treatments developed and tested in the USA and Canada can be effective in differing cultural contexts. It may also point researchers and clinicians to areas where cultural adaptation is needed to improve efficacy. TRIAL REGISTRATION: ClinicalTrials.gov NCT04277325. Registered on February 20, 2020.

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Interabled couples navigate various systems of care as they respond to the needs of the disabled partner. Interabled couples are defined as one disabled partner and one nondisabled partner. Emotionally focused therapy (EFT) has shown benefits in reducing relationship distress and increasing the experience of security within couples. The study used interpretative phenomenological analysis to address how EFT therapists make sense of their lived experience working with interabled couples in couple therapy. The purpose of the study was to examine the experiences of therapists' serving interabled couples. The study explored the experiences of 10 EFT therapists who served at least one interabled couple in couple therapy. Findings resulted in four superordinate themes, (a) ableism; (b) self-of-the-therapist; (c) reported relationship dynamics of interabled couples; and (d) the "fit" of EFT approach with interabled couples. The themes demonstrate a need to further identify disability-responsive practices within EFT in serving interabled couples.

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Emotionally focused therapy (EFT) is an empirically supported intervention for relationship distress with an established model of supervision. This study examined whether incorporating video feedback (VF) software into EFT supervision would improve therapists' level of development compared to traditional EFT supervision in a university training clinic. A concurrent multiple-baseline across subjects design, along with a thematic analysis of qualitative data, were used in this proof-of-concept study of the new supervision component. Overall, quantitative findings suggested that using VF in EFT supervision resulted in some improvement to therapists' development, while qualitative findings showed that all participants supported the incorporation of VF into EFT supervision. Future research on VF is needed to provide additional insight into the use of video review supervision.

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In this review, we suggest attachment science as a framework for understanding the negative impact of loneliness and social disconnection on mental and physical health and for guiding the interventions of clinicians. We provide an overview of current findings linking loneliness and social isolation to mental health problems such as depression and anxiety, as well as to physical illnesses such as heart disease. We propose emotionally focused therapy for couples, families, and individuals to enhance the quality of people's emotional ties to significant others and their subjective sense of social connectedness. We conclude by suggesting that the strengthening of emotional, interpersonal bonds, which is the primary focus of all forms of emotionally focused therapy, can help restore emotional balance, thereby protecting people from chronic feelings of isolation and the host of health problems that they can cause.

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In general, arousal of emotions is often felt and expressed as a somatic experience in the body. In Emotionally Focused Couple Therapy (EFT), the deepening of emotional experiencing enables therapeutic change. This research explores the experiences of eight experienced EFT trainer therapists regarding their somatic experiences in their work with couples. Using interpretative phenomenological analysis of transcribed in-depth interviews, this research data yielded three core themes that captured therapists' experiences of using their own and couples' somatic experiences in therapy: (1) the importance and relevance of somatic experiences, (2) therapists' use of their own somatic experiences, and (3) working with clients' somatic experiences. The findings suggest that therapists do focus on their own and couples' somatic experiences in their work with couples, and that EFT therapists could benefit from a map to guide therapists how to focus on felt, somatic experiences as a way of maintaining an emphasis on emotional experience.

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This article aimed to extend and refine the existing roadmap of emotionally focused therapy (EFT) in cases of situational couple violence (SCV). SCV is a common problem with couples who seek out couple therapy. Based on attachment theory, academic research, EFT, and our clinical experience, we argue that SCV can be safely treated using EFT. Through a detailed case description of stage 1 of EFT with a violent couple, we demonstrate how EFT can help to reduce violence. We also discuss safety-related matters, specific therapeutic interventions, and potential limitations of the proposed method.

Este artículo tiene como finalidad ampliar y perfeccionar la hoja de ruta actual de la terapia centrada en emociones (TCE) en casos de violencia situacional de pareja (VSP). La VSP es un problema común en las parejas que buscan terapia de pareja. Sobre la base de la teoría del apego, la investigación académica, la TCE y nuestra experiencia clínica, sostenemos que la VSP puede tratarse de manera segura usando la TCE. Mediante una descripción detallada de un caso de etapa 1 de TCE con una pareja violenta, demostramos cómo la TCE puede contribuir a reducir la violencia. También comentamos asuntos relacionados con la seguridad, las intervenciones terapéuticas específicas y las posibles limitaciones del método propuesto.

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Purpose: A meta-analysis is the review of several qualifying studies where the findings of each study is analyzed and is then pooled as to determine if an intervention is effective or not. The aim of this meta-analysis was to evaluate if the intervention of Emotionally Focused Couples Therapy (EFCT), also referred to as Emotionally Focused Therapy (EFT), continues to be an effective intervention, since its last meta-analysis in 1999, and to determine whether the improvements noted in EFCT continue to be effective, over a period of time, following the initial intervention.Method: For the meta-analysis, nine studies which identify as randomized control trials (RCTs), were extracted and utilized from the original systematic search. These nine studies were used to evaluate EFCT's initial pre to post-treatment effectiveness. The portion of the meta-analysis, which evaluates whether EFCT sustained improvement at follow-up, consisted of four studies that identify as RCTs.Results: The results strongly suggest that the intervention of EFCT not only improved marital satisfaction (Hedge's g coefficient = 2.09) but also, the improvement in marital satisfaction was sustained at follow up. This sustained improvement was evident through the results of both the Friedman's repeated-measures and the post hoc Wilcox (χ2 = 6.500, p = 0.039).Conclusion: The findings provide preliminary support that, as it relates to marital satisfaction, EFCT is an effective treatment, both in facilitating change during treatment, and in maintaining those improvements following treatment.

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This paper reviews the current debate between differentiation and attachment in treating couples through exploring the tenets of crucible therapy (Schnarch, 1991) and emotionally focused couple therapy (Johnson, 2004). We provide a review of the two theories-as well as the two "pure form" example models-and explore the debate in light of the integrative movement in couple and family therapy (Lebow, 2014). We also examine points of convergence of the two theories and models, and provide clinicians and researchers with an enhanced understanding of their divergent positions. Both differentiation and attachment are developmental theories that highlight the human experience of balancing individuality and connection in adulthood. The two models converge in terms of metaconcepts that pervade their respective theories and approach. Both models capitalize on the depth and importance of the therapeutic relationship, and provide rich case conceptualization and processes of therapy. However, they substantially differ in terms of how they view the fundamental aspects of adult development, have vastly divergent approaches to how a therapist intervenes in the room, and different ideas of how a healthy couple should function. In light of the deep polarization of the two models, points of integration-particularly between the broader theories of attachment and differentiation-are offered for therapists to consider.

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Sixteen years of war created significant challenges for military couples and seems to contribute to their relational distress. Military couples seek out pastoral counselors for assistance with their relational distress. Many of these pastoral counselors are military chaplains or pastors serving close to military bases. The integration of pastoral counseling with evidence-based theory is presented as an option to serve military couples in their relational distress. Emotionally Focused Couple Therapy is presented as an example.

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Emotionally Focused Therapy for Couples (EFT) is a brief evidence-based couple therapy based in attachment theory. Since the development of EFT, efficacy and effectiveness research has accumulated to address a range of couple concerns. EFT meets or exceeds the guidelines for classification as an evidence-based couple therapy outlined for couple and family research. Furthermore, EFT researchers have examined the process of change and predictors of outcome in EFT. Future research in EFT will continue to examine the process of change in EFT and test the efficacy and effectiveness of EFT in new applications and for couples of diverse backgrounds and concerns.

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OBJECTIVE: To test the effect on psychopathology and quality of life of Emotionally Focused Therapy (EFT), Dietary Counseling (DC), and Combined Treatment (CT) in treatment-seeking patients with Binge Eating Disorder (BED) and obesity. METHODS: Utilizing an observational study design, 189 obese adult patients with BED were treated by manualized therapy protocols. An independent assessment of health-related quality of life (Obesity-Related Well-Being questionnaire - ORWELL-97), attitudes toward eating (Eating Inventory - EI), binge eating (Binge Eating Scale - BES) and body uneasiness (Body Uneasiness Test - BUT) was performed at baseline, end-of-treatment, and six-month follow-up. These data are the secondary outcomes of a previously published treatment study. RESULTS: A higher dropout rate was observed in the DC compared to the EFT and CT groups, while body weight decreased significantly in all three groups. Pre-post scores on the BES, BUT Global Severity Index, and EI Hunger subscale significantly decreased in the CT and EFT groups (but not the DC group). At six-month follow-up, 71% of participants in CT and 46% of participants in EFT had a BES score below the threshold of attention for BED (≤16), whereas no participants in the DC group reached this target. Finally the ORWELL-97 score decreased significantly in all groups, but significantly more so in the CT and EFT groups. CONCLUSION: Results support the utility of combining EFT and DC in the treatment of patients with BED and obesity, emphasizing the usefulness of techniques focused on cognitive emotional processing for changing eating disorder psychopathology and quality of life.

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