Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds

Canadian Psychology, Nov 2003 by Preece, Melady, Delongis, Anita

SUSAN M. JOHNSON Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds New York: Guilford Press, 2002, 226 pages (ISBN 1-57230-735-8, US$30.00)

Emotion-Focused Therapy (EFT) is an empirically validated approach to couples therapy (Johnson, Hunsley, Greenberg, & Schindler, 1999) that has been replicated by independent investigators. Emotion-focused therapy is based in part on the theoretical underpinnings of systems and attachment perspectives. Two previous books describing the clinical aspects of this approach have been published, Emotionally Focused Therapy for Couples (Johnson & Greenberg, 1988) and The Practice of Emotionally Focused Martial Therapy: Creating Connection (Johnson, 1996). In this volume, the approach is extended to a consideration of the role that past trauma plays in current marital problems. In addition, the book provides a succinct overview of attachment theory, and responds to criticisms that arise in its application to treatment.

Johnson maintains that an individual's emotional difficulties can often be most productively addressed by considering the relational aspects. Negative interactional cycles arc maintained because the individuals involved are trying to fulfill their emotional needs. From an attachment perspective, a secure emotional connection with a significant other provides a "safe haven," or base from which to operate. Such an approach emphasizes that a strong emotional connection does not interfere with, but rather promotes, a healthy autonomy and resilience.

The process of EFT consists of nine steps (Greenberg & Johnson, 1988). They are: 1) determining the conflict issues in the struggle between partners, 2) identifying the negative interaction cycle, 3) acknowledging the unspoken feelings underlying the interactional positions, 4) reframing the problems in terms of these underlying feelings, 5) identifying with the underlying emotions and corresponding aspects of the self, 6) accepting the emotion experience of the partner, 7) restructuring interactions based on the new understandings of the underlying wants and needs, 8) establishing new interactional cycles, and 9) consolidating new positions.

Trauma survivors who are seeking marital therapy may not have made the connection between their traumatic experiences and current difficulties in their interpersonal relationships. However, the somewhat erratic and mystifying responses of a partner to uncertainty and change in the couple's life can sometimes be understood in the context of the past trauma. Post Traumatic Stress Disorder (PTSD) typically manifests itself as, among other symptoms, chronic irritability and depression, which may cause "secondary" trauma that affects the other partner and the marital relationship. Johnson details the ways that an insecure attachment can increase and sustain the negative effects of trauma, and argues that a secure attachment provides an antidote to the negative effects of traumatic experience.

The major symptoms that are required for a diagnosis of PTSD are re-experiencing of a past traumatic event, numbing and avoidance, and increased arousal. These symptoms can play havoc with marital relationships. Re-experiencing past events can be triggered unpredictably, sometimes even by the actions of one's partner. At such times, individuals may appear disconnected from their loved ones, leading to hurt feelings and misunderstandings. Further, partners of those traumatized may interpret the resulting withdrawal of their traumatized spouse as a lack of caring. In addition, particularly in marital therapy, issues related to anger and irritability (amplified by increased arousal) can interfere with the development and maintenance of close marital bonds.

Interestingly, the symptoms used to diagnose PTSD do not include many of the issues that trauma survivors often report being most problematic. A DSM IV field trial (van der Kolk, van der Hart, & Marmar, 1996) found that depression, angry outbursts, self-destructive behaviour, distrust, and shame were the symptoms for which individuals with PTSD most frequently sought help. Another common problem was an inability to sustain satisfactory relationships with others. This book focuses on helping partners to develop an understanding of the emotions that underlie problematic marital interactions when one or both partners has experienced trauma in the past.

Throughout, Johnson uses the "dragon" as a metaphor to refer to the spectre of trauma in the lives of couples. She notes that, "We know that we are not designed to face dragons alone." Johnson suggests that "formulating the dragon as the problem" removes any need for blame towards either party. The goal of the therapy is to transform the problematic relationship into a safe haven, a secure base from which to fight the dragon. In this newly constructed place of safety, the traumatized partner learns to view the other as an "ally" in the fight against the dragon. "Rituals of comfort and soothing" are seen as an important building block in the development of the safe haven.