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The couple's project : one year follow-up study Hansen, Cynthia 1990

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THE COUPLE'S PROJECT ONE YEAR FOLLOW-UP STUDY by CYNTHIA HANSEN B.A., Simon F r a s e r U n i v e r s i t y , 1980 THESIS SUBMITTED I N PARTIAL FULFILMENT THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES D e p a r t m e n t o f C o u n s e l l i n g P s y c h o l o g y We a c c e p t t h i s T h e s i s as c o n f o r m i n g t o t h e r e q u i r e d s t a n d a r d THE UNIVERSITY OF B R I T I S H COLUMBIA S e p t e m b e r , 1990 © C y n t h i a H a n s e n , 1990 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of C o u n s e l l i n g P s y c h o l o g y The University of British Columbia Vancouver, Canada Date September 19, 1990 DE-6 (2/88) i i ABSTRACT One year after receiving 12 sessions of Emotionally Focused Couples Therapy (EFT), 9 of the o r i g i n a l 14 voluntary, moderately distressed couples in James (1988) study, were tested to determine whether or not treatment gains were maintained or Increased over a one year span of time after receiving therapy. It was hypothesized that couples who received an EFT treatment would show improvement on the mean scores of the Dyadic Adjustment Scale (DAS), the Psychosocial Intimacy Questionnaire (PIQ), the Communication Scale (CS) and Target Complaints (TO, over a one year span of time after receiving therapy. More s p e c i f i c a l l y , a trend was anticipated. The trend was expected to be that of an increase on mean scores between pre-test and post-test followed by a decrease between post-test and four months follow-up and then a recovery or Improvement between four months and one year after receiving therapy. The 9 couples completed four self-report measures and participated in a structured interview. The hypothesis was supported by the research findings. Results indicated that post-treatment regression subsided between four months follow-up and one year follow-up. As a r e p l i c a t i o n of Remple's (1986) study, this i i i i n v e s t i g a t i o n d i d not show the dramatic i n c r e a s e s to post-treatment l e v e l s between four months and one year a f t e r therapy that Remple (1986) found. However the r e s u l t s of t h i s study do support the n o t i o n t h a t EFT i s e f f e c t i v e i n ma i n t a i n i n g increased m a r i t a l s a t i s f a c t i o n over a one year span of time. iv TABLE OF CONTENTS Abstract i i Table of Contents iv L i s t of tables v i L i s t of Figures v i i CHAPTER I: Introduction 1 Background of the Problem 1 History of Marital Therapy 2 The Problem 4 Purpose and Hypothesis 6 CHAPTER II: Literature Review 8 Follow-up studies in Marital Therapy 8 Emotionally Focused Couples Therapy 16 Theoretical Background 16 Research Studies on EFT 22 Conceptual Hypothesis 25 CHAPTER I I I : Design and Methodology 26 Design of the o r i g i n a l study..' 26 Subjects 26 Therapists 28 Therapist Training 28 Therapist Integrity 29 Design of the One Year Follow-up Study 30 Subjects 30 Assessment Procedures 31 V O t h e r M e a s u r e m e n t P r o c e d u r e s 35 D a t a A n a l y s i s 37 D a t a A n a l y s i s P r o c e d u r e s 37 P r e l i m i n a r y A n a l y s i s 38 A n a l y s i s o f Q u a n t i t a t i v e D a t a 38 A n a l y s i s o f Q u a l i t a t i v e d a t a 40 CHAPTER I V : R e s u l t s a n d D a t a A n a l y s i s 41 R e s u l t s o f P r e l i m i n a r y A n a l y s i s 41 R e s u l t s o f Q u a n t i t a t i v e D a t a 41 R e s u l t s o f Q u a l i t a t i v e D a t a 50 CHAPTER V: D i s c u s s i o n o f R e s u l t s 53 Summary 59 L i m i t a t i o n s 60 R e c o m m e n d a t i o n s 61 REFERENCES 66 APPENDIX 72 vi LIST OF TABLES Table I 48 Table II 49 Table III 51 Table IV 53 Table V 55 L I S T OF F I G U R E S F i g u r e 1 48 F i g u r e 2 49 F i g u r e 3 51 F i g u r e 4 53 F i g u r e 5 55 1 CHAPTER I: INTRODUCTION BACKGROUND: Marriage is important in providing a means of meeting the adult needs of closeness, contact, and intimacy. Marriage has the a b i l i t y to enhance partner's s a t i s f a c t i o n by f u l f i l l i n g these primary adult needs. As James (1988) points out, "people who are married have better physical and emotional health, l i v e longer and are more s a t i s f i e d with l i f e than are people who are separated or divorced." (James, 1988, p.l) Lending support to James' (1988) statement, Lowenthal and Haven (1968) analyzed l i f e h i s t o r i e s and found that the happiest, healthiest people in later years were people who were involved in at least one close personal relationship during their l i f e t i m e . Although marriage is important to well-being, in North America, one th i r d of marriages end in divorce (James (1988). Evidence suggests that the implications of marital distress are far reaching. Gurin, Veroff and Feld (1960) report marital d i s t r e s s as the most common reason people seek the help of mental health professionals. Sager, Gundlach, Kremer, Levy and Royce (1968) surveyed c l i e n t s who received individual psychotherapy. They found that 50% of these c l i e n t s disclosed serious marital problems through the course of therapy. A further 25% had marriage related d i f f i c u l t i e s . 2 History of Marital Therapy: Although marital therapy is currently considered a subspeciality of family therapy by the majority of c l i n i c i a n s , i t s history of development stems farther back than family therapy. (Gurman et a l . , 1986) Marital therapy developed independently with i t s roots " i n the marriage counselling t r a d i t i o n and in the psychoanalytically oriented practices of interpersonally oriented psychiatry in the t h i r d and fourth decades of this century" (Gurman et a l . / 1986, p.566). For example, marital therapy was used in the psychiatric treatment of schizophrenia and of symptomatic children and adolescents (Gurman et a l . , 1986). With the development of psychotherapy came a change in causal thinking from one of linear c a u s a l i t y to the more current view of c i r c u l a r causality. This s h i f t in thinking lead to the development of a systemic view in which connectedness, inter-dependence and context are viewed as important ingredients, a l l of which interact to create the environment in which an Individual, couple or family exist and function. Thus, in the systemic t r a d i t i o n , marital therapy is now considered a sub-speciality of family therapy. Marital therapy i s now practised in the treatment of adult disorders as well as interpersonal c o n f l i c t s . Currently there is enough evidence to support the effectiveness of psychotherapy including marital therapy. As Gurman et a l . (1986) say: "(Research has) now established 3 convincingly that in general the practice of family and marital therapy leads to positive outcomes." (p.570) There has been a lack of long-term follow-up on treatment outcome studies in psychotherapy. Gottman and Markman (1978) reviewed 55 studies on systematic desensitization conducted between 1970-1976. Of the 55 studies reviewed, only 25 had any follow-up at a l l and only 6 studies included retesting after a period of 6 months. Gottman and Markman's (1978) review exemplifies the lack of follow-up studies in research and reminds us of an important gap which research should address. Bergin (1971) highlights the importance of follow-up studies which exam the c l i e n t ' s s i t u a t i o n on more than one occasion. Remple (1987) supports th i s view. As Remple (1987) says: "Behaviour can vary over time, showing either improvement or deterioration, and multiple follow-up assessment isolates the patterning or configuration of e f f e c t s , thereby providing detailed information on the s p e c i f i c consequences of treatment... follow-ups need to allow adequate opportunity for the effects of the treatment forms that are employed in therapy to emerge (Remple, 1986, p.10). Gottman and Markman (1978) stress the importance of implementing the same assessment procedures at long term follow-up as are used at pre-test and post-test. As a r e p l i c a t i o n of Remple's (1986) study, t h i s study addressed the. issue of the effectiveness of Emotionally Focused Couple's therapy in increasing couple's 4 marital s a t i s f a c t i o n over a one year span of time after receiving therapy. THE PROBLEM: Emotionally Focused Couple's Therapy is a contemporary treatment package which focuses on the role of af f e c t and intrapsychic experience in couple interactions (Greenberg and Johnson, 1976). This approach is designed to increase the lev e l of s a t i s f a c t i o n and intimacy in couple relationships. The e f f i c a c y of EFT has been determined in four outcome studies to date: Johnson and Greenberg, 1985a, and 1985b; Goldman, 1987; James,1988. Only one study (Remple, 1987) to date has addressed the issue of the long-term effectiveness of EFT. Johnson and Greenberg (1985a) compared the effectiveness of EFT to a Cognitive Behavioral Marital Therapy (CBMT) and a w a i t - l i s t control group. Although both the EFT and CBMT treatments showed s i g n i f i c a n t gains over the wait l i s t control group, EFT was superior to CBMT on measures of marital adjustment, intimacy and reduction of target complaints at post-treatment. At 10 week follow-up, EFT was superior on measures of marital adjustment. Adding support to their findings, Johnson and Greenberg (1985b) conducted a p a r t i a l r e p l i c a t i o n of their o r i g i n a l study (ie.Johnson and Greenberg, 1985a). W a i t - l i s t controls were given eight sessions of EFT. Although the ove r a l l e f f e c t was less than 5 one half of that found in the o r i g i n a l study, s i g n i f i c a n t changes were noted on most of the dependant variables. Goldman (1987) compared the outcome of EFT to an Integrated-Systemic therapy (IS) and a wait l i s t control. At post-test, both treatment groups showed s i g n i f i c a n t gains over untreated controls on measures of marital adjustment, goal attainment, c o n f l i c t resolution and reduction of target complaints. No d i f f e r e n t i a l outcome effects were found between treatment groups at post-test. Although the IS group maintained post-test gains at the four-month follow-up, the EFT group deteriorated s i g n i f i c a n t l y on a l l measures except c o n f l i c t resolution. Remple (1986) conducted a one year follow-up study of Goldman's (1987) study. Interestingly, at the one-year follow-up, Remple (1986) found the EFT group had improved from the 4 month follow-up back to levels comparable to post-treatment scores. Remple speculated that this finding suggests a "sleeper" e f f e c t in EFT. In an attempt to determine how EFT might be enhanced, James (1988) compared the outcome of a treatment group receiving 12 sessions of EFT to a group receiving 8 sessions of EFT plus four sessions of Communication S k i l l s Training (CT) and a wait l i s t control group. James (1988) found that both the EFT and the EFT+CT groups achieved s i g n i f i c a n t l y higher gains than the waiting l i s t control group at post-test on the measures of marital adjustment (DAS) and target complaint improvement (TC). James (1988) found trends 6 towards significance on measures of intimacy (PIQ), and passionate love (PLS) although no s i g n i f i c a n t differences were found on these measures. On the measure of communication (CS), only the EFT+CT group achieved s i g n i f i c a n t l y higher scores than the waiting l i s t control group. No d i f f e r e n t i a l e f f e cts were found between the 2 treatment groups at post-test. Like Goldman (1987), James (1988) found some deterioration of the two treatment groups at the four month follow-up. This study was a r e p l i c a t i o n of Remple's (1986) study. The problem that this study attempted to address was what the e f f e c t of time would be for couples who received 12 one hour sessions of EFT in James (1988) study. PURPOSE AND HYPOTHESIS: In order to assess the long-term effectiveness of EFT, the purpose of this investigation was to conduct a one year follow-up of the EFT active treatment group in James' (1988) study. S p e c i f i c a l l y , t h i s investigation assessed the effects of 12 one hour sessions of EFT on the dependent measures of marital adjustment, communication, intimacy, and target complaints over a one year span of time after receiving therapy. The researcher hypothesized that couples who receive Emotionally Focused Couples Therapy (EFT) would show improvement on the mean scores of the Dyadic Adjustment Scale (DAS), the Psychosocial Intimacy Questionnaire (PIQ), the 7 Communication Scale (CS) and Target Complaints (TO over a one year span of time after receiving therapy. More s p e c i f i c a l l y , the trend was anticipated to be that of an increase on scores between pre-test and post-test followed by a decrease on scores and then a recovery or improved marital s a t i s f a c t i o n after four months. 8 CHAPTER II: LITERATURE REVIEW The focus of this l i t e r a t u r e review w i l l be on follow-up studies of outcome research in marital therapy. F i r s t , follow-up studies on various approaches to marital therapy w i l l be considered. Second, conceptual models for an Emotionally Focused Treatment Approach w i l l be discussed. F i n a l l y , outcome research on Emotionally Focused Couples therapy w i l l be reviewed. FOLLOW-UP STUDIES IN MARITAL THERAPY: Few outcome studies in marital therapy provide follow-up data beyond post-treatment assessment. Remple (1986) says: "In fact, in couples therapy, l i t t l e follow-up, short or long term has been done" (Remple, 1986, p.10). Without follow-up data i t is impossible to determine the long-term effectiveness of therapeutic approaches in marital therapy. Follow-up studies in psychotherapy research are "either absent or too brief to catch the long term e f f e c t s " (Luborsky, Singer, and Luborsky, 1975,p.1005). Some of the studies which have addressed the issue of long-term effectiveness by providing follow-up data are discussed below. Crowe (1978) conducted a comparative outcome study which included follow-up data. 42 couples were assigned to three groups: (1) a d i r e c t i v e therapy group which primarily 9 u t i l i z e d contracting, (2) an insight oriented marital therapy group, and (3) a control condition where couples met with a therapist who avoided giving advice or interpretation. Using a 16 question s e l f report global measure of marital adjustment, Crowe (1978) found the insight group was s i g n i f i c a n t l y superior to the control group at 9 month follow-up. This was not the case at post-therapy, 3 month follow-up or 18 month follow-up. Crowe (1978) found no differences between the insight group and the control group on improvement of sexual adjustment, general individual adjustment or s p e c i f i c target complaints. Yielding more promising scores, Crowe (1978) found that the contracting group was more e f f e c t i v e in reducing marital d i s t r e s s at the 9 month and the 18 month follow-up as indicated by the marital adjustment scale. On the measure of sexual adjustment, the contracting group was s i g n i f i c a n t l y superior to the control group at post-test, at 9 month follow-up and at 18 month follow-up. On the measure of individual adjustment, the contracting approach was s i g n i f i c a n t l y superior to the control group at post-treatment assessment and nine month follow-up. Inter-personal and intra-personal target complaints both showed greater improvement for the contracting group as compared to the control group. Overall the contracting group scored higher on 11 out of 20 opportunities to d i f f e r from the control condition following therapy. 10 Boelens et a l . (1980) conducted a study comparing 10 sessions of group based behavioral contingency contracting and a str a t e g i c therapy which was modelled after Haley's (1976) approach to strategic therapy. Haley's treatment was designed to provide insight into overt and covert power struggles. Boelens et a l . (1980) randomly assigned 21 couples to one of three therapy conditions: a behavioral contracting group, an insight oriented group, and a wait l i s t control group. The assumption made was that insight would lead to changes in the interactions and communication patterns of couples. Assessment of outcome was based on: (1) the Maudsley Marital Questionnaire (MMQ), a marital adjustment scale; (2) the Marital Deprivation Scale (MDS), a marital attitude scale; (3) partner ratings of the severity of their three main marital problems; (4) therapist ratings of the couple's re l a t i o n s h i p and (5) an observational rating scale of negative and positive verbal behaviour (MICS). In comparing pre and post-test scores, both the behavioral contracting and the insight oriented approaches were s i g n i f i c a n t l y higher than the w a i t - l i s t control group on the MMQ, the MDS, partner ratings, therapist ratings and observational measures of verbal interactions. At one month follow-up, the insight-oriented group had deteriorated so that no s i g n i f i c a n t differences were noted between th i s group and the control group. In comparing the findings of Crowe (1978) to the 11 findings of Boelens et a l . (1980) Beach and O'Leary (1985) point out that Boelen's et a l (1980) used more structured interventions than were used in the Crowe (1978) study. This could account for the success of the insight-oriented group in Boelens et al.(1980) study. Since Boelens et a l . (1980) only provide follow-up data at one month after treatment i t is not possible to compare the long-term effectiveness of their Insight-oriented group to the effectiveness of the Crowe (1978) insight-oriented group where data was provided at the 3 month and 18 month follow-up. Gurman et a l . (1986), point out that the Boelens et al.(1980) study and the Crowe, (1978) study do not provide adequate measures because their therapeutic interventions do not f i t with the therapy intended. As Gurman et a l . (1986) say, "therapist provision of insight is almost never an aim of s t r a t e g i c therapy" (Gurman et a l . , 1986, p.583). In terms of a substantial contribution to knowledge, the studies offer l i t t l e . The only s i g n i f i c a n t finding is that insight is not very e f f e c t i v e no matter i f i t is the r e s u l t of the interpretation of c o n f l i c t s and defenses (Crowe, 1978), or insight into overt and covert power struggles (Boelens et a l . , 1980). Baucom (1982) investigated the use of contracting in marital therapy by randomly assigning 72 m a r i t a l l y distressed couples to four treatment conditions: (1) quid pro quo contracting only; (2)communication t r a i n i n g plus contracting; (3) communication t r a i n i n g only and a w a i t - l i s t control 12 group. Measures of outcome were based on observer rating of positive and negative behaviour and two s e l f - r e p o r t measures of global marital s a t i s f a c t i o n : (1) areas of change (Wiess et a l . 1973) and (2) the Locke-Wallace marital adjustment scale (Locke & Wallace, 1959). Results proved the contracting only group to be superior to the w a i t - l i s t control group on 3 of the 4 measures: the 2 s e l f report measures and observer ratings of negative behaviour. These treatment effects were maintained at the three month follow-up. Baucom (1982) concluded that contracting is e f f e c t i v e in reducing marital d i s t r e s s . The communication tr a i n i n g plus contracting group was superior to the control group on a l l four dependant measures. 13 of the 17 couples who provided follow-up data showed no deterioration of post-therapy gains. The communication only group also yielded superior results compared to the control group on a l l dependant measures except observer rating of positive verbal behaviour. Once again, treatment effects were maintained at follow-up. Baucom's findings suggest that not only were a l l of the treatments e f f e c t i v e but that the treatment effects lasted over time. It could be argued that 3 months i s a r e l a t i v e l y short follow-up time. Longer periods of time between treatment and follow-up that show maintenance of treatment gains would y i e l d even more convincing evidence in support of the treatments imposed by Baucom (1982). 13 Jacobson (1977) conducted a one year follow-up of a controlled outcome study which evaluated the long-term effectiveness of a combination of problem-solving contracting on marital s a t i s f a c t i o n . Married couples were randomly assigned to either a problem-solving and contingency contracting group or a minimal contact w a i t - l i s t control group. Negative and positive verbal behaviour was measured using trained observers (MICS). Couple's were also asked to report on marital s a t i s f a c t i o n using Locke and Wallace's Marital Adjustment Scale. At post-test, a l l couples who received the communication and contracting t r a i n i n g performed better than the control group couples. At the one year follow-up, couples were asked to complete the s e l f -report marital inventories. At t h i s time gains on global marital s a t i s f a c t i o n were maintained. Subsequently, Jacobson (1978) investigated the outcome of two d i f f e r e n t kinds of problem-solving and contracting treatment approaches on marital d i s t r e s s . In t h i s study, 32 couples were randomly assigned to one of four groups: (1) a problem-solving and good f a i t h contracting group; (2) a problem-solving and quid pro quo contracting group; (3) a wait l i s t control group; and (4) a placebo control group. As in the Jacobson (1977) study, trained observers rated p o s i t i v e , negative and neutral verbal behaviour (MICS). In addition, two s e l f - r e p o r t measures: the Marital Adjustment Scale (Locke and Wallace, 1959) and the Marital Happiness 14 Scale (Hops, Wi l l s , Patterson and Weiss, 1971) were administered as global measures of marital s a t i s f a c t i o n . Change in rate of negative verbal behaviour for both of the problem-solving/contracting groups was s i g n i f i c a n t l y better than for w a i t - l i s t controls and placebo controls at post-test. Both of the treatment groups improved s i g n i f i c a n t l y on the two se l f - r e p o r t measures as compared to controls. At one year follow-up, the Locke-Wallace (1959) Marital Adjustment Scale was administered to assess couples. Gains in marital adjustment were maintained at one year follow-up. Jacobson et a l . (1984) conducted a re-analysis of four previously published studies on Behavioral Marital therapy. The authors c l a s s i f i e d BMT (a=148) couples into three categories: improved, unimproved and deteriorated. They base the i r c r i t e r i a of c l i n i c a l significance on post-test scores f a l l i n g outside the range of marital d i s t r e s s . The authors used a r e l i a b l e change index based on standard error of measurement. At post-test, they found s l i g h t l y less than one t h i r d of the subjects moved from the distressed to the non-distressed range. At six month follow-up, 60% maintained t h i s status while 28% deteriorated. This re-analysis shows that two thirds of couples who receive BMT remain c l i n i c a l l y distressed after therapy. Since there is no equivalent data analysis of non-behavioral marital therapies, i t is not possible to make any comparisons (Gurman et a l . , 1986). 15 Jacobson et a l . , (1987) conducted a two year follow-up study on the effects of a complete behavioral marital therapy package (CO) compared to two of i t s components: behaviour exchange (BE) and communication problem-solving t r a i n i n g (CPT). Data was collected on 34 couples who had completed the treatment and were available at 2 years after treatment for follow-up. Couples were randomly assigned to one of the three treatment groups. A global measure of marital s a t i s f a c t i o n and a che c k l i s t of presenting problems were used to assess change. The authors found no s i g n i f i c a n t differences between the treatment groups on these measures. Couples in the CO group however, were most l i k e l y to be happily married and least l i k e l y to be separated or divorced at 2 year follow-up. Jacobson et a l s . , (1987) used an interesting approach which warrants consideration. They attempted to i d e n t i f y variables which might predict long-term outcome. The authors conducted standardized telephone interviews. Although larg e l y unsuccessful in t h i s attempt, the interviews indicated neither therapist attributes nor maintenance of s k i l l s derived through treatment were associated with long-term marital s a t i s f a c t i o n . However, s t r e s s f u l l i f e events subsequent to the termination of treatment seemed to have a negative impact on the degree of marital s a t i s f a c t i o n (Jacobson et a l s . , 1987). 16 EMOTIONALLY FOCUSED COUPLES THERAPY: Theoretical Background: Developed by Greenberg and Johnson (1986), Emotionally Focused couples therapy (EFT) is an approach which combines experiential theory and systemic theory into an integrated model of marital therapy. The approach "emphasizes the role of a f f e c t in change and the role of communication and inte r a c t i o n a l cycles in maintaining problem states" (Greenberg and Johnson, 1986, p.253). Experiential therapy grew out of humanistic-existential theory. Gestalt therapy (Perls, 1951), a major experiential therapy is a h o l i s t i c approach which views resolution of "organism-environment and mind-body d u a l i t i e s [as] v i t a l to healthy functioning" (Greenberg and Johnson, 1986, p.253). Greenberg and Johnson (1986) speculated that Gestalt views would "lend themselves to an integration with systemic perspectives in which context is regarded as an important determinant of behaviour" (Greenberg and Johnson, 1986, p .253). According to systemic theory, the nature of the relationship between the individual and the environment determines behaviour. Context and perception are both seen as important determinants of behaviour. Gestalt therapy "attempts to overcome both organism-environment and mind-body d u a l i t i e s by adopting a f i e l d conception of human functioning that leads to focusing on what is occurring between the 17 organism and the environment at the contact boundary" (Greenberg and Johnson, 1986, p.253). The focus of Gestalt therapy is on blocks to experiencing and awareness ( i e . r e s t r i c t i o n s on awareness, avoidance and disowning aspects of current experience) which are believed to result in individual dysfunction (Greenberg and Johnson, 1986). In terms of human functioning, experiencing Is seen as the primary referent of data. The therapist's role i s to enter the c l i e n t ' s frame of reference and explore the r e a l i t y of the world as the c l i e n t experiences i t (Greenberg and Johnson, 1986). "Acceptance of 'what i s ' , by both therapist and c l i e n t , i s a cornerstone of thi s phenomenological approach. As blocks to experiencing and r e s t r i c t i o n s of awareness are encountered, the c l i e n t i s helped to i d e n t i f y with and integrate these aspects of functioning, thereby expanding the scope of experience and making available p o t e n t i a l l y adaptive organismic feelings and needs" (Greenberg and Johnson, 1986, p.254). Greenberg and Johnson (1986) believe that "at any given moment, there are a large number of internal processes out of which an individual's conscious experience emerges" (Greenberg and Johnson, 1986, p. 255). Greenberg and Johnson (1986) acknowledge their indebtedness to Satir ' s (1967) approach. Staying in the experiential realm, Satir (1967) developed the a f f e c t i v e -systemic approach. As a family systems the o r i s t , Satir (1967) 18 believed that the family functions as a system and regarded the feeling or emotional system of the family as of primary importance. This system is expressed through communication and therefore Satir (1967) endeavoured to have people communicate congruently. Satir (1967) believed that a mature person is able to: (a) be in touch with feelings and needs, (b) communicate these feelings and needs c l e a r l y and (c) accept others as d i f f e r e n t . Satir (1967) believed that s e l f -esteem and self-concept are r e c i p r o c a l l y related to communication dysfunction in couples. Satir (1967) used support and nurturing to f a c i l i t a t e change: "the supportive emphasis helps people experience and express feelings congruently." (Greenberg and Johnson, 1986, p.256). As mentioned e a r l i e r , EFT combines the experiential as well as the systemic views. In the experiential t r a d i t i o n , EFT emphasizes the role of a f f e c t in change (Greenberg and Johnson, 1986). In the systemic t r a d i t i o n , EFT emphasizes the role of communication and interactional cycles in the maintenance of problem states. EFT deals with both the individual sub-system and the couple system. Individual processes and how they influence the couple system are seen as c e n t r a l . Thus, EFT views the individual sub-system and the couple system as interdependent and varying simultaneously and r e f l e x i v e l y . The organizational equilibrium of these individual and couple systems is maintained simultaneously via negative interaction cycles 19 ( t y p i c a l l y pursue-vithdraw in character) and by some individual processes being more dominant in focal awareness (Greenberg and Johnson, 1986; James, 1988). Change in couples' interactions is brought about by reframing negative interactional cycles in terms of underlying emotional experiences in each partner. In EFT attention is paid to current interaction and the current experiential process within the i n d i v i d u a l . Change occurs by changing the c l i e n t ' s view of s e l f and by a change in their context (ie partner's communication). Following the exper i e n t i a l t r a d i t i o n , insight into " s e l f " is not enough. The c l i e n t must experience on an emotionally meaningful l e v e l . Partners must encounter each other in the session and part i c i p a t e in a corrective emotional experience. This process re-establishes the p o s s i b i l i t y of having a positive human relationship with each other (Greenberg and Johnson, 1986) . This approach assumes that partners have healthy feelings, needs and wants that w i l l emerge with the help of the therapist. A major hypothesis of EFT i s that accessing and expressing primary feelings, needs and wants by spouses can aid adaptive problem-solving and produce intimacy. EFT recognizes that major needs for couples include closeness, contact, comfort and intimacy. EFT s t r i v e s to meet these needs by exploring intra-psychic fears of closeness and int e r a c t i o n a l patterns that prevent closeness. These 20 i n t e r a c t i o n a l patterns are major targets for change. In EFT, therapist intervention involves establishing a trusting relationship with both partners and then encouraging each to make e x p l i c i t statements to their partner of current experiencing of feelings and needs. A d i s t i n c t i o n is made between ta l k i n g about feelings and the experience of feelings in a l i v e manner in the present. Good s k i l l s in communication are seen as developing out of change, in that emotionally oriented encounters change the sty l e of couple's communication. Experiencing new feelings (underlying feelings) helps motivate problem-solving and good communication practices. Seeing the partner as more receptive and accessible also f a c i l i t a t e s open communication. Through disclosure of underlying fears the spouse develops a new perception of their partner's underlying feelings (Greenberg and Johnson, 1986). In summary, the deepening of experience brings new aspects of the s e l f into focal awareness. Interactional behaviours are p o s i t i v e l y reframed in terms of underlying emotional states. This leads to a change in the sequence of interactions. The change process is as follows: 1. The individual perceives him/herself d i f f e r e n t l y by bringing experiences into focal awareness. 2 . The spouses witnesses t h i s leading to them seeing their partner d i f f e r e n t l y . 3. The individual's personal reorganization leads to 21 d i f f e r e n t behaviour in their interaction with their spouse. For example, the individual shares their v u l n e r a b i l i t y and now asks for reassurance from their spouse rather than blaming their spouse. 4. The spouses new perception leads to d i f f e r e n t responses ( i e . comforts rather than withdraws). 5. The individual sees himself d i f f e r e n t l y as a res u l t of spousal responses. The therapist role in t h i s process is to establish a therapeutic a l l i a n c e with both partners and then to f a c i l i t a t e accessing of the c l i e n t ' s emotional experience. The therapist reframes the couple's Interactions and helps the c l i e n t s to symbolize and integrate t h i s new experience in a way that w i l l enhance the couple's responsiveness to one another. The therapist achieves t h i s by continually focusing the c l i e n t inward and by focusing on the here and now, thus heightening the c l i e n t s ' experience. Greenberg and Johnson (1986) i d e n t i f y nine treatment steps: 1. Delineating c o n f l i c t issues in the core struggle. 2. Identifying the negative int e r a c t i o n a l cycle. 3. Accessing unacknowledged feelings. 4. Reframing the problem, in terms of underlying needs. 5. Promoting i d e n t i f i c a t i o n of disowned needs. 6. Promoting acceptance of the partner's experience. 7. F a c i l i t a t i n g expression of needs and wants. 22 8. Establishing emergence of new solutions. 9. Consolidating new positions. (Greenberg and Johnson, 1986) RESEARCH STUDIES ON EMOTIONALLY FOCUSED COUPLES THERAPY: The following studies bear pa r t i c u l a r significance to th i s research study as they investigate the effects of EFT. A review of EFT outcome research yields promising results and c a l l s for further investigations into the effectiveness of t h i s approach. One of the f i r s t investigations into the e f f i c a c y of EFT was a comparative outcome study conducted by Johnson and Greenberg (1985a). In t h i s study, the researchers compared Cognitive-Behavioral marital therapy (CBMT) and Emotionally Focused couples therapy (EFT). Johnson and Greenberg (1985a) randomly assigned 45 couples to two active treatment groups and to a w a i t - l i s t control group. Results showed that after eight sessions both treatment groups showed improvement over w a i t - l i s t controls on measures of goal attainment, marital adjustment, level of intimacy and target complaints. EFT was superior to CBMT on marital adjustment, l e v e l of intimacy and reduction of target complaints. To add further support to these findings, Johnson and Greenberg (1985b) conducted a p a r t i a l r e p l i c a t i o n of their o r i g i n a l study by giving the w a i t - l i s t control group eight sessions of EFT. S i g n i f i c a n t changes were noted on most of 23 the dependent measures used in the o r i g i n a l study. Interestingly, the overa l l e f f e c t was less than one half of that noted in the main study ( i e . Johnson and Greenberg, 1985a). The authors attributed t h i s to the use of novice therapists in the r e p l i c a t i o n study. The results of the Johnson and Greenberg (1985a) and (1985b) studies are more promising than the other studies of non-behavioral marital therapy reviewed above. As Gurman et a l . (1986) state: "When attention to out of awareness experience and feelings is paired with active therapist e f f o r t s to reframe and modify overt behaviour and to translate the connection between inner experience and overt behaviour as in the Johnson and Greenberg (1985a,1985b) studies, much more impressive outcomes are achieved." (p. 584) Goldman (1987), conducted an outcome study of the d i f f e r e n t i a l effects of EFT and Structural Strategic therapies on couples' c o n f l i c t resolution. Goldman u t i l i z e d interventions d i s t i n c t i v e to each approach. Clients were given 10 sessions of either EFT or Structural Strategic therapy. Client's were assessed at termination of treatment and at 4 month follow-up. Although s i g n i f i c a n t gains were noted at post-test, at 4 month follow-up both groups had regressed. Remple (1986) conducted a one year follow-up on the Goldman (1987) study. Implementing the same measures as were used in the Goldman study, Remple (1986) found that at one 24 year after receiving EFT therapy, couples had improved their scores from the four month follow-up suggesting a "sleeper e f f e c t " . These findings are of particular interest to thi s researcher given the findings in the James (1988) study. As mentioned e a r l i e r , James (1988) conducted an outcome study which measured the effects of EFT. When compared to a wait l i s t control group, couples who received 12 sessions of EFT showed s i g n i f i c a n t increases on the measures of marital s a t i s f a c t i o n (DAS) and reduction of target complaints (TC) at post-test. Although there were trends toward significance on measures of intimacy (PIQ) and communication (CS), no s i g n i f i c a n t differences were found. Like Goldman (1987) had discovered, James found that couples had regressed when measured at four month follow-up. The question l e f t to be answered then was whether couples would experience gains to post treatment levels when measured at one year follow-up as they did in Remple's (1986) one year follow-up of the Goldman (1987) study. By conducting a p a r t i a l r e p l i c a t i o n of the Remple (1986) study (in conducting a one year follow-up of the James (1988) study) t h i s question was addressed by the researcher in thi s study. The James (1988) study provided a unique opportunity not only to conduct a long-term follow-up study on the effectiveness of a bona fide psycho-dynamic experiential marital therapy, that i s , Emotionally Focused therapy, but also to re p l i c a t e the Remple (1986) study. 25 CONCEPTUAL HYPOTHESIS: The review of the l i t e r a t u r e indicated that the general trend found in EFT marital therapy outcome studies is that couples regress from post-treatment levels after the termination of therapy. Because Remple (1986) discovered that the EFT group in the Goldman (1987) study recovered to post-treatment levels between the four month and the one year follow-up, a finding which is contrary to the general trend of post-treatment regression, this researcher questioned whether couples who received EFT in James' (1988) study might show a similar trend. It was hypothesized that couples who receive EFT would show improvement on the mean scores of the Dyadic Adjustment Scale (DAS), the Psychosocial Intimacy Questionnaire (PIQ), the Communication Scale (CS), and Target Complaints (TC) over a one year span of time after receiving therapy. More s p e c i f i c a l l y , the trend was anticipated to be that of an increase, followed by a decrease and then a recovery, or improved marital s a t i s f a c t i o n after four months. CHAPTER II I : DESIGN AND METHODOLOGY Design of Original Study: The basic design of the James (1988) study was a three factor, 3x7x3 treatment by therapist by occasion, mixed model. This design assumed the couple as a unit of analysis as determined by the combined score of the male and the female within the dyad divided by two. The o r i g i n a l study took the following form: 01 R TI 02 03 01 R T2 02 03 01 R 02 03 T2 Where: Tl= 12 one hour sessions of Emotionally Focused couples therapy T2= 8 one hour sessions of Emotionally Focused therapy plus four one hour sessions of communication s k i l l s t r a i n i n g . Wait l i s t controls were given T2 after the completion of the main experiment. Subjects: Subjects were obtained v i a a newspaper a r t i c l e in the Vancouver sun, Vancouver Courier, and the Province. Subjects went through an i n i t i a l telephone screening interview followed by an assessment interview. Couples were screened based on the following c r i t e r i a : 1. Partners must have co-habitated for a minimum of twelve months and be currently l i v i n g together. 2 7 2. Partners must have had no immediate plans for divorce. 3. Partners must not have received any psychiatric treatment or psychiatric h o s p i t a l i z a t i o n within the last two years. 4. Partners must have had no reported problems with drugs or alcohol. 5. Partners must have had no reported primary sexual dys funct ion. 6. Partners scores on Dyadic adjustment scale must not have f a l l e n in the severely distressed range.(Note, James (1988) followed Burger and Jacobson's (1979) c r i t e r i a of at least one partner scoring below 100, and Spanier's (1976) norm which was determined by studying 70 divorced couples). 7. Partners had to consent to research procedures, testing and audio-video taping. 8. Partners must not have been currently involved in any other psychologically oriented treatment, on either an individual or a couple basis, (James, 1988). In the o r i g i n a l study there were 42 couples (n=42). From t h i s group, 14 couples were randomly assigned to the three treatment groups: EFT, EFT plus CT, and the wait l i s t c o n t r o l . Couples in the wait l i s t control group were advised that there would be a three month waiting period before counselling would begin. Demographics were collected for the 42 couples in the o r i g i n a l study. Demographic data for the ten couples to be used in the proposed study are: 28 1. The number of years l i v i n g together ranged from 2-26 years with the average for the group being 9.4 years. 2. The number of children per couple ranged from 0-4 children with the average number being 1.5. 3. 30% of the couples had received previous marital counselling. 4. The average age=42.6 years. 5. The couples gross income ranged from under 15,000 to above 55,000 per anum. 6. The average number of years of education was 13.95 years. Therapists: Therapists were volunteer graduate students from the Department of Counselling Psychology at The University of B r i t i s h Columbia. Therapists were randomly assigned to treatments. In the EFT treatment there were two male therapists and f i v e female therapists. In EFT+ CT treatment there were three male therapists and four female therapists. Data were gathered concerning the following therapist c h a r a c t e r i s t i c s gender, general experience in counselling, experience in couples counselling, amount of tr a i n i n g in marital/family therapy. Therapist Training: A l l therapists received t r a i n i n g using the EFT Manual (see James, 1988). Training consisted of Instruction, 29 modelling, tape presentations of interventions, and behavioral rehearsal of the EFT interventions. Training was conducted by the investigator (Paul James) under the supervision of Dr. John Friesen, Department of Counselling Psychology, U.B.C. Therapists were given twelve hours of tr a i n i n g followed by six two and one half hour group supervision sessions. These were held bi-weekly, combining therapists from both treatment groups. Therapists assigned to the EFT treatment group were given two further two and one half hour group supervision sessions as an intact group. Therapists assigned to the EFT+CT treatment group were given four such supervision sessions. Supervision consisted of video tape analysis and discussion. Therapist Integrity: Therapist accuracy in implementing EFT treatment interventions was ensured by having two independent raters rated randomized segments of EFT audio-taped sessions. The raters were two magisterial students from the Department of Counselling Psychology U.B.C. The raters were given ten hours of t r a i n i n g . There were two phases in the rating . During phase 1 sessions 2-8 were analyzed. In phase 2 sessions 9-11 were analyzed. 30 DESIGN OF THE ONE YEAR FOLLOW-UP STUDY: As mentioned above, the o r i g i n a l study took the following form: 01 R TI 02 03 01 R T2 02 03 01 R 02 03 T3 The design of the one year follow-up study took the following form: 01 TI 02 03 04 Where TI = 12 one hour sessions of EFT. As in the James (1988) study, the unit of analysis in the one year follow-up study was the couple as determined by the combined score of the male and the female within a dyad divided by two; i e . , the average score for the dyad. Subjects: The one year follow-up study considered only one treatment group from the o r i g i n a l study; that was, TI, the group which received twelve sessions of Emotionally Focused Therapy. Nine of the 14 couples in TI of the o r i g i n a l study served as subjects (n=9). A l e t t e r r e c r u i t i n g these subjects for the follow-up study study was sent out to a l l 14 couples who participated in the o r i g i n a l study. Although a l l 14 couples responded to the l e t t e r , 5 were unable to p a r t i c i p a t e . 3 of the couples offered no explanation for not wishing to participate . One 31 couple chose not to participate because they were now separated. One couple i n i t i a l l y agreed to participate in the one year follow-up study but moved out of province prior to the study and consequently contact with them was l o s t . The c r i t e r i a for screening the couples for the one year follow-up study was that couples must be w i l l i n g and able to participate in a one and one half hour follow-up interview and to complete the follow-up instruments. Assessment Procedures: The couples were asked to participate in a one and one half hour interview to take place at their residence one year after the termination of treatment in the o r i g i n a l study. The nine couples were assessed by administering the four primary instruments used in the o r i g i n a l study (one secondary measure, the Passionate Love Scale, was not used). The measures were: 1. Dyadic Adjustment Scale (DAS) (Spanier, 1976): The DAS is a commonly used measure of marital adjustment. Although the scale measures individuals' adjustment to the relat i o n s h i p i t also offers the a b i l i t y to measure the couples' l e v e l of adjustment to the rel a t i o n s h i p . "Although developed primarily out of the family-sociological t r a d i t i o n , the DAS can be used meaningfully within a wide range of therapeutic orientations" (Spanier & F i l s i n g e r , 1983, p. 32 161). The DAS includes four subscales: Dyadic Consensus, Dyadic Cohesion, Dyadic S a t i s f a c t i o n and A f f e c t i o n a l Expression. For the purposes of t h i s study, only the t o t a l scores were considered. The DAS has 32 items and a range of possible scores of between 0-151 The r e l i a b i l i t y for the entire 32 item scale i s .96. Spanier (1976) established the v a l i d i t y of the DAS in three ways: " F i r s t , judges determined content v a l i d i t y based on the t h e o r e t i c a l dimensions. Second, the scale discriminated between married and divorced samples, suggesting c r i t e r i o n related v a l i d i t y . . . . Third, the DAS has the construct v a l i d i t y of conforming to a t h e o r e t i c a l structure". (Spanier & F i l s i n g e r , 1983, p.162) The types of v a l i d i t y offered by the scale include content v a l i d i t y , c r i t e r i o n related v a l i d i t y (scale discriminates between married and divorced couples), concurrent v a l i d i t y (scale correlated with Marital Adjustment Test, Locke and Williamson, 1950) and construct v a l i d i t y (scale conforms to a t h e o r e t i c a l structure). Spanier's (1976) norms for married couples are 114.8 (SD 17.8) and for divorced couples are 70.7 (SD 23.8). In the o r i g i n a l study the DAS was used as a screening and a pre-treatment measure as well as "a general measure of outcome at termination and follow-up" four months after treatment (James, 1988, p.70). The DAS was administered one year after treatment as a long-term follow-up measure in the one year follow-up study. 33 2. Communication Scale (CS) (Olson, Fournier and Drunkman,1985): This ten item subscale of the ENRICH Marital Inventory (ENRICH) stands for: Evaluating and Nurturing Relationship Issues, Communication and Happiness. The scale assesses the individual's feelings, b e l i e f s , and attitudes about marital communication. This is a standardized measured which is based on a sample of 672 couples. Olson et a l . (1985) report an internal consistency (Chronbach's alpha) of .68; based on a sample of 115 individuals and a four week inte r v a l testing occasion, they report a t e s t - r e - t e s t r e l i a b i l i t y of .90. 3. Psychosocial Intimacy Questionnaire (PIQ) (Tesch, 1985): The PIQ assesses the construct of psychosocial intimacy in adult and adolescent relationships and can be used as a construct in friendship, dating, or marital relationships. The psychometric properties of this measure were based on three studies of college aged samples. In terms of construct v a l i d i t y , the scale correlates both p o s i t i v e l y and negatively on scores of measures of similar and d i s s i m i l a r constructs respectively. R e l i a b i l i t y of the measure for opposite sex relationships shows an internal consistency of .98 and a t e s t - r e - t e s t r e l i a b i l i t y of .84. According to Tesch (1985), psycho-social intimacy is contingent upon three major factors: I. Romantic Love: items pertaining to love, emotional expression, physical intimacy and interdependence. 34 II. Supportiveness: Items pertaining to respect, helpfulness and acceptance. III . Communication Ease: Items pertaining to being oneself, communicating, and a lack of ambivalence about the re l a t i o n s h i p . As in the o r i g i n a l study, three items were excluded (825, #34, and #60) because these items seemed inappropriate to the couples under consideration. 4. Target Complaints (TC) (Battle, Imber, Koehn-Saric, Stone, Nash, & Frank, 1966): TC i s used to measure the effectiveness of treatment in r e l a t i o n to presenting problems in therapy. TC is an individualized measure which assesses individuals' spontaneously expressed presenting complaints or target complaints. TC ratings of improvement have been shown to be e f f e c t i v e outcome measures in many d i f f e r e n t types of therapy studies (Mintz and K e i s l e r , 1982). The r e l i a b i l i t y of Target Complaints was based on two studies by Battle et a l . , (1966). The f i r s t study showed a c o r r e l a t i o n of .68 between rankings of complaints before and after an assessment interview with no s i g n i f i c a n t change in the severity of ratings. The second study showed no s i g n i f i c a n t differences in target complaints reported to d i f f e r e n t interviewers. V a l i d i t y of the measure is shown by the fact that TC correlated s i g n i f i c a n t l y with other outcome measures. Also, target complaints were congruent with pre-testlng complaints in an independent psychiatric assessment. Mintz and Kiesler (1982) report good face v a l i d i t y because target complaint Items are obtained 35 from spontaneous reports. In the o r i g i n a l study couples were asked at the assessment interview to write down 3 relationship issues in order of p r i o r i t y which they hoped to resolve in therapy. At the post-test interview couples were asked to rate the degree of improvement of these three complaints. Data analysis was based on the degree of improvement of the primary target complaint. This was done because Mintz and Keisler (1982) noted that the var i a t i o n in the severity of the primary i n i t i a l problem is l i k e l y to be smaller than the va r i a t i o n in the severity of the second and th i r d complaints (James, 1988, p.73). In the one year follow-up study, couples were asked once again to rate their stated target complaints in terms of perceived improvement. OTHER MEASUREMENT PROCEDURES: Structured Interview: In addition to the quantitative data, a structured interview was conducted in order to gather q u a l i t a t i v e data. This interview was designed to e l i c i t information with regard to l i f e events which may have had an influence on the le v e l of marital s a t i s f a c t i o n ( i e . loss of employment, deaths, f i n a n c i a l s i t u a t i o n etc.) The interview attempted to assess how the couples f e l t the Emotionally Focused therapy may have influenced their degree of marital s a t i s f a c t i o n . Following is the l i s t of questions which were asked. 36 Questions: 1. Do you perceive your relationship as having improved, deteriorated or remained the same since the end of counselling in the Couple's Project? 2. To what do you attribute t h i s improvement, deterioration or maintenance? 3. What s t r e s s f u l l i f e events or l i f e changes have occurred since the end of counselling in the "Couple's Project" ? ( l e . change of job, deaths, b i r t h s , moves, etc.) 4. To what degree do you think these s t r e s s f u l l i f e events or l i f e changes have influenced how you are doing in your rel a t i o n s h i p now? C i r c l e the appropriate response. not at a l l very l i t t l e somewhat moderately a great deal 5. How much has your rela t i o n s h i p changed as a r e s u l t of these s t r e s s f u l l i f e events or l i f e changes? C i r c l e : not at a l l very l i t t l e somewhat moderately a great deal 6. What further counselling, i f any, have you received since the end of counselling in the "Couple's Project"? (Type, length) 7. If you have received further counselling, has t h i s counselling influenced how you are doing In your relationship now? Explain. 37 Operational Hypothesis: The hypothesis under investigation in this study was that couples who receive EFT would show a trend of improvement on the mean scores of the Dyadic Adjustment Scale (DAS), the Psychosocial Intimacy Questionnaire (PIQ), the Communication Scale (CS), and Target Complaints (TC) over a one year span of time after receiving therapy. More s p e c i f i c a l l y , the trend anticipated was one of improvement from pre-test to post-test followed by regression at four months follow-up and then an improvement at one year follow-up . DATA ANALYSIS: This study investigated the ef f e c t of an e x p e r i e n t i a l l y focused marital therapy, EFT, on the dependant measures of marital adjustment, communication, intimacy and reduction of target complaints over a one year span of time. It was hypothesized that the outcome of receiving EFT would be improved marital s a t i s f a c t i o n as measured by the four dependant variables: the DAS, PIQ, CS and TC. Remple's (1986) one year follow-up study suggests that the EFT treatment may have a "sleeper e f f e c t " ; that i s , with time, the treatment may influence increased marital s a t i s f a c t i o n by showing increases on the dependant variables between four month follow-up and one year follow-up. Therefore, the hypotheses w i l l be stated as follows: 38 HI: It was hypothesized that couples who received Emotionally Focused Couples Therapy would show improvement on the mean scores of the Dyadic Adjustment Scale (Spanier, 1676), the Psychosocial Intimacy Questionnaire (Tesch, 1985), the Communication Scale (Olson et a l . , 1985), and Target Complaints (Battle et a l . , 1966) over a one year span of time after receiving therapy. DATA ANALYSIS PROCEDURES: A preliminary analysis was followed by analysis of quantitative and then q u a l i t a t i v e data. A description of each analysis is presented below. Preliminary Analysis: Because only 9 of the 14 o r i g i n a l EFT couples from James' (1988) study participated in the one year follow-up study, there existed the p o s s i b i l i t y that subject selection bias might confound the interpretations of treatment r e s u l t s . Assumptions of group equivalence (participants versus non-participants) were tested by comparing the mean scores at four month follow-up on the DAS for the two groups. This comparison was done by using a t- t e s t to compare the 2 independent group means. Analysis of Quantitative Data: The data on the 4 c r i t e r i o n measures were analyzed. Couples' mean scores on the DAS, PIQ, CS and TC were plotted on li n e graphs. A repeated measures analysis of variance was then conducted in order to determine the existence of s i g n i f i c a n t increases on mean scores of the DAS, PIQ, CS, and TC over four occasions i e . , pre-treatment, post-treatment, four months after treatment and one year after treatment. Only post-treatment, four month follow-up and one year follow-up scores were available on the Target complaints measure. This was because Target Complaints measures amount of improvement of primary complaints as measured at pre-test. Therefore, the analysis took the following form: 1. Analysis A: a one group (EFT) by four occasions (pre-test, post-test, four month follow-up and one year follow-up) repeated measures analysis of variance on the DAS (t o t a l score), CS and PIQ. 2 . Analysis B: a one group (EFT) by three occasions (post-test, four month follow-up, and one year follow-up) repeated measures analysis of variance on TC. Since the analysis of variance indicated s i g n i f i c a n t differences, a post hoc analysis was conducted. The Student Newman-Keuls method of pair-wise comparisons was used to determine s i g n i f i c a n t differences on couple mean scores across occasions on the four measures: DAS, CS, PIQ, and TC. the importance of using this method is that i t allowed pair-wise comparisons (differences between a l l possible pairs of means) on the f i r s t , second, t h i r d and fourth occasions. Because a trend of improvement was anticipated over time, a trend analysis was conducted on the data. This analysis provided an overall picture of the data by id e n t i f y i n g points of i n f l e c t i o n in the data and thereby revealing patterns of change on mean scores over time. Analysis of Qualitative Data: The structured interview provided additional information as to the changes couple's experienced over a one year span of time after receiving EFT. The information gathered from the interviews was compiled and summarized. A summary of the results i s presented in Chapter IV. 41 CHAPTER IV: RESULTS AND DATA ANALYSIS Results of Preliminary Analysis: In order to check i f any s t a t i s t i c a l l y s i g n i f i c a n t differences existed between couples who participated in the one year follow-up study (group 1) and couples who chose not to participate (group 2), a t-test was used to compare the mean scores of the two groups at four month follow-up. The DAS was selected as the c r i t e r i o n measure because i t was the measure used to determine inclusion in the o r i g i n a l (James, 1988) study, and because a graphical analysis, as can be seen in Figure 1, indicated the largest spread between the groups as compared with differences between mean scores for the other standardized measures ( i e . CS,PIQ, TC). Results indicated no s i g n i f i c a n t differences between the group of participants (M> 101.2) and the group of non-participants (E=91.2), t(12) = .00286, p<.05. Results of Quantitative Data: Dyadic Adjustment Scale: A repeated measures analysis of variance was conducted using the DAS scores as measured on four occasions: pre-te s t , post-test, four month follow-up and one year follow-up. These scores can be seen in Table I. A l i n e graph representing these scores can be seen in Figure 2. A summary Anova table for a l l four dependent variables used in the study is represented in Table II. The analysis showed a 42 C a C f a 2 c o S 280 r-270 -260 -250 -240 -230 -220 -210 -110 -100 -90 -80 -% 50 -40 -30 -20 -10 -0 — Legend: 0- D y a d i c Adjustment Scale d~ Psychosocial Intimacy Scale X~ Communication Scale O - Target Complaints aon-part ic ipants participants PRE POST Occassions 4 months I year Figure 1: Participant vs. N o n - Participant M e a n Scores on Se l f - repor t Measures Table I : Data Gathered on Dyadic Adjustment Scale Raw Score, Mean and Standard Deviation Across Four Occasions Couple # Pre-test Post-test Four Mo. Follow-up One Year Follow-up 1 85.5 104 99.5 96.5 2 84 100.5 97 101.5 3 85.5 104 99.5 78.5 4 78.5 104 89.5 89.5 5 103.0 116 113 114 6 80.5 110.5 109 110.5 7 76.5 96 93 87 8 104.5 124.5 108.5 113 9 81 102.5 102 97.5 X 86.5 106.8 101.2 98.1 SD. 10.21 8.73 7.75 12.32 44 150 r 140 130 | 120 -3 110 >- 100 [-g 9 0 M 8. 8 0 IA C 70 PRE POST 4 months Occassions 1 year Figure2: Mean Stores on the Dyadic Ajustment Scale ot Pre-treatment. Post-treatment, 4 Month Follow-up & 1 year Follow- up 45 T a b l e , H : Repeated Measures one Factor Analysis of Variance Analysis pf variance Across 4 Occasions; Mean, (Std. Dev.). and F-ratlos Pre-test Post-test Four mos. Follow-up One year Follow-up Variable X X X X F PR F DAS 86.55 (10.21) 106.88 (8.73) 101.22 (7.75) 98.11 25. (12.13) 56 0.0001 PIQ 228.22 (19.95) 264.11 (24.36) 249.94 (26.30) 246.94 (33.27) 6. 20 0.0029 CS 26.22 (3.29) 34.27 (4.38) 29.50 (3.96) 31.22 (4.19) 28 .33 0.0001 TC 4.61 (.416) 4.11 (.416) 4.05 (.634) 6 .28 0.0097 Note: 1. n~9 for Emotionally Focused Therapy treatment 2. S t a t i s t i c s (F,P) represent across time analysis 3. DAS= Dyadic Adjustment Scale, PIQ= Psychosocial Intimacy Questionnaire, CS= Communication Scale, TC= Target Complaints s i g n i f i c a n t difference in the mean scores over time, £.(3,24) = 25.56, pjC.0001. Thus, the Ho of no s i g n i f i c a n t e f f e c t was rejected. Therefore the hypothesis that the couples exposed to the EFT treatment w i l l show a s i g n i f i c a n t increase in marital s a t i s f a c t i o n as measured by scores on the DAS over a one year span of time was held as tenable. To determine the difference between a l l possible pairs of means on the four occasions: pre-test, post-test, four month follow-up and one year follow-up, the Student Newman-Keuls method of pair wise comparisons was used. This method revealed s i g n i f i c a n t increases on DAS scores between pre-test and post-test, pre-test and four month follow-up, pre-test and one year follow-up, post-test and 4 month follow-up and f i n a l l y , between post-test and one year follow-up. There were no s i g n i f i c a n t differences found between four-month follow-up and one year follow-up. Trend analysis on the DAS scores across the four occasions Indicated a s i g n i f i c a n t cubic trend, F_(3,24) = 14.20, a<.0009. Psychosocial Intimacy Questionnaire: Data was gathered on the PIQ and can be seen in Table I I I . Mean scores were plotted on a li n e graph to provide a v i s u a l picture of the data (see Figure 3). A repeated measures analysis of variance was used to analyze scores on the PIQ across four occasions: pre-test, post-test, four Table I I I : Data Gathered on Communication Scale Raw Score, Mean and Standard Deviation Across Four Occasions Couple Pre-test Post-test Four Mo. One Year I Follow-up Follow-up 1 32. 5 35 31.5 32 2 25 34.5 29.5 28.5 3 28.5 37.5 31 31 4 22.5 29.5 25 28 5 26.5 41 32 37 6 28 35 35 34.5 7 26.6 36.5 31.5 33.5 8 25 33.5 30 33.5 9 21.5 26 22.5 23 X 26.2 34.27 29.7 27.1 SD. 3.29 4.38 3.96 4.19 Figure 3-* Mean Scores on the Psychosocial Intimacy Questionaire at Pre-treatment, Post-treatment, 4 Month Follow-up & 1 Year Follow-up 49 month follow-up and one year follow-up. The analysis indicated the following. There were s i g n i f i c a n t therapy effects over time on PIQ scores, £.( 3,24) = 6.20, p_<.0029. Therefore, the hypothesis that couples exposed to EFT w i l l show a s i g n i f i c a n t increase in marital s a t i s f a c t i o n as measured by scores on the PIQ over a one year span of time was held as tenable. As before, the Student Newman-Keuls method of pair-wise comparisons was used to determine the differences between a l l possible pairs of means on the four occasions: pre-test, post-test, four month follow-up, and one year follow-up. A s i g n i f i c a n t difference was found between pre-test and each of the other three occasions: post-test, four month follow-up and one year follow-up. No s i g n i f i c a n t differences were seen between post-test and four month follow-up, post-test and one year follow-up, and four months follow-up and one year follow-up Trend analysis indicated a s i g n i f i c a n t cubic trend, F(3,24) = 5.29, p_<.03. Communication Scale: Data was gathered for scores on CS across the four occasions and is represented in Table IV. Mean scores were plotted on a lin e graph (see Figure 4). The repeated measures analysis of variance conducted on the communication Scale scores across the four occasions (pre-test, post-test, Table IV: Data Gathered on P s y c h o s o c i a l Intimacy S c a l e Raw Score, Mean, and Standard D e v i a t i o n Across Pour Occasions Couple P r e - t e s t Post t e s t Four Month One Year # Follow-up Follow-up 1 251.5 257 261.5 267 2 224 262.5 229.5 242.5 3 227 270.5 262 205 4 192 242.5 202 226 5 249 313.5 284.5 299.5 6 221.5 226. 5 271 270.5 7 223.5 264.5 260.5 245.5 8 252 281.5 256.0 267.5 9 213.5 258.5 222.5 197 X 229.3 235.38 249.94 246.2 SD. 19.86 24.36 26.30 33.27 51 Figure 4: Mean Scores on m« Communication Scale at Pre-treatment, Poit treatment, 4 Month Follow-up and 1 year Follow-up 52 four month follow-up and one year follow-up) indicated that there was a s i g n i f i c a n t increase on CS scores over the four occasions, F_(3,24) = 28 . 33, p_<.0001 (see Table 1). Therefore, the hypothesis that couples exposed to EFT treatment w i l l have a s i g n i f i c a n t increase in marital s a t i s f a c t i o n as indicated by scores on the Communication Scale as measured over a one year span of time after receiving therapy. The Student Newman-Keuls method of pair-wise comparisons indicated a s i g n i f i c a n t difference in mean scores between pre-test and post-test, pre-test and four months follow-up, pre-test and one year follow-up, post-test and four month follow-up and post-test and one year follow-up. No s i g n i f i c a n t differences were found between four month follow-up and one year follow-up. Trend analysis showed no s i g n i f i c a n t trends of the mean score . Target Complaints: Data was gathered for scores on the Target Complaints measure and can be seen in Table V. The data was plotted on a l i n e graph and can be seen in Figure 5. A repeated measures analysis of variance was used to analyze scores on Target Complaints as measured at post-test, four month follow-up and one year follow-up. Pre-test scores were excluded because the Target Complaints instrument measures the reduction of Table V : Data Gathered on Target Complaints Raw Scores, Mean and Standard Deviation Across Three Occasions Couple Post-test Four Month One Year ft Follow-up Follow-up 1 4.0 4.0 4.5 2 5.0 4.0 4 . 5 3 5.0 4.0 3.0 4 4.5 4.0 4.0 5 5.0 5.0 5.0 6 5.0 4.5 4.5 7 4 . 5 4.0 3.5 8 4 . 5 4.0 4.0 9 4.0 3.5 3 . 5 X 4.6 4.1 4 .05 SD. .416 . 416 .634 5r c Ol 1 1 : 1 /< 1— PRE POST 4 months 1 year Occassions Figure 5: Mean Scores on Target Complaints at Post-treatment, 4 Month Follow-up & 1 Year Follow up primary complaints which couples i d e n t i f i e d at pre-test by applying a numerical value to the degree of change noted by couples after treatment. The analysis indicated a s i g n i f i c a n t improvement on mean TC scores over a one year span of time, H O , 2 4 ) = 6 . 2 8 , p_<.0097. Therefore the Ho of no s i g n i f i c a n t treatment ef f e c t was rejected and the hypothesis that couples exposed to EFT treatment w i l l show a s i g n i f i c a n t increase in marital s a t i s f a c t i o n as measured over a one year span of time was held as tenable. The Student Newman-Keuls method of pair-wise comparison showed a s i g n i f i c a n t difference between mean scores as measured at post-test and four month follow-up and post-test and one year follow-up. No s i g n i f i c a n t differences were found between four month follow-up and one year follow-up. Trend analysis showed no s i g n i f i c a n t trends of the mean scores. Results of Qualitative Data: A structured interview was conducted at one year follow-up. The interview was designed to flush out possible extraneous variables which might have influenced the results.The interview consisted of 7 questions. A descriptive summary of the results of the structured interviews w i l l be presented. In response to the question of whether couple's 55 perceived their relationships as having improved, deteriorated or remained the same since the end of counselling in the Couple's Project, 7 of the 9 couples (78%) reported that they f e l t t heir r e l a t i o n s h i p had improved. 2 of the 9 (22%) reported that they f e l t their relationship had deteriorated. When asked what they attributed this improvement or deterioration to, of the couples who reported improvement, 6 of 7 reported that they were able to communicate better; 5 of 7 reported having a better understanding of their partner's needs; and 4 of 7 reported having a stronger commitment to the relat i o n s h i p and to working on relationship issues. Of the two couples who reported deterioration since the end of counselling, one couple blamed a lack of time together while the other couple f e l t they had missed the support of counselling and were lacking in communication s k i l l s . In response to the question of what s t r e s s f u l l i f e events or l i f e changes had occurred since the end of counselling, 5 couples mentioned job related stress or changes. 2 couples reported having a baby, one couples' daughter got married, one couple reported family i l l n e s s and one couple reported the loss of close friends who had moved out of the country. Of the two couples who reported deterioration in their r e l a t i o n s h i p , only one of the couples reported s t r e s s f u l l i f e events or changes. This is interesting as i t seems to contradict the findings in the 56 Jacobson et a l . (1978) study. Jacobson et a l . (1978) analyzed standardized telephone interviews of 34 couples 2 years after receiving marital therapy. The authors concluded that " s t r e s s f u l l i f e events subsequent to therapy termination were negatively related to marital s a t i s f a c t i o n " (Jacobson et a l . (1978, p. 187). When asked to what degree couples f e l t these events or changes had influenced how they were currently doing in their relationships, 2 couples reported "not at a l l " , 2 couples chose "very l i t t l e " , 2 couples said "moderately", while 3 couples said "a great deal". When asked how much their relationship had changed as a result of these s t r e s s f u l events or l i f e changes, 3 of the 9 couples reported "not at a l l " , 1 of the 9 reported "very l i t t l e " , 1 of the 9 reported "moderately" and 3 of the 9 reported "a great deal". One couple reported no changes. Couples were asked i f they had obtained further counselling since the end of the Couple's Project. 4 of the 9 couples reported that they had received further counselling. Two of these couples obtained individual counselling for issues unrelated to their r e l a t i o n s h i p , while two couples attended group workshops; one focused on communication s k i l l development while the other focused on parenting. Of the four couples who had received further counselling, only the couple who attended the parenting group f e l t that the counselling had influenced their relationship. 57 CHAPTER V: DISCUSSION OF RESULTS Positive treatment effects are r a r e l y maintained over the long term (Remple, 1968, pp.54 & 55). The l i t e r a t u r e indicates a lack of research concerned with the maintenance of treatment gains over time. Remple (1986) notes that in her review of the existing research on the long term effects of psychotherapeutic treatment " i t appears that the rate of positive outcomes, though high at termination of therapy, was much lower at follow-up: 85 percent of studies reported positive results at termination, only 14 percent reported transfer or maintenance e f f e c t s . [It would appear] that maintenance i s the exception rather than the r u l e " (Remple, 1986, pp. 54 & 55). Despite these u n l i k e l y odds, Remple (1986) found that couples who had received EFT and had regressed at four month follow-up, recovered to post-treatment levels when measured one year after therapy. Remple (1986) concluded that her study "strongly supports the occurrence of positive outcomes at follow-up and c l e a r l y established the power of...the EF therapy...in the treatment of marital discord and the maintenance of change over a one year period" (Remple, 1986, p.55). James (1988) questioned what results might be found one year after treatment for the couples who received EFT therapy in his study. He c i t e d Remple's (1986) findings and speculated that EFT may have long-term self-generating e f f e c t s . The goal of the current research was to replicate 58 Remple's (1986) study in order to determine whether treatment gains through receiving Emotionally Focused Couple's Therapy in James'(1988) study were maintained or improved over a one year span of time after receiving therapy. In t h i s study, the researcher conducted follow-up interviews with 9 of the o r i g i n a l 14 couples who had received the EFT treatment in the James (1988) study. At the follow-up interview, couples were given a package of instruments which they were asked to complete independently and return to the researcher immediately. Instruments given to the couples were: the Dyadic Adjustment Scale, the Psycho-social Intimacy Questionnaire, the Communication Scale and Target Complaints questionnaire. After completing the measures, couples were interviewed with regard to q u a l i t a t i v e information which may have influenced the r e s u l t s . In analyzing the quantitative data, the couple score, an average of partner's scores, as opposed to the individual scores were used as the unit of analysis. This i s consistent with other research in marital therapy (Remple, 1986, p.59). It i s also consistent with the analysis in the o r i g i n a l James (1988) study. James (1988) used the average score as of partners as the unit of analysis and then repeated the analysis using Individual scores in order to examine gender differences. This was not done in the one year follow-up since gender differences were not applicable to t h i s study. A concern o£ the researcher was that couples who had 59 not achieved much improvement through the EFT treatment may have chosen not to participate in the follow-up study while those couples who gained the most chose to be included. This explanation would imply that the results of the follow-up study could only be considered generalizable to couple populations which were most responsive i n i t i a l l y to t h i s type of therapy. The q u a l i t a t i v e data of t h i s study might support t h i s view. At one year follow-up, a very high percentage, 78 percent of the subjects (7 of 9 couples) reported that their r e l a t i o n s h i p had improved while only 22 percent (2 of 9 couples) f e l t their relationship had deteriorated. However, a comparison of the mean scores of the participants versus the non-participants indicated no s i g n i f i c a n t differences between these two groups at four month follow-up. Therefore i t was assumed that couples who participated in the one year follow-up study were e s s e n t i a l l y no d i f f e r e n t than the couples who chose not to p a r t i c i p a t e . The r e s u l t s of t h i s study supported the hypothesis. EFT was demonstrated to e f f e c t i v e in s i g n i f i c a n t l y increasing couple's marital s a t i s f a c t i o n over a one year span of time. A repeated measures analysis of variance indicated a s t a t i s t i c a l l y s i g n i f i c a n t increase on the measures of marital adjustment (DAS), communication (CS), intimacy (PIQ), and target complaints (TC) over a one year span of time. The Newman-Keuls pair-wise comparisons indicated no s i g n i f i c a n t differences for couple's mean scores between four 60 month follow-up and one year follow-up on any of the four c r i t e r i o n measures. This finding may not be contradictory to the hypothesis were an improvement was anticipated between four months after treatment and one year after treatment. The lack of s i g n i f i c a n t differences between mean scores at four months after treatment and at one year after treatment may r e f l e c t a decline in post-treatment regression as couples mean scores s t a b i l i z e . Trend analysis indicated a s i g n i f i c a n t cubic trend for the mean scores on the DAS and the PIQ. A s i g n i f i c a n t cubic trend must be interpreted independently of the Newman-Keuls pair-wise comparison: "...by using trend analysis one can examine s t a t i s t i c a l l y the shape of the curve that results when the means of the dependent variables Yj, [in t h i s case, scores on the DAS,PIQ, CS, and TC] are plotted for the J levels of the factor (independent variable. In such si t u a t i o n s , the use of trend analysis i s usually more informative than multiple comparisons" (Glass & Hopkins, 1984, p.386). Si g n i f i c a n t cubic trends were evident for the mean scores on the DAS and the PIQ. Thus, in both of these cases there was no longer a decline in scores after four months follow-up. Hence, the quantitative results of this study supported the power of EFT in not only increasing marital s a t i s f a c t i o n , but also in maintaining the e f f e c t s over a one year span of time. The results of the trend analysis support the notion that EFT may have long-term self-generating 61 effects as there was evidence that mean scores for the DAS and the PIQ began to improve after four months follow-up. The results of the q u a l i t a t i v e data lend further support to the hypothesis. A large percentage (78%) of couples reported improvement in their relationships since counselling in James'(1988) study. The goal of EFT i s to bring intra-psychic experience into awareness and determine how these experiences are brought into the relat i o n s h i p through interaction. EFT f a c i l i t a t e s partners understanding of how past experiences are brought into the relat i o n s h i p and how they a f f e c t i nteraction. The goal therefore is to have partner's view one another's behaviour in a new way so that they may be more supportive of one another. This may explain why couples experienced an Improved a b i l i t y to communicate. Partner's may be reacting in a more supportive manner when they r e a l i z e the roots of their spouse's behaviour. Thus, rather than reacting in a defensive manner, they may be more w i l l i n g to accept or acknowledge and l i s t e n to their partner. This explanation seems plausible in l i g h t of the responses given in James(1988) structured interview. In James' (1988) study, 50% of couples i d e n t i f i e d the category " coming to new understandings or r e a l i z a t i o n s (often deeply f e l t ) about myself, my partner, or the re l a t i o n s h i p " and 25% i d e n t i f i e d "seeing my partner experience feelings (often with rea l intensity) that he or she does not show t y p i c a l l y in our r e l a t i o n s h i p " as major components of change (James, 1988, p. 114). In this study, 6 of the 7 couples who f e l t their relationship had improved attributed this to improved communication. These results support Remple's (1986) speculation that there may be processes operating in an EFT treatment which allow for open and honest communication between partners. It i s important to consider other factors which may have Influenced couples' perceived improvement. One possible factor which might influence improvement i s seeking additional counselling. However, less than half (4 of 9) couples engaged in further counselling after counselling in the o r i g i n a l study. Of these four couples, only one couple reported that the additional counselling had any influence on their r e l a t i o n s h i p . This couple was one of the two couples that reported relationship deterioration at one year follow-up. Assumptions made about the lack of impact of further counselling are only speculation. One might think that Increased stress or l i f e changes might influence marital s a t i s f a c t i o n . A l l but 3 of the 9 couples reported s t r e s s f u l events or l i f e changes had occurred since the end of counselling. Three of these couples reported that these events or changes had a great deal of influence on changes in their r e l a t i o n s h i p . Three of 9 couples represents about 33% of the subjects f e l t that stress/changes influenced their r e l a t i o n s h i p . This i s not a 63 large percentage. It i s l i k e l y that most of the couple's experienced success in managing these s t r e s s f u l events/ l i f e changes as indicated by reports that t h e i r r e l a t i o n s h i p had improved. Perhaps t h i s could be at t r i b u t e d to the EFT they rece ived. SUMMARY: The r e s u l t s of t h i s study support Remple's (1986) findings in that regression was not seen to continue aft e r four months follow-up. However, res u l t s of t h i s study did not show the dramatic increases to post treatment levels at one year follow-up that Remple (1986) found. It could be argued that t h i s study reinforces the view that EFT is a powerful form of t r e a t i n g marital discord in that couples scores on the DAS and PIQ stopped d e c l i n i n g a f t e r four months follow-up were seen to maintain treatment e f f e c t s between four month follow up and one year follow-up. Trend analysis showed a s i g n i f i c a n t cubic trend on the measures of marital adjustment (DAS), intimacy (PIQ), and reduction of target complaints (TC). Adding further support to t h i s view, the q u a l i t a t i v e data revealed that the majority of couples f e l t t h e i r r elationships had improved over a one year span of time a f t e r therapy. 64 LIMITATIONS: A l i m i t a t i o n of t h i s study is the sample s i z e . There was a reduction in the number of couples who met the follow-up c r i t e r i a from the number who participated in the o r i g i n a l study (James, 1988). In the o r i g i n a l study (James, 1988), there were 42 couples randomly assigned to two treatment groups (EFT and EFT+CT) and a waiting l i s t control group. In t h i s study only 9 of the 14 couples who received the EFT treatment in James' (1988) study were assessed. These 9 couples represent a p a r t i c u l a r sub-sample of the couples who pa r t i c i p a t e d in the o r i g i n a l study. However, a comparison of the two groups on 4 month follow-up scores indicates no s i g n i f i c a n t differences between the group of 9 p a r t i c i p a n t s and the group of 5 non-participants. Scores on the DAS for t h i s sub-sample at pre-treatment (Mj=86.5, SD=10.21, range=76.5-104.5) indicate moderate to severe d i s t r e s s l e v e l s and therefore the r e s u l t s from t h i s study only apply to t h i s population. Another l i m i t a t i o n of t h i s study is the therapist s k i l l l e v e l . James(1988) notes that "the therapists in t h i s study were somewhat less advanced than therapists in e a r l i e r studies [on EFT] in terms of l e v e l of academic achievement and degree of c l i n i c a l experience with couples [M=1.93 years]" (James, 1988, p.127). Thus, the results of t h i s follow-up study would only apply to couples receiving EFT from therapists who had s i m i l a r s k i l l l e v e l s as the 65 therapists in James1 (1988) study. The time factor might be seen as a l i m i t a t i o n . Over the course of a year i t i s possible that environmental influences or events may have influenced the r e s u l t s . The structured interview was an attempt to address the impact of such confounding varia b l e s . RECOMMENDATIONS: There i s a need for more long-term follow-up studies on the effectiveness of EFT. Since the re s u l t s of t h i s study supported the findings in Remple's (1986) follow-up study, a r e p l i c a t i o n of these two studies might shed further l i g h t on these outcomes. Follow-up studies on EFT that took place over a longer period of time (ie two years or longer) were couples could be tested in more d e t a i l over more occasions would provide valuable information with regard to the s e l f -generating e f f e c t s of EFT treatment. In addition, follow-up studies of EFT which included a larger sample size and/or a l l of the couples who receive the treatment might provide more conclusive r e s u l t s . In l i g h t of the environmental factors which may influence the r e s u l t s of such long term follow-up studies, i t would be advisable to c o l l e c t both q u a l i t a t i v e and quantitative data. Given that many couples in t h i s study reported the occurrence of s t r e s s f u l l i f e events and l i f e changes, more detailed interviews which focus on the impact of such events on couples marital s a t i s f a c t i o n might be use f u l . 66 REFERENCES Azrin, N.H., Besalel, V.A., Bechtel, R., Michalicek, A., Mancera, M., C a r r o l l , D., Shudford,D., Cox,J. (1980). Comparison of r e c i p r o c i t y and discussion-type counselling for marital problems. American Journal of  Family Therapy, 8_, 21-28. Bat t l e , C , Imber, S., Koehn-Saric, R., Stone, A., Nash, E. & Frank, J. (1966). Target complaints as a c r i t e r i a of improvement. American Journal of Psychotherapy,. 20, 184-192. Baucom, D.H. (1982). A comparison of behavioral contracting and problem-solving/communications t r a i n i n g in behavioral•marital therapy. Behaviour Therapy P 13, 162-174. Baucom, D.H. & Hoffman, J.A. (1985). The effectiveness of marital therapy: Current status and a p p l i c a t i o n to the c l i n i c a l s e t t i n g . In N. Jacobson & A. Gurman (Eds.), C U h i , c a X Handbook of Marital Therapy. New York, G u i l f o r d . Baucom, D.H. & Lester, G.W. (1982, Nov.). The u t i l i t y of cognitive r e s t r u c t u r i n g as a supplement to behavioral  marital therapy. Paper presented to the annual meeting of the Association for the Advancement of Behaviour Therapy, Los Angeles. Beach, S.R. & O'Leary, K.D. (1985). The current status of outcome research in marital therapy. In L.L'Abate (Ed.), Handbook of Family Psychology and  Psychotherapy (pp. 1035-1071). Homewood I I : Dow Jones-Irwin. Bergin, A. (1971). The evaluation of therapeutic outcomes. In A.Bergin & S. G a r f i e l d (Eds.) Handbook of  Psychotherapy and Behaviour Change: An Empirical  Analys i s . New York: Wiley. Boelens, W., Emmelkamp, P., Mac G i l l a v r y , D.H. and Markvoort (1980). A c l i n i c a l evaluation of marital treatment: Reciprocity, counselling vs. system-theoretic counselling. Behavioral Analysis & modification, 4. 85-96. Burger, A.L. & Jacobson, N.S. (1979). The r e l a t i o n s h i p between sex role c h a r a c t e r i s t i c s , couple s a t i s f a c t i o n and problem-solving s k i l l s . American Journal of Family Therapy/ 1*. 52-61. 6 7 Crowe, M.J. (1978). Conjoint marital therapy: A cont r o l l e d outcome study. Psychological Medicine,, 8. 623-636. Emmelkamp,P., VanderHelm, M., MacGillavry, D., and van Zanten, B. (1984). Marital therapy with c l i n i c a l l y distressed couples: A comparative evaluation of system-theoretic, contingency contracting and communication s k i l l s approaches. In K. Hahlweg & N.S. Jacobson (Eds.) Marital Therapy and  Interaction. New York: G u i l f o r d . Epstein,N. and Jackson, E. (1978). An outcome study of short-term communication t r a i n i n g married couples. Journal of Consulting and C l i n i c a l Psychology, 46., 207-212. Ewart, C.K. (1978, Nov.). Behaviour therapy with older couples: E f f e c t s of t r a i n i n g measured by the marital adjustment scale. Paper presented at the annual meeting of the Association for the Advancement of Behaviour Therapy, Chicago. Girodo, M., Stein, S.J. & Dotzenroth, S.E. (1980). The eff e c t s of communication s k i l l s t r a i n i n g and contracting on marital r e l a t i o n s . Behavioral  Engineering. 6. 61-76. Glass, G.V. & Hopkins, K.D. (1984). S t a t i s t i c a l Methods in  Education and Psychology. New Jersey: Prentice H i l l . Goldman, A. (1987). The comparative e f f i c a c y of an Emotionally Focused and Integrated Systemic couples . therapy. Unpublished doctoral d i s s e r t a t i o n , University of B r i t i s h Columbia. Goldstien, A.P., Lopez, M. & Greenleaf, D. (1979). Introduction. In Goldstien, A.P. & Kanfer, F. (Eds.) 1979. Maximizing Treatment Gains: Transfer  Enhancement in Psychotherapy. New York: Academic Press. Gottman, J. & Markman, H.J. (1978). Experimental designs in psychotherapy research. In S. G a r f i e l d & A. Bergin (Eds.), Handbook of Psychotherapy and Behaviour  Change (2nd e d i t i o n ) . New York: Wiley. Greenberg, L.S. (1984). A task analysis of interpersonal c o n f l i c t r e s o l u t i o n . In Rice, L.L. & Greenburg, L.S. (Eds.)., Patterns of Change (pp.67-123). New York: The Guilford Press. 68 Greenberg, L.S. & Johnson, S.M. (1986). Emotionally focused couples therapy. In N.S. Jacobson & A.S. Gurman (Eds.), C l i n i c a l Handbook of Marital Therapy (pp.253-278). New York: G u i l f o r d . Greenberg, L.S. & Pinsof, W.M. (1986). Process research: Current trends and future perspectives. The  Psychotherapeutic Process (pp. 1-20). New York: The Guilford Press. Gurin, G.D. & Feld, S. (1960). Americans view of t h e i r mental health. Monograph Series No.4. New York: Basic Books. Gurman, A.S., Kniskern, D.P. & Pinsof W.M. (1986). Research on the Process and outcome of marital and family therapy. In S.L. G a r f i e l d & A.E. Bergin (Eds.) Handbook of Psychotherapy and Behaviour Change (3rd Ed.), (pp. 565-624). New York: Wiley & Sons. Haley, J. (1976). Problem-solving therapy. San Fransico: Jessey-Bass. Hahlweg, K., Schindler, L., Revenstorf, D., Brengelmann, J.C. (1984). The Munich marital therapy study. In K. Hahlweg & N.S. Jacobson (Eds.), Marital Interaction:  Analysis and Modification. New York: G u i l f o r d . Jacobson,N.S. (1977). Problem-solving and contingency contracting in the treatment of marital discord. Journal of Consulting and C l i n i c a l Psychology,, 4 5, 92-100. Jacobson, N.S. (1978). S p e c i f i c and non-specific factors in the effectiveness of a behavioral approach to the treatment of marital discord. Journal of Consulting  and C l i n i c a l Psychology,, 46., 4 4 2-445. Jacobson, N.S. (1978a). A review of research on the effectiveness of marital therapy. In T. Paolino & B. McCrady (Eds.), Marriage and Marital Therapy. New York: Brunner/Mazel. Jacobson, N.S. (1979a). Behavioral treatments for marital discord: A c r i t i c a l a p p r a i s a l . In M. Hersen, R. E i s l e r & P. M i l l e r (Eds.), Process in Behaviour  Modification. (Vol.7). New York: Academic Press. Jacobson, N.S. (1979b). Increasing pos i t i v e behaviour in severely distressed marital r e l a t i o n s h i p s : The e f f e c t s of problem-solving t r a i n i n g . Behaviour  Therapy, 10, 311-326. 69 Jacobson, N.S. (1985). Family therapy outcome research: Potential p i t f a l l s . Journal of Marital & Family  Therapy. 11. 149-158. Jacobson, N.S., F o l l e t t e , W.C. & Revenstorf, D. (1984). Psychotherapy outcome research: Methods for Reporting V a r i a b i l i t y and Evaluating C l i n i c a l S i g n i f i c a n c e . Behaviour Therapy, 15, 336-352. Jacobson, N.S. & F o l l e t t e , W.W. (1985). C l i n i c a l s i g n i f i c a n c e of improvement r e s u l t i n g from two behavioral marital therapy components. Behaviour Therapy. 16, 249-262. Jacobson, N.S. & Margolin, G. (1979). Marital Therapy; Stategles Based on Several Learning and Behaviour Exchange P r i n c i p l e s . New York: Brunner/Mazel. Jacobson, N.S., F o l l e t t e , W.C, Revenstorf, D., Baucom, D.H., Hahlweg, K. & Margolin, G. (1984c). V a r i a b i l i t y in outcome and c l i n i c a l s i g n i f i c a n c e of behavioral marital therapy: A reanalysis of outcome data. Journal of Consulting and C l i n i c a l Psychology. 52, 497-514. Jacobson, N.S., Schmaling, K.B. & Holtzworth-Monroe (1987). Component analysis of behavioral marital therapy: 2-year follow-up and predi c t i o n of relapse. Journal  of Marital and Family Therapy. 13. P P . 187-196. James, P. (1988). A constructive outcome study of Emotionally Focused couples therapy. Unpublished doctoral d i s s e r t a t i o n , University of B r i t i s h Columbia, Vancouver. Johnson, S.M. & Greenberg L.S. (1985a). D i f f e r e n t i a l e f f e c t s of e x p e r i e n t i a l and problem-solving interventions in resolving marital c o n f l i c t . Journal of Consulting  and C l i n i c a l Psychology, 53, 175-184. Johnson, S.M. & Greenberg, L.S. (1985b). Emotionally Focused Couples Therapy: An outcome study. Journal of  Marital and Family Therapy. 11, 313-317. L'Abate, L. & McHenry, S. (1983). Handbook of Marital  Interventions. New York: Grune & Stratton. 7 0 Lieberman, R., Levine, J . , Wheeler, E., Sanders, N., and Wallace, C.J. (1976). Marital therapy in groups: a comparative evaluation of behavioral and interaction formats. Acta P s y c h i a t r i c a Scadinavia, 266, 1-34. Locke, H.J. & Wallace, K.M. (1959). Short marital adjustment prediction t e s t s : Their r e l i a b i l i t y and v a l i d i t y . Marriage and Family Living,. 21, 251-255. Locke, H.J. & Williamson, R.C. (1958). Marital Adjustment: A factor analysis study. American S o c i o l o g i c a l Review,  28. 562-569. Lowenthal, M.F. & Haven, S.W. (1968). Interaction and adaptation: Intimacy as a c r i t i c a l v a r i a b l e . American S o c i o l o g i c a l Review, 22, 20-30. Luborsky, L., Singer, B., and Luborsky, L. (1975). Comparative studies of psychotherapies: Is i t true that "everyone has won and a l l must have prizes?". Archives of General Psychiatry. 22, 995-1008. Mehlam, S.K., Baucom, D.H. and Anderson, D. (1983). Effectiveness of cotherapists versus single therapists and immediate versus delayed treatment in behavioral marital therapy. Journal of Consulting and  C l i n i c a l Psychology, 51, 258-266. Mintz J . & K e i s l e r D.J. (1982) Individualized measures of psychotherapy outcome. In P.C. Kendall & J.N. Butcher (Eds.), Handbook of Research Methods in C l i n i c a l  Psychology, (pp. 491-534). New York: .Wiley & Sons. Olson, D.H., Fournier, D.G. & Drunkman, J.H. (1985). ENRICH: Enriching and nurturing r e l a t i o n s h i p issues, communication and happiness. In D.H. Olson, H.I. McGibbln, H. Barnes, A. Larsen, M. Muxen & M. Wilson (Eds.), Family Inventories (pp. 67-75). University of Minnesota: Family Social Science. Per l s , F., H e f f e r l i n e , R. & Goodman, P. (1951). Gestalt  Therapy. New York: J u l i a n Press. Remple, R. (1987). A one year follow-up of the d i f f e r e n t i a l e f f e c t s of e x p e r i e n t i a l and systemic interventions in  resolving marital c o n f l i c t . Unpublished Masters thesis, U n i v e r s i t y of B r i t i s h Columbia, Vancouver. Sager, C.J., Gundlach, R., Kremer, M., Levy, R. & Royce, J.R. (1968). The married In treatment. Archives of General Psychiatry. 19_, 205-217. 7.1 S a t i r , V. (1967). Conjoint Family Therapy. Palo Alto: Science & Behaviour Books. Spanier, G.B. (1976). Measuring dyadic adjustment: New scales for assessing the q u a l i t y of marriage and si m i l a r dyads. Journal of Marriage and the Family, 18, 15-28. Spanier, G.B. & E. F i l s i n g e r (1983). The Dyadic Adjustment Scale. In E. F i l s i n g e r , Marriage and Family  Assessment. Beverly H i l l s : Sage. pp. 155-168. Tesch, S.A. (1985) The Psycho-social Intimacy Questionnaire: V a l i d a t i o n a l studies and an investi g a t i o n of sex ro l e s . Journal of Social and Personal Relationships. 2, 471-488. Winer, B.J. (1971). S t a t i s t i c a l P r i n c i p l e s in Experimental Design. New York: McGraw-Hill. 7 2 APPENDIX 

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