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

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THE C O U P L E ' S P R O J E C T ONE  Y E A R FOLLOW-UP  STUDY  by CYNTHIA B.A.,  Simon  HANSEN  Fraser University,  1980  THESIS SUBMITTED I N PARTIAL FULFILMENT THE R E Q U I R E M E N T S MASTER  FOR THE DEGREE OF  OF  ARTS  in  THE F A C U L T Y OF GRADUATE Department  We  accept to  STUDIES  of Counselling Psychology  this  T h e s i s as  the required  conforming  standard  THE U N I V E R S I T Y OF B R I T I S H September,  COLUMBIA  1990  © C y n t h i a Hansen,  1990  In  presenting  degree freely  this  at the  thesis  in  partial  fulfilment  University of  British  Columbia, I agree that the  available for reference and study.  copying  of  department  this or  publication of  thesis by  for  his  scholarly  or  this thesis for  her  I further  purposes  Counselling  DE-6  (2/88)  September  19, 1990  Psychology  requirements  agree that  It  financial gain shall not  The University of British Columbia Vancouver, Canada  Date  the  may be  representatives.  permission.  Department of  of  is  for  an advanced  Library shall make it  permission for  granted  by  understood  the that  extensive  head of my copying  or  be allowed without my written  ii  ABSTRACT  One Focused  year  after  Couples  voluntary,  Therapy  moderately  study, were t e s t e d gains were  (EFT),  determine  maintained  It was  or  Questionnaire  couples  couples  (DAS),  original  in  (TO,  or  not  therapy.  More s p e c i f i c a l l y ,  who  on the the  received  post-test  p o s t - t e s t and four months Improvement between  an  EFT  mean scores of the  P s y c h o s o c i a l Intimacy  a trend  to be that of an  between p r e - t e s t and  treatment  a one year span of  over a one year span of time a f t e r  expected  14  James (1988)  the Communication Scale (CS) and  Complaints  trend was  the  therapy.  Scale  (PIQ),  of  whether  show improvement  Adjustment  9  Increased over  hypothesized that  treatment would  12 s e s s i o n s of E m o t i o n a l l y  distressed  to  time a f t e r r e c e i v i n g  Dyadic  receiving  was  Target  receiving  anticipated.  i n c r e a s e on  The  mean scores  followed by a decrease between  follow-up and  then a  r e c o v e r y or  four months and one year a f t e r  receiving  therapy. The  9 couples completed  participated  in  a  structured  supported by the r e s e a r c h post-treatment  four  self-report  i n t e r v i e w . The hypothesis  findings.  regression  measures and  subsided  Results  indicated  between  four  (1986)  study,  was that  months  follow-up and one year f o l l o w - u p . As  a  replication  of  Remple's  this  iii investigation treatment therapy study  did  levels  that do  span of t i m e .  between  Remple  support  maintaining  n o t show  the dramatic four  (1986) f o u n d . the  increased  notion marital  months  increases to postand  However that  EFT  one  year  the r e s u l t s is  satisfaction  after  of t h i s  effective  over  a one  in year  iv TABLE OF CONTENTS Abstract  ii  Table of Contents  iv  List  vi  of t a b l e s  L i s t of F i g u r e s  vii  CHAPTER I: I n t r o d u c t i o n  1  Background of the Problem  1  H i s t o r y of M a r i t a l Therapy  2  The Problem  4  Purpose and Hypothesis  6  CHAPTER I I : L i t e r a t u r e Review  8  Follow-up s t u d i e s i n M a r i t a l Therapy  8  Emotionally  16  Focused Couples Therapy  T h e o r e t i c a l Background  16  Research Studies  22  on EFT  Conceptual Hypothesis CHAPTER I I I :  25  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  29  Integrity  Design of the One Year Follow-up Study  30  Subjects  30  Assessment Procedures  31  V  Other  Measurement  Data  Analysis  Data  Analysis  Preliminary  CHAPTER  Procedures  37 Procedures  37  Analysis  38  Analysis  of Q u a n t i t a t i v e  Analysis  of Q u a l i t a t i v e data  IV:  Results  and Data  Data  Analysis  Results  of Preliminary  Results  of Quantitative  Results  of Q u a l i t a t i v e Data  C H A P T E R V: D i s c u s s i o n  35  Analysis  of Results  Data  38 40 41 41 41 50 53  Summary  59  Limitations  60  Recommendations  61  REFERENCES  66  APPENDIX  72  vi LIST OF TABLES  Table I  48  Table II  49  Table I I I  51  Table IV  53  Table V  55  LIST  OF F I G U R E S  Figure  1  48  Figure  2  49  Figure  3  51  Figure  4  53  Figure  5  55  1 CHAPTER I: INTRODUCTION  BACKGROUND: Marriage i s the  adult  important i n p r o v i d i n g a  needs  of  closeness,  means of meeting  contact,  and  intimacy.  Marriage has the a b i l i t y t o enhance p a r t n e r ' s s a t i s f a c t i o n by fulfilling out,  "people  emotional life 1988,  these primary a d u l t needs. who  are married  have  physical  and  live  and are more s a t i s f i e d  with  health,  longer  p.l)  Lending  the  support  healthiest  involved  r e l a t i o n s h i p during their Although marriage America,  to  people  i n at  d i v o r c e d . " (James,  James'  (1968) analyzed l i f e  happiest,  people who were  least  (1988) statement,  h i s t o r i e s and found i n l a t e r years were one  c l o s e personal  lifetime.  i s important  t o w e l l - b e i n g , i n North  one t h i r d of marriages end i n d i v o r c e (James  Evidence suggests are  better  than are people who are separated or  Lowenthal and Haven that  As James (1988) p o i n t s  that the  f a r reaching.  marital distress  Gurin,  i m p l i c a t i o n s of m a r i t a l Veroff  and  as the most common  Feld  (1988). distress  (1960) r e p o r t  reason people seek the  help of mental h e a l t h p r o f e s s i o n a l s . Sager, Gundlach, Kremer, Levy  and  individual  Royce  (1968)  psychotherapy.  surveyed They  found  clients that  who 50%  received of  these  c l i e n t s d i s c l o s e d s e r i o u s m a r i t a l problems through the course of therapy.  A f u r t h e r 25% had marriage r e l a t e d  difficulties.  2  H i s t o r y of M a r i t a l Although  marital  subspeciality clinicians,  of  therapy  family  i t s history  than f a m i l y developed  Therapy:  therapy.  a  by  majority  of  its  fourth  p.566).  decades For  psychiatric  of  f a r t h e r back  M a r i t a l therapy "in  the  marriage  i n the p s y c h o a n a l y t i c a l l y  oriented  psychiatry  i n the  third  t h i s c e n t u r y " (Gurman et a l . / 1986,  example,  treatment  stems  roots  p r a c t i c e s of i n t e r p e r s o n a l l y o r i e n t e d and  the  et a l . , 1986)  with  and  considered  development  (Gurman  counselling tradition  currently  therapy  of  independently  is  marital of  therapy  was  schizophrenia  used  i n the  and of symptomatic  c h i l d r e n and a d o l e s c e n t s (Gurman et a l . , 1986). With the development of causal  thinking  current  view  lead  to  the  in  function.  therapy i s now M a r i t a l therapy disorders  of  of  inter-dependence a l l of  which an Thus,  a  are  which i n t e r a c t  systemic  in  which  viewed  to create  as the  or f a m i l y e x i s t  tradition,  marital  considered a s u b - s p e c i a l i t y of f a m i l y  therapy.  i s now  the  in thinking  view  context  I n d i v i d u a l , couple  in  a change i n  shift  systemic  and  practised  as w e l l as i n t e r p e r s o n a l  Currently  came  l i n e a r c a u s a l i t y to the more  c a u s a l i t y . This  development  ingredients,  environment and  one  of c i r c u l a r  connectedness, important  from  psychotherapy  there  is  enough  e f f e c t i v e n e s s of psychotherapy  in  the treatment  of a d u l t  conflicts. evidence  to  support  i n c l u d i n g m a r i t a l therapy.  Gurman et a l . (1986) say: "(Research has) now  established  the As  3  c o n v i n c i n g l y that  in  general  the  practice  of  f a m i l y and  m a r i t a l therapy leads to p o s i t i v e outcomes." (p.570) There  has  treatment Markman  been  outcome (1978)  a  lack  studies  in  reviewed  desensitization  of  long-term  psychotherapy. 55  conducted  follow-up  studies  between  Gottman  on  on and  systematic  1970-1976.  Of  the 55  s t u d i e s reviewed, o n l y 25 had any follow-up a t a l l and only 6 s t u d i e s included r e t e s t i n g Gottman and  after  Markman's (1978)  a  period  r e s e a r c h should address.  the importance s i t u a t i o n on t h i s view. time,  of follow-up more than  multiple  configuration information  of on  therapy to (1978)  exam the c l i e n t ' s  says: "Behaviour  improvement  assessment effects,  or  the  the  1986,  importance  procedures  at long  p r e - t e s t and p o s t - t e s t .  forms  detailed  consequences  that  and  p a t t e r n i n g or  providing  specific  treatment  can vary over  deterioration,  isolates thereby  the  emerge (Remple,  stress  assessment  the  important  Bergin (1971) h i g h l i g h t s  treatment... follow-ups need to a l l o w adequate the e f f e c t s of  an  one o c c a s i o n . Remple (1987) supports  either  follow-up  us of  s t u d i e s which  As Remple (1987)  showing  6 months.  review e x e m p l i f i e s the lack of  follow-up s t u d i e s i n r e s e a r c h and reminds gap which  of  of  opportunity for are  employed i n  p.10). Gottman and Markman  of  implementing  the  same  term follow-up as are used at  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 e f f e c t i v e n e s s of E m o t i o n a l l y Focused  Couple's therapy  i n i n c r e a s i n g couple's  4  marital  satisfaction  over  a  one  year  span of time a f t e r  r e c e i v i n g therapy.  THE  PROBLEM: E m o t i o n a l l y Focused  treatment  package  Couple's Therapy  which  focuses  isa  on the r o l e of a f f e c t and  i n t r a p s y c h i c experience i n couple i n t e r a c t i o n s Johnson,  1976).  This  approach  l e v e l of s a t i s f a c t i o n and The  efficacy  of  EFT  s t u d i e s t o date: Johnson  i s designed t o i n c r e a s e the  been  and  Goldman, 1987; James,1988. date has addressed the  (Greenberg and  intimacy i n couple  has  contemporary  determined  Greenberg,  relationships. i n four outcome  1985a,  and 1985b;  Only one study (Remple, 1987) to  issue of  the long-term  effectiveness  of EFT. Johnson  and Greenberg  (1985a) compared the e f f e c t i v e n e s s  of EFT t o a C o g n i t i v e B e h a v i o r a l M a r i t a l Therapy wait-list  control  treatments  group.  showed  significant  control  group,  marital  adjustment,  complaints a t  Although  EFT  was  gains  superior  intimacy  both  and  post-treatment. At  the EFT and CBMT  over  to  findings,  Johnson  and  p a r t i a l r e p l i c a t i o n of t h e i r Greenberg,  1985a).  s e s s i o n s of EFT. Although  list  on measures of  reduction  of  target  10 week follow-up, EFT was  Greenberg  Adding support t o  (1985b) conducted a  o r i g i n a l study  Wait-list  the wait  CBMT  s u p e r i o r on measures of m a r i t a l adjustment. their  (CBMT) and a  controls  the o v e r a l l  (ie.Johnson and  were  given  e f f e c t was  eight  l e s s than  5  one  half  of  that  found  i n the o r i g i n a l study,  significant  changes were noted on most of the dependant v a r i a b l e s . Goldman  (1987)  compared  Integrated-Systemic therapy At  the  outcome  (IS)  and a  untreated  controls  EFT  wait l i s t  p o s t - t e s t , both treatment groups showed  over  of  No  on measures of m a r i t a l  differential  outcome  between treatment groups a t p o s t - t e s t . maintained p o s t - t e s t  gains at  conflict  resolution.  Remple  on a l l measures except  (1986)  scores.  conducted  Remple  f i n d i n g suggests a " s l e e p e r " e f f e c t  James  an attempt (1988)  EFT  a  one year  I n t e r e s t i n g l y , at  to  determine  compared  the  speculated  had  p l u s four  s e s s i o n s of  that  this  i n EFT.  how  EFT might  outcome  of  r e c e i v i n g 12 s e s s i o n s of EFT to a group of  follow-up, the  follow-up, Remple (1986) found the EFT group  post-treatment  In  were found  from the 4 month follow-up back to l e v e l s comparable  improved to  of t a r g e t  Although the IS group  follow-up study of Goldman's (1987) study. the one-year  control.  adjustment,  effects  the four-month  EFT group d e t e r i o r a t e d s i g n i f i c a n t l y  an  s i g n i f i c a n t gains  goal attainment, c o n f l i c t r e s o l u t i o n and r e d u c t i o n complaints.  to  a  be enhanced,  treatment  group  receiving 8 sessions  Communication S k i l l s  (CT) and a wait l i s t  c o n t r o l group.  both  the EFT+CT groups achieved s i g n i f i c a n t l y  the  EFT  and  higher gains than the w a i t i n g l i s t on  the  complaint  measures  of  improvement  marital (TC).  James (1988)  Training  found  that  c o n t r o l group at p o s t - t e s t  adjustment James  (DAS)  (1988)  and  found  target trends  6 towards  significance  passionate love were  found  (PLS) on  (CS),  significantly  higher  although  of  no  intimacy  (PIQ), and  significant  differences  measures.  only scores  differential  treatment groups  measures  these  communication  group. No  on  On  the  measure  the  EFT+CT  than  the w a i t i n g l i s t  effects  at post-test.  (1988) found some d e t e r i o r a t i o n  group  of  achieved control  were  found  Like  Goldman (1987), James  of the  two  between  treatment  the 2  groups  at the four month follow-up. T h i s study The problem e f f e c t of  was  a  r e p l i c a t i o n of Remple's (1986) study.  that t h i s study attempted  time would be f o r couples who  s e s s i o n s of EFT  PURPOSE AND  HYPOTHESIS: EFT,  In  order  the  James'  to  purpose  to conduct a one year follow-up in  what the  r e c e i v e d 12 one  hour  i n James (1988) study.  e f f e c t i v e n e s s of  group  to address was  (1988)  assess  of t h i s  of the study.  the  long-term  investigation  EFT a c t i v e  was  treatment  Specifically,  this  i n v e s t i g a t i o n assessed the e f f e c t s of 12 one hour s e s s i o n s of EFT  on  the  dependent  measures  communication, intimacy, and  target  year span of time a f t e r r e c e i v i n g The  researcher  Emotionally  Focused  hypothesized Couples  of  marital  complaints  adjustment, over  a one  therapy. that  Therapy  couples who r e c e i v e (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  one  time  year  span  of  s p e c i f i c a l l y , the  Target Complaints  after  trend was  receiving  anticipated  (TO  therapy. to be  over a More  that of an  increase on scores between p r e - t e s t and p o s t - t e s t f o l l o w e d by a decrease  on scores and then a r e c o v e r y or improved  satisfaction after  four months.  marital  8 CHAPTER I I : LITERATURE REVIEW  The  focus of t h i s  studies  of  outcome  l i t e r a t u r e review w i l l research  follow-up s t u d i e s on v a r i o u s will  be  considered.  E m o t i o n a l l y Focused Finally,  outcome  therapy w i l l  be  in  marital  approaches  Second,  Treatment research  follow-up  therapy.  to  First,  m a r i t a l therapy  conceptual Approach  on  be on  models  will  Emotionally  for  an  be d i s c u s s e d . Focused Couples  reviewed.  FOLLOW-UP STUDIES IN MARITAL THERAPY: Few data  outcome s t u d i e s i n m a r i t a l therapy provide  beyond  post-treatment  assessment. Remple (1986) says:  "In f a c t ,  i n couples therapy,  term has  been done"  data  it  is  e f f e c t i v e n e s s of Follow-up absent  or  (Luborsky, studies  studies too  little  to  effectiveness  in brief  have by  p.10). Without  determine  t h e r a p e u t i c approaches psychotherapy to  catch  Singer, and Luborsky, which  follow-up, s h o r t or long  (Remple, 1986,  impossible  the  long  follow-up  long-term  issue data  are  "either  term  1975,p.1005). the  follow-up  i n m a r i t a l therapy.  research  the  addressed  providing  follow-up  effects"  Some  of the  of  long-term  are  discussed  below. Crowe (1978) conducted included follow-up groups:  (1)  a  d a t a . 42 directive  a comparative  outcome study which  couples were therapy  group  assigned to three which  primarily  9 u t i l i z e d contracting, group, and  (3) a  therapist  who  Using  16  significantly  question  or  was  18  to not  month  on  sexual  of  or  group was  marital  the  18  adjustment,  found  On  adjustment, the c o n t r a c t i n g group c o n t r o l group  at  month  18  adjustment, superior and  nine  the  group  contracting  opportunities therapy.  group  month follow-up.  t a r g e t complaints both  the  On  contracting  to the c o n t r o l  contracting  to  9 month  found  general  Y i e l d i n g more the  contracting  m a r i t a l d i s t r e s s at as  the was  the  indicated measure  of  significantly  measure  approach at  of  was  by  the the  sexual superior and  individual  significantly  post-treatment assessment  Inter-personal  showed  no  individual  at p o s t - t e s t , at 9 month follow-up  follow-up.  was  the c o n t r o l group  that  follow-up  scale.  to the  at  (1978)  complaints.  (1978)  month  adjustment  group  group and  target  Crowe  measure of  i n s i g h t group  Crowe  more e f f e c t i v e i n reducing  9 month and  global  control  insight  specific  promising s c o r e s ,  the  follow-up.  the  adjustment  report  the case at post-therapy, 3 month  d i f f e r e n c e s between improvement  self  with a  or i n t e r p r e t a t i o n .  Crowe (1978) found the  superior  This  therapy  c o n t r o l c o n d i t i o n where couples met  m a r i t a l adjustment,  follow-up  insight oriented marital  avoided g i v i n g advice  a  follow-up.  (2) an  greater  and  intra-personal  improvement  as compared to the c o n t r o l group. group  scored  higher  on  11  out  differ  from the c o n t r o l c o n d i t i o n  for  the  Overall of  20  following  10 Boelens e t a l . (1980) conducted a study comparing 10 sessions and  of group  a  based  strategic  behavioral  therapy  which  (1976) approach t o s t r a t e g i c designed  to  provide  contingency  was modelled a f t e r Haley's  therapy. Haley's  insight  contracting  into  overt  treatment was  and covert  power  s t r u g g l e s . Boelens e t a l . (1980) randomly assigned 21 couples to one  of three  therapy c o n d i t i o n s : a b e h a v i o r a l  group, an i n s i g h t o r i e n t e d group.  The  assumption  changes i n the  group,  made  interactions  and  a  was that and  wait  contracting list  control  i n s i g h t would lead to  communication  patterns of  c o u p l e s . Assessment of outcome was based on: (1) the Maudsley Marital Questionnaire the  Marital  scale;  (MMQ), a m a r i t a l adjustment  Deprivation  (3) partner  Scale  r a t i n g s of  (MDS),  the  a  s c a l e ; (2)  marital attitude  severity  of  their  three  main m a r i t a l  problems; (4)  t h e r a p i s t r a t i n g s of the couple's  relationship  and  observational  negative and  p o s i t i v e v e r b a l behaviour  (5)  an  pre and p o s t - t e s t s c o r e s , the  insight  oriented  rating (MICS).  both the b e h a v i o r a l  approaches  verbal  therapist  ratings  interactions.  oriented  group  At  had  and  deteriorated  d i f f e r e n c e s were noted between  c o n t r a c t i n g and  the MDS,  observational  one month  of  In comparing  were s i g n i f i c a n t l y  than the w a i t - l i s t c o n t r o l group on the MMQ, ratings,  scale  higher partner  measures of  follow-up, the i n s i g h t so  this  that  group  no s i g n i f i c a n t and  the c o n t r o l  group. In  comparing  the  findings  of  Crowe  (1978)  to the  11 f i n d i n g s of Boelens et point  out  that  a l . (1980)  Boelen's  Beach and  O'Leary (1985)  et a l (1980) used more s t r u c t u r e d  i n t e r v e n t i o n s than were used i n the Crowe (1978) could account  f o r the  success of the  in Boelens et al.(1980) only provide  follow-up  i s not p o s s i b l e to their  at one  compare  Insight-oriented  the  group  3 month and  Boelens et  long-term to  the  e f f e c t i v e n e s s of  e f f e c t i v e n e s s of  where data  18 month follow-up.  do not  therapeutic intended.  interventions  et  almost  do  al.,  never  1986,  provided  and  the Crowe,  adequate measures because t h e i r not  fit  As Gurman et a l . (1986) say,  of i n s i g h t i s (Gurman  provide  was  an  aim  p.583).  with  the  therapy  "therapist provision  of  s t r a t e g i c therapy"  In terms of a s u b s t a n t i a l  c o n t r i b u t i o n to knowledge, the s t u d i e s o f f e r l i t t l e . significant  finding  i s that  defenses  i n t e r p r e t a t i o n of  the  use  m a r i t a l therapy by randomly a s s i g n i n g four  c o n t r a c t i n g only; (3)  covert  (Boelens et a l . , 1980).  Baucom (1982) i n v e s t i g a t e d  to  only  conflicts  (Crowe, 1978), or i n s i g h t i n t o overt and  power s t r u g g l e s  couples  The  i n s i g h t i s not very e f f e c t i v e no  matter i f i t i s the r e s u l t of the and  the  Gurman et a l . (1986),  p o i n t out that the Boelens et al.(1980) study (1978) study  a l . (1980)  month a f t e r treatment i t  Crowe (1978) i n s i g h t - o r i e n t e d group at the  i n s i g h t - o r i e n t e d group  study. Since data  study. This  communication  treatment  of  contracting in  72 m a r i t a l l y d i s t r e s s e d  conditions:  (1)  (2)communication t r a i n i n g plus training  only  and  a  quid  pro  quo  contracting;  wait-list  control  12 group. Measures  of outcome  were based on observer r a t i n g of  p o s i t i v e and negative behaviour and two of g l o b a l m a r i t a l s a t i s f a c t i o n : al.  1973)  and  (1) areas of change (Wiess et  (2) the Locke-Wallace  (Locke & Wallace,  s e l f - r e p o r t measures  m a r i t a l adjustment  scale  1959).  R e s u l t s proved the c o n t r a c t i n g o n l y group to be s u p e r i o r to the w a i t - l i s t c o n t r o l group on 3 of the 4 self  report  measures  behaviour. three  and  observer  These treatment  month  contracting  is effective  ratings  e f f e c t s were  follow-up.  Baucom  in  measures: the 2  concluded  marital  17  couples  who  follow-up  d e t e r i o r a t i o n of post-therapy g a i n s . group a l s o  yielded superior  group on a l l dependant positive  verbal  data  The  The  s u p e r i o r to  dependant measures.  provided  that  distress.  communication t r a i n i n g plus c o n t r a c t i n g group was the c o n t r o l group on a l l four  negative  maintained at the  (1982)  reducing  of  13 of the showed  no  communication o n l y  r e s u l t s compared to the c o n t r o l  measures  behaviour.  except  observer  r a t i n g of  Once a g a i n , treatment  effects  were maintained a t follow-up. Baucom's f i n d i n g s suggest that not o n l y were a l l treatments  effective  over time.  I t could be argued that 3 months  short  follow-up  treatment and  but  time.  that the treatment e f f e c t s  Longer  follow-up t h a t  periods  show  of the lasted  is a relatively of  maintenance  time  between  of treatment  gains would y i e l d even more c o n v i n c i n g evidence i n support of the treatments imposed by Baucom  (1982).  13 Jacobson (1977) conducted controlled  outcome  study  a  one  which  year  follow-up  evaluated  the  e f f e c t i v e n e s s of a combination of problem-solving on  marital  assigned  satisfaction.  to  contracting group. using  either group  or  Negative and trained  report  on  Marital received  problem-solving  a  minimal  positive verbal  the  Scale.  year follow-up, couples marital  randomly  contingency  wait-list  behaviour was  using  At  than the  contracting  control measured  Couple's were a l s o asked to  communication  performed b e t t e r  report  (MICS).  long-term  were and  contact  satisfaction  Adjustment  couples  a  observers  marital  Married  of a  Locke  and  Wallace's  p o s t - t e s t , a l l couples and  contracting  training  c o n t r o l group c o u p l e s . At the  were  asked  inventories.  to  complete  who  the  At t h i s time gains on  one  selfglobal  m a r i t a l s a t i s f a c t i o n were maintained. Subsequently, Jacobson (1978) of  two  different  kinds  investigated  of problem-solving and  treatment approaches on m a r i t a l d i s t r e s s . couples were  randomly assigned  to one  problem-solving  and  good  faith  problem-solving  and  quid  pro  wait l i s t  c o n t r o l group; and  in  Jacobson  the  (1977)  p o s i t i v e , negative and addition, Scale  two  (Locke and  Wallace,  In t h i s  contracting quo  study,  outcome  contracting study,  32  of four groups: (1) a group;  (2) a  c o n t r a c t i n g group; (3) a  ( 4 ) a placebo  neutral  self-report  the  trained  verbal  c o n t r o l group. As observers  behaviour  rated  (MICS). In  measures: the M a r i t a l Adjustment 1959)  and  the  M a r i t a l Happiness  14 Scale  (Hops,  Wills,  Patterson  and  Weiss,  1971)  were  administered as g l o b a l measures of m a r i t a l s a t i s f a c t i o n . Change i n r a t e of negative v e r b a l behaviour the  problem-solving/contracting  b e t t e r than  for w a i t - l i s t  post-test.  Both  of  groups  c o n t r o l s and the  was  treatment  groups  s e l f - r e p o r t measures  controls.  follow-up,  year  M a r i t a l Adjustment Scale was Gains  in  marital  improved  as compared to  the Locke-Wallace  administered  adjustment  significantly  placebo c o n t r o l s at  s i g n i f i c a n t l y on the two At one  for both of  were  to  assess  maintained  (1959)  couples.  at one  year  follow-up. Jacobson et a l . (1984) previously published The  authors  s t u d i e s on  classified  c a t e g o r i e s : improved, their c r i t e r i a falling  BMT  a  r e - a n a l y s i s of four  Behavioral Marital  (a=148)  couples  therapy.  into  three  unimproved and d e t e r i o r a t e d . They base  of c l i n i c a l  outside  conducted  significance  the range  of m a r i t a l  used a r e l i a b l e  change  index  based  measurement. At  p o s t - t e s t , they found  t h i r d of the s u b j e c t s moved from  on p o s t - t e s t scores d i s t r e s s . The  on  standard  authors e r r o r of  s l i g h t l y l e s s than  the d i s t r e s s e d  to the non-  d i s t r e s s e d range. At s i x month follow-up, 60% maintained s t a t u s while 28% d e t e r i o r a t e d . two  thirds  of  couples  who  receive  d i s t r e s s e d a f t e r therapy. Since analysis  of  non-behavioral  This  re-analysis BMT  there i s  marital  remain  one  this  shows that clinically  no e q u i v a l e n t data  therapies,  it  p o s s i b l e to make any comparisons (Gurman et a l . , 1986).  i s not  15 Jacobson et a l . ,  (1987)  conducted a  two year follow-up  study on the e f f e c t s of a complete  b e h a v i o r a l m a r i t a l therapy  package (CO) compared to  its  exchange (CPT).  (BE)  and  Data was  the treatment for  two  of  communication  c o l l e c t e d on  and were  components: behaviour  problem-solving  34 couples  who  had  completed  a v a i l a b l e at 2 years a f t e r  treatment  f o l l o w - u p . Couples were randomly assigned  three  treatment  training  groups.  A  global  to one  measure  of  of the marital  s a t i s f a c t i o n and a c h e c k l i s t of p r e s e n t i n g problems were used to  assess  change.  The  authors  d i f f e r e n c e s between the treatment Couples  in  the  CO  h a p p i l y married and at  2  year  group  groups  however,  no  on  significant  these measures.  were most l i k e l y to be  l e a s t l i k e l y to be separated  follow-up.  interesting  found  approach  Jacobson which  et  warrants  or d i v o r c e d  a l s . , (1987) used an consideration.  They  attempted  to i d e n t i f y v a r i a b l e s which might p r e d i c t  long-term  outcome.  The  telephone  interviews.  authors Although  the i n t e r v i e w s maintenance  of  conducted largely  indicated  standardized  unsuccessful in this  neither  therapist  a t t r i b u t e s nor  skills  derived  through  a s s o c i a t e d with  long-term  marital  satisfaction.  stressful  events  life  subsequent  treatment seemed to have a negative marital satisfaction  to  the  impact on  (Jacobson et a l s . , 1987).  attempt,  treatment  were  However,  termination  of  the degree  of  16 EMOTIONALLY FOCUSED COUPLES THERAPY: T h e o r e t i c a l Background: Developed Focused  by Greenberg  couples therapy  experiential  theory  (EFT)  and  affect  in  interactional (Greenberg  i s an  change  and  cycles  in  the  holistic  "organism-environment  would  role  of  communication and problem  states"  and Johnson, 1986, p.253).  is a  grew out of h u m a n i s t i c - e x i s t e n t i a l  (Greenberg  themselves  of  which views r e s o l u t i o n of  to  an  behaviour"  [as] v i t a l to  and Johnson, 1986, p.253).  speculated  p e r s p e c t i v e s i n which context determinant  major e x p e r i e n t i a l  mind-body d u a l i t i e s  and Johnson (1986)  "lend  1951), a  approach  and  functioning"  Greenberg  which combines  "emphasizes the r o l e  maintaining  theory. G e s t a l t therapy ( P e r l s ,  healthy  approach  The approach  E x p e r i e n t i a l therapy  therapy  (1986), E m o t i o n a l l y  systemic theory i n t o an i n t e g r a t e d  model of m a r i t a l therapy. of  and Johnson  that  integration  i s regarded (Greenberg  G e s t a l t views with  as  and  systemic  an important  Johnson,  1986,  p .253). According relationship  to  systemic  between  the  theory, individual  the  nature  and  the  of the environment  determines  behaviour. Context and p e r c e p t i o n are both seen as  important  determinants  "attempts  of  behaviour.  Gestalt  t o overcome both organism-environment  d u a l i t i e s by adopting a f i e l d t h a t leads t o  focusing  on  therapy  and mind-body  conception of human f u n c t i o n i n g what  i s occurring  between the  17 organism  and  (Greenberg therapy  the  environment  at  the  and Johnson, 1986, p.253).  i s on  blocks  to  contact  boundary"  The focus  experiencing  of G e s t a l t  and awareness ( i e .  r e s t r i c t i o n s on awareness, avoidance  and disowning  aspects of  current  believed  result  experience)  which  are  i n d i v i d u a l d y s f u n c t i o n (Greenberg  the  functioning, experiencing  primary  of  referent  the  world  as  client,  approach.  the  is a  As  with and  c l i e n t experiences  the  potentially (Greenberg  to  encountered,  integrate  expanding  these  scope  of  adaptive and  The t h e r a p i s t ' s r o l e i s to  of  of  the  aspects  organismic  of  internal  conscious experience  r e s t r i c t i o n s of  i s helped t o i d e n t i f y  of  experience  therapist  phenomenological  and  client  f u n c t i o n i n g , thereby  and  making  feelings  available  and  needs"  p.254). Greenberg and Johnson  (1986) b e l i e v e that "at any given number  this  experiencing  Johnson, 1986,  i t (Greenberg and  'what i s ' , by both  cornerstone  blocks  awareness are  data.  Is seen as  frame of r e f e r e n c e and explore the r e a l i t y  Johnson, 1986). "Acceptance and  in  and Johnson, 1986).  In terms of human  enter the c l i e n t ' s of  to  processes  moment, there  are a large  out of which an i n d i v i d u a l ' s  emerges" (Greenberg  and Johnson, 1986,  p. 255). Greenberg  and  indebtedness  to  experiential  realm,  systemic approach.  Johnson  Satir's Satir  (1967)  (1986)  acknowledge  approach.  (1967)  developed  Staying  their i n the  the a f f e c t i v e -  As a f a m i l y systems t h e o r i s t , S a t i r  (1967)  18 b e l i e v e d that  the f a m i l y  f u n c t i o n s as a system and  the f e e l i n g or emotional system importance. and  This  therefore  system  Satir  person (b)  the f a m i l y  endeavoured  Satir  these  and  self-concept  to  have  with f e e l i n g s  feelings  and  accept others as d i f f e r e n t . S a t i r esteem  communication people  (1967) b e l i e v e d that a mature  i s able t o : (a) be i n touch  communicate  as of primary  i s expressed through  (1967)  communicate c o n g r u e n t l y .  of  regarded  needs,  needs c l e a r l y and  (1967)  are  and  b e l i e v e d that  reciprocally  self-  related  in  support and  f a c i l i t a t e change: "the s u p p o r t i v e  emphasis  helps  people  experience  Satir  to  communication d y s f u n c t i o n n u r t u r i n g to  couples.  (c)  and  express  c o n g r u e n t l y . " (Greenberg and Johnson, 1986, As mentioned  e a r l i e r , EFT  w e l l as the systemic views. EFT emphasizes  the r o l e  Johnson, 1986). the  role  of  In  of a f f e c t  and  states.  individual  and  sub-system  processes and how as c e n t r a l . the  couple  system  simultaneously  and  equilibrium  these  maintained  of  as  EFT  deals  couple  with  system.  both the Individual are seen  the i n d i v i d u a l sub-system interdependent  individual via  and  emphasizes  couple system  reflexively.  simultaneously  tradition,  i n t e r a c t i o n a l c y c l e s i n the  the  EFT views  experiential  t r a d i t i o n , EFT  they i n f l u e n c e the  Thus,  p.256).  i n change (Greenberg  the systemic  maintenance of problem  feelings  combines the e x p e r i e n t i a l as  In the  communication  (1967) used  The and  negative  couple  and  and  varying  organizational systems  interaction  is  cycles  19 (typically  pursue-vithdraw  i n d i v i d u a l processes (Greenberg  and  couples'  negative  is  interactions  to  is  current  context  the  c l i e n t ' s view  (ie  in  each  experiential The  client  tradition, must  some  experience  an  of  In  EFT  the c u r r e n t  Change occurs  by  by a change i n t h e i r Following  into " s e l f "  on  terms  partner.  communication). insight  about by  in  i n t e r a c t i o n and  of s e l f and  partner's  brought  cycles  e x p e r i e n t i a l process w i t h i n the i n d i v i d u a l . changing  by  James, 1988).  experiences  paid  and  dominant i n f o c a l awareness  interactional  u n d e r l y i n g emotional attention  character)  being more  Johnson, 1986;  Change i n reframing  in  the  i s not enough.  emotionally  meaningful  l e v e l . Partners  must encounter  each other  i n the s e s s i o n and  participate  a  emotional  experience.  in  corrective  process r e - e s t a b l i s h e s  the p o s s i b i l i t y  human r e l a t i o n s h i p with each  other  This  of having a p o s i t i v e  (Greenberg  and  Johnson,  partners  have  healthy  1986) . This  approach  assumes  that  f e e l i n g s , needs and  wants t h a t w i l l  the t h e r a p i s t .  major hypothesis of EFT  and  A  e x p r e s s i n g primary  can  aid  adaptive  feelings,  needs  by  comfort  and  exploring  interactional  needs and  problem-solving and  r e c o g n i z e s t h a t major needs contact,  emerge with  for  intimacy.  intra-psychic  patterns  that  i s that accessing wants by spouses  produce intimacy.  couples EFT  the help of  EFT  include closeness,  s t r i v e s to meet these  fears  prevent  of  closeness  closeness.  and  These  20  i n t e r a c t i o n a l p a t t e r n s are major t a r g e t s f o r change. In EFT, t h e r a p i s t i n t e r v e n t i o n  involves e s t a b l i s h i n g a  t r u s t i n g r e l a t i o n s h i p with both p a r t n e r s and then  encouraging  each to make e x p l i c i t statements to t h e i r partner  of c u r r e n t  e x p e r i e n c i n g of  f e e l i n g s and  needs.  A distinction  between t a l k i n g about f e e l i n g s and the experience i n a l i v e manner i n the present. Good s k i l l s are seen as developing oriented  out  encounters  communication. feelings)  of  change,  change  the  Experiencing  helps  motivate  and a c c e s s i b l e  and  of  feelings  and  good  the partner as more r e c e p t i v e  fears  the  spouse  Through  develops  t h e i r partner's underlying f e e l i n g s  summary,  aspects  of  behaviours emotional  the  the self  deepening into  are p o s i t i v e l y states.  of  focal  reframed  T h i s leads  experience  a new  (Greenberg  i n terms  of u n d e r l y i n g  to a change i n the sequence of i s as f o l l o w s :  1.  him/herself  The  individual  b r i n g i n g experiences The  partner The  b r i n g s new  awareness. I n t e r a c t i o n a l  i n t e r a c t i o n s . The change process  3.  (underlying  Johnson, 1986). In  2.  couple's  a l s o f a c i l i t a t e s open communication.  d i s c l o s u r e of u n d e r l y i n g p e r c e p t i o n of  i n that emotionally  problem-solving  communication p r a c t i c e s . Seeing  of f e e l i n g s  i n communication  style  new  i s made  perceives  differently  by  i n t o f o c a l awareness.  spouses witnesses  t h i s leading  t o them seeing  their  differently. individual's  personal  reorganization  leads  to  21 different  behaviour  in t h e i r  interaction  For example, the i n d i v i d u a l  shares  now  from  asks  for  reassurance  blaming  their  4.  spouses new  The  The  spousal  p e r c e p t i o n leads  r a t h e r than  individual  therapist  therapeutic  spouse  and  r a t h e r than  to d i f f e r e n t  responses  withdraws).  sees himself  role  in this  alliance  with  f a c i l i t a t e a c c e s s i n g of therapist  d i f f e r e n t l y as a r e s u l t of  reframes  that w i l l  another. The the c l i e n t  the couple's and  inward and  is  to  partners  client's  establish and  emotional  then  to  helps  experience i n  couple's responsiveness to  achieves t h i s by  a  experience.  I n t e r a c t i o n s and  i n t e g r a t e t h i s new  enhance the  therapist  process both  the  the c l i e n t s to symbolize a way  vulnerability  responses.  The  The  their  spouse.  spouse.  ( i e . comforts 5.  their  with t h e i r  continually  one  focusing  by f o c u s i n g on the here and now,  thus  h e i g h t e n i n g the c l i e n t s ' e x p e r i e n c e . Greenberg and  Johnson  (1986)  identify  nine  treatment  steps: 1. D e l i n e a t i n g c o n f l i c t i s s u e s i n the core s t r u g g l e . 2. I d e n t i f y i n g  the negative i n t e r a c t i o n a l  3. A c c e s s i n g unacknowledged 4.  Reframing  cycle.  feelings.  the problem, i n terms of u n d e r l y i n g 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 p a r t n e r ' s experience.  7. F a c i l i t a t i n g e x p r e s s i o n of needs and  wants.  22  8. E s t a b l i s h i n g emergence of new 9.  Consolidating  new  solutions.  positions.  (Greenberg  and  Johnson,  1986)  RESEARCH STUDIES ON EMOTIONALLY FOCUSED COUPLES THERAPY: The  following  studies  bear  particular  s i g n i f i c a n c e to  t h i s r e s e a r c h study as they i n v e s t i g a t e the e f f e c t s of EFT. A review of EFT outcome calls this  for  investigations  promising r e s u l t s and  i n t o the e f f e c t i v e n e s s  of  approach. One  was  further  research y i e l d s  a  of the f i r s t comparative  Greenberg  (1985a).  Cognitive-Behavioral Focused  investigations outcome  In  study  t h i s study, marital  i n t o the e f f i c a c y of EFT conducted  45 couples  therapy (CBMT) and E m o t i o n a l l y Greenberg  (1985a)  to two a c t i v e treatment  and to a w a i t - l i s t c o n t r o l group. eight sessions  and  the r e s e a r c h e r s compared  couples therapy (EFT). Johnson and  randomly a s s i g n e d  by Johnson  Results  groups  showed that a f t e r  both treatment groups showed improvement over  w a i t - l i s t controls  on measures  adjustment,  of intimacy and t a r g e t complaints. EFT  superior reduction  goal  to CBMT on m a r i t a l adjustment, of t a r g e t  To add Greenberg  level  of  marital was  l e v e l of intimacy and  complaints.  f u r t h e r support  (1985b) conducted a  o r i g i n a l study  attainment,  by g i v i n g  to these partial  f i n d i n g s , Johnson replication  the w a i t - l i s t  s e s s i o n s of EFT. S i g n i f i c a n t  changes were  of t h e i r  c o n t r o l group noted on  and  eight  most of  23  the  dependent  measures  used  in  I n t e r e s t i n g l y , the o v e r a l l e f f e c t was that  noted  in  the  main  study  1985a). The authors a t t r i b u t e d therapists  the less  promising  Greenberg  this  than  the  therapy reviewed  (1985a)  than one  ( i e . Johnson and to  i n the r e p l i c a t i o n study.  Johnson and  original  and  the The  h a l f of Greenberg,  use  of novice  results  (1985b)  study.  of  the  s t u d i e s are more  other s t u d i e s of non-behavioral  marital  above. As Gurman et a l . (1986) s t a t e :  "When a t t e n t i o n to out of awareness experience  and  f e e l i n g s i s p a i r e d with a c t i v e t h e r a p i s t e f f o r t s to reframe and  modify overt  behaviour and to t r a n s l a t e the  c o n n e c t i o n between inner experience and o v e r t as  i n the Johnson and  Greenberg  behaviour  (1985a,1985b)  studies,  much more impressive outcomes are a c h i e v e d . " (p. Goldman differential t h e r a p i e s on interventions g i v e n 10  (1987), effects  at  of  an  EFT  distinctive  therapy. C l i e n t ' s  noted  of  couples' c o n f l i c t  sessions  and a t 4 month  conducted  to  and  EFT  were assessed  follow-up.  post-test,  at  Structural  of  the  Strategic  approach. or  C l i e n t s were  Structural  Strategic  a t t e r m i n a t i o n of  treatment  Although 4  study  r e s o l u t i o n . Goldman u t i l i z e d each  either  outcome  584)  significant  gains were  month follow-up both groups had  regressed. Remple (1986) conducted Goldman (1987) study. used  i n the Goldman  a  one  year  follow-up  on the  Implementing the same measures as were study, Remple  (1986) found  t h a t at  one  24 year a f t e r  r e c e i v i n g EFT therapy, couples had improved  scores from effect".  the four  month follow-up  These f i n d i n g s  their  suggesting a "sleeper  are of p a r t i c u l a r  i n t e r e s t to t h i s  r e s e a r c h e r given the f i n d i n g s i n the James (1988) study. As mentioned e a r l i e r , James (1988) conducted study which measured the e f f e c t s of wait l i s t  c o n t r o l group,  EFT showed s i g n i f i c a n t satisfaction post-test. measures  EFT. When  compared to a  couples who r e c e i v e d 12 s e s s i o n s of  increases  on the  measures of m a r i t a l  (DAS) and r e d u c t i o n of t a r g e t complaints Although there were trends toward  of  intimacy  (PIQ) and  s i g n i f i c a n t d i f f e r e n c e s were found. discovered,  James  found  that  communication Like  had  The  question  was whether  post treatment  l e v e l s when measured a t one year  (1987) study. By (1986)  regressed when left  to be  couples would experience gains to  conducting  a  partial  study ( i n conducting a t h i s question  t h i s study.  follow-up as  replication  of the  one year follow-up of was addressed  by the  The James (1988) study provided a  unique  o p p o r t u n i t y not o n l y t o conduct  study  on  the  (1987) had  (1986) one year follow-up of the Goldman  the James (1988) study) researcher i n  (CS), no  Goldman  answered then  they d i d i n Remple's  (TC) a t  s i g n i f i c a n c e on  couples  measured at four month follow-up.  Remple  an outcome  effectiveness  e x p e r i e n t i a l m a r i t a l therapy,  of that  a long-term  follow-up  a bona f i d e psycho-dynamic i s , E m o t i o n a l l y Focused  therapy, but a l s o to r e p l i c a t e the Remple  (1986) study.  25 CONCEPTUAL HYPOTHESIS: The review trend found couples  of the l i t e r a t u r e  i n EFT  that the  follow-up, a  outcome s t u d i e s  i s that  from  post-treatment  levels  after  therapy.  Because Remple  (1986)  discovered  EFT group  post-treatment  of  m a r i t a l therapy  regress  t e r m i n a t i o n of  i n d i c a t e d that the general  i n the Goldman (1987) study recovered to  l e v e l s between the four month and the one f i n d i n g which  post-treatment  whether couples who  the  year  i s c o n t r a r y to the g e n e r a l trend  regression,  this  researcher  questioned  r e c e i v e d EFT  i n James' (1988) study might  show a s i m i l a r t r e n d . It was  hypothesized that  show improvement Scale  (DAS),  couples who  r e c e i v e EFT would  on the mean scores of the Dyadic Adjustment  the P s y c h o s o c i a l  Intimacy Q u e s t i o n n a i r e (PIQ),  the Communication Scale (CS), and Target Complaints a one year  span  specifically,  the  of  time trend  i n c r e a s e , f o l l o w e d by a improved  after was  receiving  anticipated  decrease  marital satisfaction after  and  then  (TC) over  therapy.  More  to be that of an a  four months.  recovery, or  CHAPTER I I I : DESIGN AND METHODOLOGY Design  of O r i g i n a l The  factor,  Study:  b a s i c design of the James (1988) study was a three  3x7x3  model. This  treatment  by  design assumed  therapist  the dyad  o c c a s i o n , mixed  the couple as a u n i t of a n a l y s i s  as determined by the combined female w i t h i n  by  score  d i v i d e d by  of  the male  and the  two. The o r i g i n a l  study  took the f o l l o w i n g 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  four one  hour  Wait l i s t  s e s s i o n s of E m o t i o n a l l y Focused therapy sessions  of  communication  skills  plus  training.  c o n t r o l s were given T2 a f t e r the completion  of the  main experiment. Subjects: Subjects were  obtained v i a  a newspaper  article  Vancouver sun, Vancouver C o u r i e r , and the P r o v i n c e . went  through  followed by  an  initial  an assessment  telephone interview.  screening Couples were  i n the Subjects  interview screened  based on the f o l l o w i n g c r i t e r i a : 1. P a r t n e r s must have months and  co-habitated  be c u r r e n t l y l i v i n g  for  together.  a minimum  of twelve  27 2. Partners must have had  no immediate plans f o r d i v o r c e .  3. Partners must not have r e c e i v e d  any p s y c h i a t r i c  or p s y c h i a t r i c h o s p i t a l i z a t i o n w i t h i n the l a s t two 4. Partners  must have had  treatment years.  no reported problems with drugs or  alcohol. 5.  Partners  must  have  had  no  reported  primary  sexual  dys funct i o n . 6. P a r t n e r s fallen  scores on  i n the s e v e r e l y  followed Burger one  and  partner s c o r i n g  which was  had  audio-video  Jacobson's below  to  James (1988)  (1979) c r i t e r i a  100,  consent  and  of at  Spanier's  least  (1976) norm  to  r e s e a r c h procedures,  testing  taping.  8. Partners must not other  d i s t r e s s e d range.(Note,  determined by s t u d y i n g 70 d i v o r c e d c o u p l e s ) .  7. Partners and  Dyadic adjustment s c a l e must not have  have  psychologically  been  currently  oriented  involved  treatment,  on  i n any  either  an  i n d i v i d u a l or a couple b a s i s , (James, 1988). In the o r i g i n a l From  this  group,  three treatment  study 14  there  EFT,  EFT plus CT,  c o n t r o l . Couples  i n the wait l i s t  that there would  be  c o u n s e l l i n g would  begin.  o r i g i n a l study.  42  couples  (n=42).  couples were randomly assigned  groups:  Demographics were  were  a  three  for  Demographic data f o r  used i n the proposed study  are:  the  wait  list  c o n t r o l group were advised  month  collected  and  to the  waiting  the 42 the ten  period  before  couples  i n the  couples  to be  28 1. The number of years l i v i n g together ranged with the average  f o r the group being 9.4 y e a r s .  2. The number of c h i l d r e n per couple ranged with the average 3.  30%  of  from 2-26 years  from 0-4  children  previous  marital  number being 1.5.  the  couples  had  received  counselling. 4. The average  age=42.6 y e a r s .  5. The couples gross income ranged 55,000  from under 15,000 t o above  per anum.  6. The average  number of years of education was 13.95 y e a r s .  Therapists: Therapists  were  volunteer  Department of C o u n s e l l i n g British  Columbia.  treatments.  In  t h e r a p i s t s and  the  graduate  Psychology  Therapists EFT  were  treatment  f i v e female  were  gathered  concerning  the  experience  counselling,  marital/family Therapist All (see  randomly  assigned  were  four female  general  couples  U n i v e r s i t y of  two  to male  t h e r a p i s t s . In EFT+ CT treatment  c h a r a c t e r i s t i c s gender, in  The  there  there were three male t h e r a p i s t s and Data  at  students from the  therapists.  following  experience amount  therapist  in counselling, of t r a i n i n g i n  therapy.  Training: therapists received t r a i n i n g  James,  1988).  Training  using  consisted  the of  EFT Manual Instruction,  29 modelling,  tape  presentations  behavioral rehearsal conducted  by  supervision  of the  the of  of  (Paul  James)  under  the  John F r i e s e n , Department of C o u n s e l l i n g  Psychology, U.B.C.  Therapists  training  by  followed  and  EFT i n t e r v e n t i o n s . T r a i n i n g was  investigator  Dr.  interventions,  six  s u p e r v i s i o n s e s s i o n s . These  were  two  given  and  were  twelve  one  held  half  hours of  hour  group  bi-weekly, combining  t h e r a p i s t s from both treatment groups. T h e r a p i s t s assigned to the EFT treatment group half  hour  group  were given  supervision  T h e r a p i s t s assigned  two f u r t h e r  sessions  as an i n t a c t group.  to the EFT+CT treatment  four  such  supervision  sessions.  video  tape a n a l y s i s and d i s c u s s i o n .  two and one  group were given  S u p e r v i s i o n c o n s i s t e d of  Therapist Integrity: Therapist interventions  accuracy was  in  ensured  implementing  by having  treatment  two independent r a t e r s  r a t e d randomized segments of  EFT audio-taped  r a t e r s were  students  two m a g i s t e r i a l  EFT  sessions.  The  from the Department of  C o u n s e l l i n g Psychology U.B.C. The r a t e r s were given ten hours of t r a i n i n g .  There  phase 1 s e s s i o n s were  analyzed.  were two  phases i n  2-8 were analyzed.  the r a t i n g . During  In phase  2 sessions  9-11  30  DESIGN OF THE ONE As  YEAR FOLLOW-UP STUDY:  mentioned  following  the  original  study  took  the  form:  01 R  TI 02  03  01 R  T2 02  03  01 R  above,  02 03  T3  The d e s i g n of the one year follow-up study took the  following  form: 01  TI 02  Where  03  04  TI = 12 one hour s e s s i o n s of As i n  the James  (1988) study,  the one year follow-up study was the combined  score  d i v i d e d by two;  EFT. the u n i t of a n a l y s i s i n  the couple  as determined  by  of the male and the female w i t h i n a dyad  i e . , the average  score f o r the dyad.  Subjects: The  one  year  treatment group  follow-up  from the  Nine  of the  considered  o r i g i n a l study;  group which r e c e i v e d twelve Therapy.  study  s e s s i o n s of  only  t h a t was,  T I , the  E m o t i o n a l l y Focused  14 couples i n TI of the o r i g i n a l  served as s u b j e c t s (n=9). A l e t t e r  one  study  r e c r u i t i n g these s u b j e c t s  f o r the follow-up study study was  sent out to a l l 14 couples who  o r i g i n a l study. Although  all  letter,  to  5  were  unable  14  couples  participate.  o f f e r e d no e x p l a n a t i o n f o r not wishing  participated  i n the  responded  to the  3  of the couples  to p a r t i c i p a t e  . One  31 couple  chose  not  separated. One one year  to  participate  because  couple i n i t i a l l y agreed to  follow-up study  they  participate  follow-up study participate  Assessment  lost.  and one  h a l f hour  follow-up i n t e r v i e w  the follow-up instruments.  Procedures:  The couples  were asked  to p a r t i c i p a t e  i n a one and  h a l f hour i n t e r v i e w to take place a t t h e i r r e s i d e n c e one a f t e r the t e r m i n a t i o n of treatment  instruments  used  the  in  the  Passionate  original Love  one year  i n the o r i g i n a l study.  nine couples were assessed by a d m i n i s t e r i n g  measure,  year  that couples must be w i l l i n g and able to  i n a one  and to complete  i n the  f o r s c r e e n i n g the couples f o r the one  was  now  but moved out of p r o v i n c e p r i o r to  the study and consequently c o n t a c t with them was The c r i t e r i a  were  the four primary  study  Scale,  The  (one  was  secondary  not  used).  The  measures were: 1. Dyadic Adjustment Scale (DAS) The  DAS  is  a  (Spanier, 1976):  commonly  used  measure  of  marital  adjustment. Although the s c a l e measures relationship  it  also  offers  c o u p l e s ' l e v e l of adjustment developed the DAS  primarily  can be  therapeutic  used  individuals' the  to the  adjustment  ability  to  to the  measure the  relationship.  "Although  out of the f a m i l y - s o c i o l o g i c a l  tradition,  meaningfully  orientations"  (Spanier  within &  a  wide  range  of  Filsinger,  1983,  p.  32 161).  The  Dyadic  DAS  includes  Cohesion,  four  Dyadic  subscales: Satisfaction  E x p r e s s i o n . For the purposes  of t h i s  scores were  DAS  considered.  p o s s i b l e scores of e n t i r e 32  The  between  item s c a l e  Dyadic  The  i s .96. Spanier  reliability  content  based  the  total  for the  (1976) e s t a b l i s h e d the  i n three ways: " F i r s t , on  the  32 items and a range of  v a l i d i t y of the DAS validity  Affectional  study, only  has  0-151  and  Consensus,  judges  theoretical  Second, the s c a l e d i s c r i m i n a t e d between married  determined dimensions.  and d i v o r c e d  samples, suggesting c r i t e r i o n r e l a t e d v a l i d i t y . . . . T h i r d , the DAS  has  the  theoretical The  construct structure".  types of v a l i d i t y  validity,  criterion  correlated  Williamson, 1950) theoretical  (SD  o f f e r e d by  with  conforming  & F i l s i n g e r , 1983, the s c a l e  validity  divorced  p.162)  validity  Adjustment T e s t , Locke and  Spanier's and  a  i n c l u d e content  concurrent  and c o n s t r u c t v a l i d i t y  (SD 17.8)  to  (scale discriminates  couples),  Marital  structure).  couples are 114.8  of  (Spanier  related  between married and (scale  validity  ( s c a l e conforms to a  (1976) norms f o r married  f o r d i v o r c e d couples are  70.7  23.8). In the  o r i g i n a l study  and a pre-treatment outcome  at  treatment year a f t e r  was  used as a s c r e e n i n g  measure as w e l l as "a  general measure of  termination  (James, 1988, treatment  one year follow-up  the DAS  and p.70).  follow-up" The  as a long-term  study.  DAS  was  four months a f t e r administered  one  follow-up measure i n the  33 2.  Communication  Scale  (CS)  (Olson,  Fournier  Drunkman,1985): This ten item subscale of the ENRICH Inventory  (ENRICH)  stands  R e l a t i o n s h i p Issues, assesses  the  for:  Communication and  individual's  feelings,  about m a r i t a l communication. which i s based on a (1985) r e p o r t .68;  of  The  PIQ  assesses  construct The  Happiness. The  beliefs,  scale  and a t t i t u d e s  672  couples.  Olson  et a l .  115  individuals they  and a  report  a  four week  test-re-test  .90.  P s y c h o s o c i a l Intimacy  and  of  occasion,  3.  adult  Nurturing  T h i s i s a s t a n d a r d i z e d measured  sample  sample of  testing  reliability  and  Marital  an i n t e r n a l c o n s i s t e n c y (Chronbach's alpha) of  based on a  interval  Evaluating  and  the  c o n s t r u c t of  adolescent  dating,  properties  or  of  (PIQ)  (Tesch,  1985):  p s y c h o s o c i a l intimacy i n  relationships  in friendship,  psychometric  Questionnaire  and  can  be used as a  marital relationships.  t h i s measure were based  three s t u d i e s of c o l l e g e aged samples. In terms  on  of c o n s t r u c t  v a l i d i t y , the s c a l e c o r r e l a t e s both p o s i t i v e l y and  negatively  on scores  constructs  of measures  respectively.  of s i m i l a r  Reliability  r e l a t i o n s h i p s shows an  of  of  psycho-social  is  intimacy  the  internal  test-re-test r e l i a b i l i t y  and d i s s i m i l a r  .84.  measure f o r opposite  consistency According  contingent  of  .98  to Tesch  upon  three  sex  and a (1985), major  factors: I.  Romantic  Love:  items  pertaining  e x p r e s s i o n , p h y s i c a l intimacy and  to  love,  interdependence.  emotional  34 II.  Supportiveness: Items p e r t a i n i n g to r e s p e c t , h e l p f u l n e s s  and  acceptance.  III.  Communication Ease: Items p e r t a i n i n g to being o n e s e l f ,  communicating, relationship. excluded  and As  (825,  a  lack  in  #34,  the  of  ambivalence  original  and  #60)  about  the  study, three items were  because  these  items seemed  i n a p p r o p r i a t e to the couples under c o n s i d e r a t i o n . 4. Target Complaints Nash, & Frank, of  treatment  (TC)  Stone,  1966): TC i s used to measure the e f f e c t i v e n e s s in r e l a t i o n  TC i s an i n d i v i d u a l i z e d spontaneously complaints.  ( B a t t l e , Imber, Koehn-Saric,  to p r e s e n t i n g problems i n therapy. measure which  expressed  presenting  assesses  individuals'  complaints  TC r a t i n g s of improvement have been  or  target  shown to be  e f f e c t i v e outcome measures i n 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  Complaints The of  first  was  based  reliability  on two s t u d i e s by B a t t l e et a l . ,  study showed a c o r r e l a t i o n of .68  complaints  of Target  before and  (1966).  between rankings  a f t e r an assessment i n t e r v i e w with  no s i g n i f i c a n t change i n the s e v e r i t y of r a t i n g s .  The  study showed  complaints  no s i g n i f i c a n t d i f f e r e n c e s i n t a r g e t  r e p o r t e d to d i f f e r e n t i s shown other  by the  outcome  congruent  with  interviewers.  f a c t that measures.  of the measure  TC c o r r e l a t e d s i g n i f i c a n t l y with Also,  pre-testlng  Validity  second  target  complaints  complaints in  an  were  independent  p s y c h i a t r i c assessment.  Mintz and K i e s l e r  (1982) r e p o r t good  face  target  Items are obtained  validity  because  complaint  35 from spontaneous In  the  assessment  reports.  original  interview  study  couples  to w r i t e  were  asked  down 3 r e l a t i o n s h i p  order of p r i o r i t y which they hoped to r e s o l v e the p o s t - t e s t of  on  the  three complaints.  degree  of  complaint. T h i s was done noted  that  initial  issues i n  i n therapy. At  i n t e r v i e w couples were asked to r a t e the degree  improvement of these  based  at the  the  problem  Data a n a l y s i s was  improvement of the primary t a r g e t  because  variation  in  Mintz the  and  Keisler  (1982)  s e v e r i t y of the primary  i s l i k e l y t o be s m a l l e r than the v a r i a t i o n i n  the s e v e r i t y of the second and t h i r d complaints p.73). In the one  year follow-up  (James, 1988,  study, couples  were asked  once a g a i n to r a t e t h e i r s t a t e d t a r g e t complaints i n terms of perceived  improvement.  OTHER MEASUREMENT PROCEDURES: S t r u c t u r e d Interview: In  addition  i n t e r v i e w was  to  the  conducted  quantitative  life  events which  of  marital  a structured  i n order to gather q u a l i t a t i v e d a t a .  T h i s i n t e r v i e w was designed t o e l i c i t to  data,  i n f o r m a t i o n with regard  may have had an i n f l u e n c e on the l e v e l  satisfaction  ( i e . loss  of  employment, deaths,  financial situation  e t c . ) The  how the couples f e l t  the E m o t i o n a l l y Focused therapy may have  i n f l u e n c e d t h e i r degree  i n t e r v i e w attempted  to assess  of m a r i t a l s a t i s f a c t i o n . F o l l o w i n g i s  the l i s t of q u e s t i o n s which were asked.  36 Questions: 1. Do  you  perceive  deteriorated counselling 2. To  or  your  relationship  remained  the  i n the Couple's  what do  you  as  same  having  since  improved,  the  end  of  Project?  attribute this  improvement, d e t e r i o r a t i o n  or maintenance? 3. What s t r e s s f u l s i n c e the end  l i f e events or  of c o u n s e l l i n g  l i f e changes  i n the  To what degree do you  life  changes  have  r e l a t i o n s h i p now? not at a l l  think  etc.)  these s t r e s s f u l  influenced  how  you  C i r c l e the a p p r o p r i a t e  very l i t t l e  occurred  "Couple's P r o j e c t " ? ( l e .  change of job, deaths, b i r t h s , moves, 4.  have  somewhat  are  l i f e events or doing i n your  response.  moderately  a  great  deal 5. How  much has  stressful  your r e l a t i o n s h i p changed as a r e s u l t of these  l i f e events or l i f e  not at a l l  very l i t t l e  changes?  somewhat  Circle: moderately  a  great  received  since  deal 6. What the end  further counselling, of  counselling  in  i f any, the  have you  "Couple's  Project"?  (Type,  length) 7.  If  you  counselling now?  have  received  influenced  Explain.  how  further you  counselling,  has  this  are doing In your r e l a t i o n s h i p  37 O p e r a t i o n a l Hypothesis: The that  hypothesis  couples  who  under  investigation  receive  EFT  would  i n t h i s study show  a  trend  improvement on the mean s c o r e s of the Dyadic Adjustment (DAS), the  Psychosocial  Communication Scale one  year  span  specifically,  Intimacy  (CS), and  of  time  the  trend  after  receiving  a n t i c i p a t e d was  from p r e - t e s t to p o s t - t e s t months follow-up  Questionnaire  Target Complaints  followed  by  of  Scale  (PIQ), the (TC) over a  therapy.  one  was  More  of improvement  regression  and then an improvement at one year  a t four follow-  up .  DATA ANALYSIS: This study i n v e s t i g a t e d the e f f e c t of focused m a r i t a l  therapy, EFT,  m a r i t a l adjustment,  on the  communication,  an  experientially  dependant measures of  intimacy  and r e d u c t i o n of  t a r g e t complaints over a one year span of time. It was  hypothesized t h a t  would be improved four dependant (1986)  one  marital  follow-up  have a  the treatment may showing  hypotheses  PIQ,  study  as  measured  CS and TC.  suggests  "sleeper e f f e c t " ;  of r e c e i v i n g  that  and  on  the one  EFT  by the Remple's the  EFT  that i s , with time,  influence increased marital s a t i s f a c t i o n  increases  month follow-up  satisfaction  v a r i a b l e s : the DAS,  year  treatment may  the outcome  by  dependant v a r i a b l e s between four year  w i l l be s t a t e d as  follow-up.  follows:  T h e r e f o r e , the  38  HI:  It  was  hypothesized  E m o t i o n a l l y Focused the  mean  scores  Couples of  that  couples  who  Therapy would show improvement on  the  Dyadic Adjustment Scale (Spanier,  1676), the P s y c h o s o c i a l Intimacy Q u e s t i o n n a i r e the  Communication  Complaints  Scale  (Olson  ( B a t t l e et a l . , 1966)  after receiving  received  et  (Tesch, 1985),  a l . , 1985), and  over a one  Target  year span of time  therapy.  DATA ANALYSIS PROCEDURES: A  preliminary  analysis  was  followed  by  analysis  of  q u a n t i t a t i v e and then q u a l i t a t i v e d a t a . A d e s c r i p t i o n of each a n a l y s i s i s presented  below.  Preliminary Analysis: Because  only  James' (1988)  of  the  e x i s t e d the  b i a s might confound of  month  group  independent  done  i n the  one  year  the i n t e r p r e t a t i o n s of treatment equivalence  follow-up  comparison was  o r i g i n a l EFT couples  by  from  follow-up  p o s s i b i l i t y that subject s e l e c t i o n  p a r t i c i p a n t s ) were t e s t e d by four  14  study p a r t i c i p a t e d  study, there  Assumptions  9  on  ( p a r t i c i p a n t s versus  comparing the  using  DAS a  results.  the  mean  f o r the two  t-test  to  non-  scores a t  groups.  compare  This the 2  group means.  A n a l y s i s of Q u a n t i t a t i v e 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 p l o t t e d  on l i n e graphs.  A repeated measures a n a l y s i s of v a r i a n c e was  then  in  conducted  significant TC over  occasions  four  months  Only  post-treatment,  measure. of  to  the  after  scores  i e . , pre-treatment,  existence  of  post-treatment,  treatment  and one year a f t e r  four  follow-up  were  month  available  T h i s was because Target  on  four  month  year  complaints  as measured a t p r e - t e s t .  the f o l l o w i n g form:  follow-up  repeated measures a n a l y s i s  one  measures amount  A n a l y s i s A: a one group (EFT) by four occasions  post-test,  treatment.  and  the Target  Complaints  improvement of primary complaints  T h e r e f o r e , the a n a l y s i s took  1.  determine  i n c r e a s e s on mean scores of the DAS, PIQ, CS, and  four  follow-up  order  of  and  variance  (pre-test,  one  year  follow-up)  on  the  DAS ( t o t a l  s c o r e ) , CS and PIQ.  2.  A n a l y s i s B:  a one group (EFT) by three occasions  t e s t , four month follow-up, and one  year  follow-up)  (post-  repeated  measures a n a l y s i s of v a r i a n c e on TC.  Since  the  analysis  d i f f e r e n c e s , a post hoc Newman-Keuls determine  method  significant  a c r o s s occasions  of  variance  a n a l y s i s was  of  pair-wise  differences  indicated  significant  conducted.  The Student  comparisons on  couple  was used t o mean  scores  on the four measures: DAS, CS, PIQ, and TC.  the importance  of u s i n g t h i s method i s that  wise comparisons  ( d i f f e r e n c e s between  means) on the f i r s t , Because a time,  a  analysis  trend  identifying  of  analysis  points  a l l p o s s i b l e p a i r s of  second, t h i r d and f o u r t h o c c a s i o n s .  trend  provided  i t allowed p a i r -  an of  improvement was  overall  was  anticipated  conducted  on  picture  of  inflection  in  over  the data. T h i s the  data  by  the data and thereby  r e v e a l i n g p a t t e r n s of change on mean s c o r e s over time.  A n a l y s i s of Q u a l i t a t i v e The s t r u c t u r e d as to  the changes  Data:  i n t e r v i e w provided a d d i t i o n a l i n f o r m a t i o n couple's experienced over a one year  of time a f t e r r e c e i v i n g EFT. the i n t e r v i e w s results  The i n f o r m a t i o n  gathered  span from  was compiled and summarized. A summary of the  i s presented i n Chapter IV.  41 CHAPTER IV: RESULTS AND  DATA ANALYSIS  R e s u l t s of P r e l i m i n a r y A n a l y s i s : In  order  to  differences existed one year  check  (group  mean scores of the two DAS  was  statistically who  2),  a t-test  was  groups at four  significant  participated  (group 1) and couples  who  chose not  used to compare the  month follow-up.  inclusion in  the o r i g i n a l  The the  (James,  study, and because a g r a p h i c a l a n a l y s i s , as can be seen  in F i g u r e 1, i n d i c a t e d the l a r g e s t spread between as  i n the  s e l e c t e d as the c r i t e r i o n measure because i t was  measure used to determine 1988)  any  between couples  follow-up study  to p a r t i c i p a t e  if  compared  other  with  differences  standardized  indicated  no  participants  measures  significant (M>  101.2)  between (ie.  and  the  mean scores f o r the  CS,PIQ,  differences group  the groups  TC).  Results  between the group of of n o n - p a r t i c i p a n t s  (E=91.2), t(12) = .00286, p<.05.  R e s u l t s of Q u a n t i t a t i v e Data: Dyadic  Adjustment S c a l e :  A repeated using the DAS  measures a n a l y s i s  scores  as  of v a r i a n c e was  measured  on  four  o c c a s i o n s : pre-  t e s t , p o s t - t e s t , four month follow-up and one year These  scores  can  r e p r e s e n t i n g these  be  seen  in  Table  I.  conducted  A  follow-up. line  graph  scores can be seen i n F i g u r e 2. A summary  Anova t a b l e for a l l  four  dependent  variables  used  study i s represented  i n Table I I . The a n a l y s i s showed a  i n the  42  Legend:  0- D y a d i c Adjustment Scale d~ Psychosocial Intimacy Scale  C  a  Cf a  2  c o  S  X~ Communication Scale  280 r270 260 250 240 230 220 210 -  O - Target Complaints aon-participants participants  110 100 -  90 80 % 50 40 30 20 10 0 —  Figure 1:  PRE  POST Occassions  4 months  I year  Participant vs. N o n - Participant M e a n Scores o n S e l f - r e p o r t Measures  Table I :  Data Gathered on Dyadic Adjustment Scale Raw Score, Mean and Standard D e v i a t i o n Across Four Occasions  Couple P r e - t e s t P o s t - t e s t # 1 2 3 4 5 6 7 8 9  Four Mo. Follow-up  One Year Follow-up  85.5 84 85.5 78.5 103.0 80.5 76.5 104.5 81  104 100.5 104 104 116 110.5 96 124.5 102.5  99.5 97 99.5 89.5 113 109 93 108.5 102  96.5 101.5 78.5 89.5 114 110.5 87 113 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  Table,  H :  Repeated Measures one Factor A n a l y s i s of V a r i a n c e  A n a l y s i s pf v a r i a n c e A c r o s s (Std. Dev.). and F - r a t l o s  4 Occasions;  Mean,  P r e - t e s t P o s t - t e s t Four mos. One year Follow-up Follow-up Variable  X  X  X  F  X  PR F  DAS  86.55 (10.21)  106.88 (8.73)  101.22 (7.75)  98.11 25. 56 (12.13)  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)  TC  4.61 (.416)  4.11 (.416)  31.22 28 .33 0.0001 (4.19) 6 .28 0.0097 4.05 (.634)  Note: 1. n~9 f o r E m o t i o n a l l y Focused Therapy treatment 2. S t a t i s t i c s (F,P) r e p r e s e n t a c r o s s time a n a l y s i s 3. DAS= Dyadic Adjustment S c a l e , PIQ= P s y c h o s o c i a l Intimacy Q u e s t i o n n a i r e , CS= Communication S c a l e , TC= Target Complaints  significant difference  i n the mean scores over time, £.(3,24)  = 25.56, pjC.0001. Thus, the rejected.  Ho of  no s i g n i f i c a n t  effect  Therefore the hypothesis t h a t the couples exposed  to the EFT treatment  will  marital satisfaction  as measured by scores on the DAS  one year span of time was  show  a  means  on  the  one  and  post-test, one  between a l l  year  follow-up,  i n c r e a s e s on DAS  pre-test  and  finally,  between  were  significant  follow-up and Trend occasions  possible pairs  post-test  analysis Indicated  and  T h i s method  scores between p r e - t e s t  4 month  one year  differences  one year  used.  four month follow-up, p r e - t e s t  year follow-up, p o s t - t e s t and  no  over a  the Student Newman-  of p a i r wise comparisons was  revealed s i g n i f i c a n t and  increase in  four o c c a s i o n s : p r e - t e s t , p o s t - t e s t , four  month follow-up and Keuls method  significant  held as t e n a b l e .  To determine the d i f f e r e n c e of  was  found  follow-up  follow-up.  and  There  between four-month  follow-up. on  a  the  DAS  scores  across  the  cubic  trend,  F_(3,24) =  significant  four  14.20, a<.0009.  P s y c h o s o c i a l Intimacy Data was III. visual  Questionnaire:  gathered  on  the PIQ  Mean scores were p l o t t e d on a picture  of  the  data  (see  measures a n a l y s i s of v a r i a n c e was  and can be seen i n Table l i n e graph Figure  3).  used to analyze  to provide a A repeated scores  the PIQ across four o c c a s i o n s : p r e - t e s t , p o s t - t e s t , four  on  Table I I I : Data Gathered on Communication Scale Raw Score, Mean and Standard D e v i a t i o n Across Four Occasions Couple P r e - t e s t P o s t - t e s t Four Mo. I Follow-up 1 2 3 4 5 6 7 8 9 X SD.  One Year Follow-up  32. 5 25 28.5 22.5 26.5 28 26.6 25 21.5  35 34.5 37.5 29.5 41 35 36.5 33.5 26  31.5 29.5 31 25 32 35 31.5 30 22.5  32 28.5 31 28 37 34.5 33.5 33.5 23  26.2  34.27  29.7  27.1  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  i n d i c a t e d the f o l l o w i n g . There were s i g n i f i c a n t scores,  £.( 3,24)  =  therapy e f f e c t s  over  time on PIQ  6.20, p_<.0029. T h e r e f o r e , the hypothesis  that couples exposed to EFT w i l l show a in m a r i t a l s a t i s f a c t i o n  significant  increase  as measured by scores on the PIQ over  a one year span of time was held as t e n a b l e . As before, the Student  Newman-Keuls method  of p a i r - w i s e  comparisons was used to determine the d i f f e r e n c e s between a l l p o s s i b l e p a i r s of p o s t - t e s t , four  means  on  the  four  month follow-up,  occasions: pre-test,  and one year follow-up.  A  s i g n i f i c a n t d i f f e r e n c e was found between p r e - t e s t and each of the and  other  three  one year  o c c a s i o n s : p o s t - t e s t , four month  follow-up.  follow-up  No s i g n i f i c a n t d i f f e r e n c e s were seen  between p o s t - t e s t and four month follow-up, p o s t - t e s t and one year  follow-up,  and  four  months  follow-up  and  one year  follow-up Trend  analysis  indicated  a  significant  cubic trend,  F(3,24) = 5.29, p_<.03.  Communication S c a l e : Data was gathered  for  scores  occasions and  i s represented  p l o t t e d on  line  a  measures a n a l y s i s  graph  on  CS  i n Table  IV.  (see  Figure  of v a r i a n c e conducted  Scale s c o r e s across the four occasions  across  the four  Mean scores were  4).  The repeated  on the communication (pre-test, post-test,  Table  Couple # 1 2 3 4 5 6 7 8 9 X SD.  IV:  Data G a t h e r e d on P s y c h o s o c i a l I n t i m a c y S c a l e Raw S c o r e , Mean, and S t a n d a r d D e v i a t i o n A c r o s s Pour O c c a s i o n s  Pre-test  Post t e s t  Four Month Follow-up  One Year Follow-up  251.5 224 227 192 249 221.5 223.5 252 213.5  257 262.5 270.5 242.5 313.5 226. 5 264.5 281.5 258.5  261.5 229.5 262 202 284.5 271 260.5 256.0 222.5  267 242.5 205 226 299.5 270.5 245.5 267.5 197  229.3  235.38  249.94  246.2  24.36  26.30  19.86  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 there was  follow-up and a significant  occasions,  F_(3,24)  Therefore, treatment  the  Scale  as  The  i n d i c a t e d that  i n c r e a s e on  CS scores  over the four  =  have  as  28 . 33,  a  that  p_<.0001 couples  significant  indicated  measured  receiving  follow-up)  hypothesis  will  satisfaction  one year  over  by a  Table  exposed  increase  scores one  (see  on  year  to  in  1). EFT  marital  the Communication  span  of  time  after  therapy. Student  indicated  a  significant  p r e - t e s t and pre-test  difference  post-test, pre-test  and  follow-up  Newman-Keuls method of p a i r - w i s e comparisons  and  one  year  and  i n mean scores between four  months follow-up,  follow-up, p o s t - t e s t and  post-test  and  one  year  four month  follow-up.  No  s i g n i f i c a n t d i f f e r e n c e s were found between four month f o l l o w up and  one year  Trend  follow-up.  a n a l y s i s 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  measure and can be seen i n Table V. The data was l i n e graph  and can  one  year  p l o t t e d on a  be seen i n F i g u r e 5. A repeated  a n a l y s i s of v a r i a n c e was Complaints  Complaints  used  to  analyze  scores  measures on  Target  as measured a t p o s t - t e s t , four month follow-up  follow-up. P r e - t e s t s c o r e s were excluded  Target Complaints  instrument  and  because the  measures the r e d u c t i o n of  Table V :  Couple  Data Gathered on Target Complaints Raw Scores, Mean and Standard D e v i a t i o n Across Three Occasions Post-test  Four Month Follow-up  ft  1 2 3 4 5 6 7 8 9  4.0 5.0 5.0 4.5 5.0 5.0 4. 5 4. 5 4.0  4.0 4.0 4.0 4.0 5.0 4.5 4.0 4.0 3.5  4.5 4. 5 3.0 4.0 5.0 4.5 3.5 4.0 3. 5  X  4.6  4.1  4 .05  SD.  c  One Year Follow-up  .416  .634  . 416  5r  Ol  1  PRE  1  :  POST Occassions  1  4 months  /<  1—  1 year  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 p r e - t e s t  a p p l y i n g a numerical value to the couples a f t e r  indicated a s i g n i f i c a n t  TC scores over a one p_<.0097. Therefore  year  span  of  will  satisfaction  change noted by  as  improvement on mean HO,24)  time,  the Ho of no s i g n i f i c a n t  r e j e c t e d and the hypothesis that  treatment  of  treatment.  The a n a l y s i s  was  degree  by  show  a  treatment  couples exposed  significant  measured over  =  increase  a one  year span  in  6.28, effect to EFT  marital  of time  was  held as t e n a b l e . The showed  Student a  Newman-Keuls  significant  measured at and one year  method of p a i r - w i s e comparison  difference  p o s t - t e s t and  between  mean  scores  four month follow-up and  follow-up.  No  significant  as  post-test  d i f f e r e n c e s were  found between four month follow-up and one year follow-up. Trend a n a l y s i s  showed no s i g n i f i c a n t  trends of the mean  scores.  R e s u l t s of Q u a l i t a t i v e A structured up.  The  extraneous results.The descriptive  Data:  i n t e r v i e w was  interview  was  variables  which  interview summary  of  conducted a t one year  designed  to  might  consisted the  flush  have of  results  out p o s s i b l e  influenced 7  of  follow-  questions. the  the A  structured  i n t e r v i e w s w i l l be presented. In  response  to  the  question  of  whether  couple's  55 perceived  their  deteriorated counselling  or  remained  as  the  having  same  since  improved, the  end  of  i n the Couple's P r o j e c t , 7 of the 9 couples (78%)  r e p o r t e d that of  relationships  they f e l t  t h e i r r e l a t i o n s h i p had improved.  the 9 (22%) r e p o r t e d that they f e l t  deteriorated.  When  asked  2  t h e i r r e l a t i o n s h i p had  what  they  attributed  this  improvement or d e t e r i o r a t i o n t o , of the  couples who r e p o r t e d  improvement,  they  6  communicate  of  7  reported  better;  5  of  understanding of having a working  commitment  relationship  reported d e t e r i o r a t i o n couple blamed felt  the  l a c k i n g i n communication  events  response or  life  counselling, changes. 2 daughter  5  to  to  of  the  to  better  and to  the two couples who  end  of  of  c o u n s e l l i n g , one  counselling  and were  skills.  the  couples  question had  what s t r e s s f u l  occurred  mentioned  reported  of  since  job  having  a  the  related baby,  life  end  of  stress  or  one c o u p l e s '  married, one couple r e p o r t e d f a m i l y i l l n e s s and  country.  Of  close friends  the  two  stressful  life  i n t e r e s t i n g as i t seems t o  events  or  contradict  who had moved  couples  d e t e r i o r a t i o n i n t h e i r r e l a t i o n s h i p , o n l y one reported  a  relationship  Of  the  one couple r e p o r t e d the l o s s of out  the  support  changes  couples  got  having  able  needs; and 4 of 7 r e p o r t e d  issues.  since  were  a lack of time together while the other couple  they had missed  In  reported  their partner's  stronger on  7  that  who r e p o r t e d of the couples  changes. the  findings  This  is  i n the  56 Jacobson  e t a l . (1978) study. Jacobson  s t a n d a r d i z e d telephone receiving  marital  "stressful  life  i n t e r v i e w s of 34 couples 2 years a f t e r  therapy.  (1978, p. 187).  or  asked  changes  c u r r e n t l y doing i n t h e i r all", 2  "moderately",  authors  concluded  to m a r i t a l s a t i s f a c t i o n " When  events  "not a t  The  that  events subsequent t o therapy t e r m i n a t i o n were  negatively related  these  e t a l . (1978) analyzed  to had  what  (Jacobson e t a l .  degree  influenced  relationships,  2  couples  how  felt  they  were  couples r e p o r t e d  couples chose "very l i t t l e " , 2 couples  while 3 couples s a i d  said  "a great d e a l " .  When asked how much t h e i r r e l a t i o n s h i p had changed r e s u l t of  these s t r e s s f u l events or l i f e  couples r e p o r t e d "not a t a l l " , little",  1  of  the  9  1  of  as a  changes, 3 of the 9  the  9  r e p o r t e d "very  r e p o r t e d "moderately"  and 3 of the 9  r e p o r t e d "a great d e a l " . One couple r e p o r t e d no changes. Couples  were  asked  counselling since 9  couples  counselling.  if  they  had  the end of the Couple's  reported Two  that of  they  these  had  couples  obtained Project.  4 of the  received  obtained  further  further  individual  counselling for issues unrelated to their r e l a t i o n s h i p , two  couples  attended  communication s k i l l parenting.  Of  group  workshops;  development while  the  four  the  one other  while  focused  on  focused on  couples who had r e c e i v e d f u r t h e r  c o u n s e l l i n g , o n l y the couple who attended the p a r e n t i n g group f e l t t h a t the c o u n s e l l i n g had i n f l u e n c e d t h e i r  relationship.  57 CHAPTER V: DISCUSSION OF RESULTS Positive  treatment  the long term indicates a  (Remple, lack of  effects 1968,  are r a r e l y maintained  pp.54  &  55).  The  literature  r e s e a r c h concerned with the maintenance  of treatment gains over time. Remple (1986) notes that review of  over  the e x i s t i n g  i n her  r e s e a r c h on the long term e f f e c t s of  p s y c h o t h e r a p e u t i c treatment  " i t appears  that  the  r a t e of  p o s i t i v e outcomes, though high a t t e r m i n a t i o n of therapy, much lower  at  follow-up:  positive  results  transfer  or  found  couples  four  month  regressed  at  treatment  levels  when  s t u d i e s reported  [It  would  appear]  r a t h e r than the r u l e "  Despite  that  of  o n l y 14 percent r e p o r t e d  effects.  the e x c e p t i o n  pp. 54 & 55).  (1986)  percent  termination,  maintenance  maintenance i s 1986,  at  85  these who  unlikely  had  follow-up,  measured  was  one  (Remple,  odds, Remple  received  EFT and  recovered year  that  to  after  had  post-  therapy.  Remple (1986) concluded that her study " s t r o n g l y supports the occurrence  of  positive  outcomes  at  follow-up and  e s t a b l i s h e d the power o f . . . t h e EF t h e r a p y . . . i n of m a r i t a l  d i s c o r d and  the treatment  the maintenance of change over a one  year p e r i o d " (Remple, 1986,  p.55).  James (1988) questioned what r e s u l t s might year a f t e r treatment in  his  study.  speculated  that  f o r the couples who  He EFT  e f f e c t s . The goal of  clearly  cited may  Remple's have  the c u r r e n t  be found  one  r e c e i v e d EFT therapy (1986)  long-term  findings  and  self-generating  r e s e a r c h was  to r e p l i c a t e  58 Remple's (1986) study i n order to determine gains through r e c e i v i n g E m o t i o n a l l y in James'(1988)  this  Focused  study,  the  Therapy  over a one  therapy.  researcher  conducted  i n t e r v i e w s with 9 of the o r i g i n a l 14 couples who the EFT treatment  treatment  Couple's  study were maintained or improved  year span of time a f t e r r e c e i v i n g In  whether  follow-up  had r e c e i v e d  i n the James (1988) study. At the follow-up  i n t e r v i e w , couples  were g i v e n a package of instruments which  they were asked to complete  independently  researcher  Instruments  immediately.  and r e t u r n  to the  given to the couples  were: the Dyadic Adjustment S c a l e , the P s y c h o - s o c i a l Intimacy Q u e s t i o n n a i r e , the questionnaire.  Communication Scale and Target  A f t e r completing  interviewed with  the measures,  regard to q u a l i t a t i v e  have i n f l u e n c e d the  Complaints  couples were  i n f o r m a t i o n which  may  results.  In a n a l y z i n g the q u a n t i t a t i v e data, the couple s c o r e , an average  of  partner's  scores,  as opposed to the  scores were used as the u n i t of a n a l y s i s . with other  individual  This i s consistent  r e s e a r c h i n m a r i t a l therapy (Remple, 1986,  p.59).  It i s a l s o c o n s i s t e n t with the a n a l y s i s i n the o r i g i n a l James (1988)  study.  p a r t n e r s as  James  the  a n a l y s i s using differences.  unit  (1988) of  used  analysis  I n d i v i d u a l scores T h i s was  the  not done  and  average then  score as of repeated the  i n order to examine gender i n the  one year  s i n c e gender d i f f e r e n c e s were not a p p l i c a b l e to t h i s A concern  o£ the  r e s e a r c h e r was  follow-up study.  that couples who  had  59 not achieved much improvement have chosen  not to  those couples who explanation study  participate  imply  only  be  that  EFT treatment  to be i n c l u d e d .  This  the r e s u l t s of the follow-up  considered  generalizable  to  couple  p o p u l a t i o n s which were most responsive i n i t i a l l y to t h i s of  therapy.  may  i n the follow-up study while  gained the most chose  would  could  through the  type  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,  percent of the s u b j e c t s (7 of 9 couples)  r e p o r t e d that  relationship  22  had  improved  while  only  percent  78  their  (2 of 9  couples) f e l t t h e i r r e l a t i o n s h i p had d e t e r i o r a t e d . However, a comparison  of  the mean scores of the p a r t i c i p a n t s versus the  n o n - p a r t i c i p a n t s i n d i c a t e d no s i g n i f i c a n t d i f f e r e n c e s between these two  groups a t  four month  assumed t h a t couples who up study chose  participated  were e s s e n t i a l l y  i n the one year  follow-  no d i f f e r e n t than the couples  who  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 was  follow-up. Therefore i t was  demonstrated  to  study supported effective  the h y p o t h e s i s .  in s i g n i f i c a n t l y  EFT  increasing  couple's 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. A repeated  measures  analysis  statistically significant adjustment  (DAS),  t a r g e t complaints The  of  variance  indicated  a  i n c r e a s e on the measures of m a r i t a l  communication  (CS),  intimacy (PIQ), and  (TC) over a one year span of time.  Newman-Keuls  pair-wise  comparisons  indicated  no  s i g n i f i c a n t d i f f e r e n c e s f o r couple's mean scores between four  60 month follow-up  and  c r i t e r i o n measures. the  one  year follow-up  on any  This  f i n d i n g may  be c o n t r a d i c t o r y  hypothesis were an  improvement  four months a f t e r treatment and  months a f t e r  treatment and  r e f l e c t a decline  in  was  one  lack of s i g n i f i c a n t d i f f e r e n c e s  at one  four  year a f t e r treatment  may  post-treatment  c u b i c trend  for the mean scores  a n a l y s i s one  pair-wise  can  on the  DAS  and  interpreted  J levels  means of  A  independently of  of the  factor  and  variables Yj, TC]  (independent  of trend  multiple  "...by  the dependent  on the DAS,PIQ, CS,  the use  than  comparison:  the PIQ.  analysis  comparisons"  are  plotted  variable.  In  i s u s u a l l y more  (Glass  & Hopkins,  p.386).  scores  cubic  on the DAS was  follow-up. supported  no  and  longer  the PIQ.  were  power  i n scores  quantitative of  EFT  year span of time. notion  that  The EFT  evident  for  Thus, i n both of  a decline  Hence, the the  trends  i n not  s a t i s f a c t i o n , but a l s o i n m a i n t a i n i n g  the  indicated a s i g n i f i c a n t  curve  Significant  there  couples  examine s t a t i s t i c a l l y the shape of the  such s i t u a t i o n s ,  1984,  as  trend  [ i n t h i s case, scores  informative  regression  using  t h a t r e s u l t s when the  for the  scores  The  at  s t a b i l i z e . Trend a n a l y s i s  the Newman-Keuls  to  a n t i c i p a t e d between  between mean  trend must be  four  year a f t e r treatment.  mean scores  s i g n i f i c a n t cubic  not  of the  these cases  a f t e r four months  results only  the mean  of  t h i s study  increasing  the e f f e c t s over  marital a  one  r e s u l t s of the trend a n a l y s i s support may  have  long-term  self-generating  61 e f f e c t s as  there was  evidence that  and the PIQ began to improve a f t e r  mean scores f o r the DAS  four months follow-up.  The r e s u l t s of the q u a l i t a t i v e data lend f u r t h e r to  the  reported  hypothesis.  A  large  percentage  (78%)  support  of couples  improvement i n t h e i r r e l a t i o n s h i p s s i n c e c o u n s e l l i n g  i n James'(1988) study. The into  goal  of  awareness  brought  EFT  and  into  the  i s to bring intra-psychic  determine  how  relationship  through  f a c i l i t a t e s p a r t n e r s understanding are  brought  into  interaction.  the  The goal  one another's behaviour s u p p o r t i v e of  one  these  of  relationship therefore i s  experience  experiences  are  interaction.  EFT  how  past experiences  and  how  t o have  they  affect  p a r t n e r ' s view  i n a new way so that they may be more  another.  This  may  explain  why couples  experienced an Improved a b i l i t y t o communicate. P a r t n e r ' s may be r e a c t i n g i n a more s u p p o r t i v e manner when they r e a l i z e the roots  of  their  spouse's  behaviour.  r e a c t i n g i n a d e f e n s i v e manner, they  Thus, may be  rather  than  more w i l l i n g to  accept or acknowledge and l i s t e n to t h e i r p a r t n e r . This  explanation  responses g i v e n James' (1988)  in  seems  James(1988)  identified real  in  structured  light  of  the  interview.  In  study, 50% of couples i d e n t i f i e d  " coming to new understandings f e l t ) about  plausible  or  realizations  the c a t e g o r y ( o f t e n deeply  myself, my p a r t n e r , or the r e l a t i o n s h i p " and 25% "seeing my partner experience f e e l i n g s  ( o f t e n with  i n t e n s i t y ) that he or she does not show t y p i c a l l y  i n our  r e l a t i o n s h i p " as major components 114).  In  this  relationship  study,  had  treatment between It  These  that there which  support  may be processes for  this  open  and  felt their  to  improved  Remple's  operating  (1986)  in  an EFT  honest communication  partners. i s important to consider  Influenced factor  couples'  which  additional  might  reported  improvement.  influence  counselling.  the o r i g i n a l  other f a c t o r s which  perceived  study. Of  have  possible  is  l e s s than h a l f  counselling after  these four  may  One  improvement  However,  couples engaged i n f u r t h e r  seeking (4 of 9)  counselling in  c o u p l e s , only one couple  that the a d d i t i o n a l c o u n s e l l i n g had any i n f l u e n c e on  their relationship. t h a t reported up.  attributed  results  allow  (James, 1988, p.  of the 7 couples who  improved  communication. speculation  6  of change  This couple  was one  of the two couples  r e l a t i o n s h i p d e t e r i o r a t i o n a t one  Assumptions  made  c o u n s e l l i n g are only One might  the  follow-  lack of impact of f u r t h e r  speculation.  think  might i n f l u e n c e  about  year  that  Increased s t r e s s  marital s a t i s f a c t i o n .  occurred  s i n c e the end of c o u n s e l l i n g . Three of these couples  reported  that  couples  on  changes  represents  in  about  stress/changes i n f l u e n c e d  or  or changes their 33%  life  of the 9  reported  these events  events  A l l but 3  changes  couples  influence  stressful  or l i f e  had a  changes  great deal of  relationship. of  the  Three  subjects  their relationship.  had  This  felt  of 9 that  i s not a  63 l a r g e percentage.  It  e x p e r i e n c e d success  is likely  of the couple's  i n managing these s t r e s s f u l events/  changes as i n d i c a t e d by improved.  t h a t most  reports that  Perhaps  t h i s could  results  of  their relationship  be a t t r i b u t e d  to the EFT  life had they  rece i v e d .  SUMMARY: The findings  in  this  that r e g r e s s i o n  four months f o l l o w - u p . the dramatic  one year  follow-up that that  powerful  this  Remple  study  four month  marital  to  f o l l o w up  complaints  (DAS),  and  q u a l i t a t i v e data  after  therapy.  levels at  I t c o u l d be  the view t h a t EFT  treatment  (PIQ),  further  revealed that  t h e i r r e l a t i o n s h i p s had  study d i d  in  that  improved  support  couples  e f f e c t s between  the measures and  is a  four months  one year f o l l o w - u p . Trend  intimacy  (TC). Adding  found.  discord  showed a s i g n i f i c a n t c u b i c t r e n d on adjustment  of t h i s  stopped d e c l i n i n g a f t e r maintain  (1986)  seen to c o n t i n u e a f t e r  (1986)  reinforces  and PIQ  f o l l o w - u p were seen  not  Remple's  i n c r e a s e s to post treatment  form of t r e a t i n g  s c o r e s on the DAS  was  support  However, r e s u l t s  not show  argued  study  analysis  of m a r i t a l  r e d u c t i o n of t a r g e t to  this  view, the  the m a j o r i t y of couples  felt  over a one year span of time  64  LIMITATIONS: A limitation was  of t h i s  study i s  the sample s i z e .  a r e d u c t i o n i n the number of c o u p l e s who  up c r i t e r i a study  from the number who  (James, 1988). In  original  study  original  (James, 1988),  groups  (EFT and EFT+CT) and a w a i t i n g l i s t c o n t r o l group.  treatment  only  of  participated two  a s s i g n e d to two  the 14 couples who  i n James' (1988)  couples r e p r e s e n t  the  9  randomly  i n the  follow-  were  study  couples  participated  the  there  this  42  the  met  There  study  were  the  this  assessed.  on  4  month  group of  at  follow-up scores i n d i c a t e s  no  group of  9 participants  Scores on the DAS  pre-treatment  to  t h e r e f o r e the  who of  (Mj=86.5,  range=76.5-104.5) i n d i c a t e moderate to severe l e v e l s and  EFT  a comparison  5 non-participants.  sub-sample  In  These 9  a p a r t i c u l a r sub-sample of the couples  s i g n i f i c a n t d i f f e r e n c e s between the and  r e c e i v e d the  i n the o r i g i n a l study. However,  groups  treatment  results  for  SD=10.21,  distress  from t h i s study o n l y a p p l y  this population. Another  level. were  somewhat [on  degree  years]"  less  the t h e r a p i s t  EFT] of  (James,  in  terms of  l e v e l of academic achievement  1988,  experience p.127).  therapists  who  had  apply  with  in  study  than  clinical  therapists  in t h i s  skill  advanced  f o l l o w - u p study would o n l y from  study i s  James(1988) notes t h a t "the t h e r a p i s t s  studies and  l i m i t a t i o n of t h i s  couples  earlier  [M=1.93  Thus, the r e s u l t s of t h i s to  similar  couples skill  receiving levels  as  EFT the  65  therapists The  i n James  (1988) s t u d y .  1  limitation.  Over the  course of a year i t i s p o s s i b l e t h a t environmental  influences  or  time f a c t o r might  events may have  interview  was  confounding  be seen as a  influenced  an  attempt  the  to  results.  address  The s t r u c t u r e d  the  impact of such  variables.  RECOMMENDATIONS: There the  i s a need f o r more long-term f o l l o w - u p  effectiveness  of  EFT.  S i n c e the r e s u l t s of t h i s  supported the f i n d i n g s i n Remple's r e p l i c a t i o n of  s t u d i e s on  (1986)  these two s t u d i e s might  study  f o l l o w - u p study, a  shed f u r t h e r  l i g h t on  these outcomes. Follow-up s t u d i e s on EFT t h a t took p l a c e over a longer p e r i o d of time c o u l d be t e s t e d provide  ( i e two y e a r s or longer) were c o u p l e s  i n more  valuable  detail  information  g e n e r a t i n g e f f e c t s of EFT  over with  more  o c c a s i o n s would  regard  treatment. In  to  the  self-  a d d i t i o n , follow-up  s t u d i e s of EFT which i n c l u d e d a l a r g e r sample s i z e and/or a l l of  the couples who r e c e i v e the  conclusive  results.  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