Research conducted with the Adult Attachment Interview (AAI) has provided a wealth of information regarding how adults behave in and respond to relationships. Unfortunately, despite the AAI\'s usefulness in assessing attachment orientation, administering the AAI requires intensive training, cost, and time. Because of this, a limited number of researchers are able to use the AAI despite the measure\'s demonstrated psychometric properties and utility for research related to attachment theory. The present study aimed to utilize the Linguistic Inquiry and Word Count software to assess attachment orientation in the context of an attachment-based couple therapy, with the broad goal of potentially expanding our ability to measure attachment orientation in research. The results indicate that attachment orientation is a meaningful metric for analyzing individuals\' speech regarding their relationships in an attachment-based couple therapy. / Master of Science

Communal coping (CC: Lyons, Mickelson, Sullivan & Coyne, 1998) is an approach to dealing with problems characterized by a sense that the problem and responsibility for solving it are shared. CC has been shown to relate to relationship duration and health outcomes, but its role in couple therapy has not been examined. The purpose of the present study was to examine whether pre-treatment, observer-rated CC would predict or moderate retention and drinking outcome in 2 types of couple therapy for alcoholism. Seventy heterosexual couples in which 1 partner was alcoholic attended up to 20 sessions of conjoint cognitive-behavioral (CBT) or family systems (FST) therapy. Regression analyses were used to examine the relationship between CC and retention in therapy (number of sessions attended and treatment completion), and between CC and abstinence from alcohol at last contact with the study. Due to differential attrition from measurement, analyses of drinking outcome were exploratory. Results indicated that couples low in baseline CC attended fewer sessions of CBT, while CC was not associated with attendance of FST. CC therefore functioned as a moderator of retention in treatment rather than a general predictor of response. Exploratory analyses of drinking outcome did not reveal a relationship between CC and abstinence from alcohol. Moreover, CC did not increase in the course of either therapy, and within-couple changes in CC were not associated with retention. Preliminary evidence for discriminant validity of CC was found: results suggest our measure of CC is distinct from indices of relationship quality. Pending replication, results suggest that baseline CC may moderate the relationship between the type of treatment and treatment retention.

Few therapists test their assumptions about how they do therapy against what they actually do. The purpose of this study was to test how well integration is practiced within the proposed theoretical framework of one therapist. Qualitative and quantitative data were designed to answer four research questions: fidelity to the integrated model, client change, how working with the integrated model influenced ongoing sessions or cases, and change in the integrated model through the course of the study. Three couples were used as the sample; 17 sessions were coded and analyzed to answer the research questions. Results indicate that the therapist maintained fidelity to the integrated model that resulted in positive change for each couple. Using the integrated model was found to influence ongoing sessions and cases in a number of ways that also resulted in changes of the integrated model. Other findings, limitations, and clinical implications are discussed.

Couple therapy research demands a shift in focus from quantitative to qualitative studies that explore therapist behaviours such as the role of the therapist due to the significant gap between research and practice, where research is often irrelevant and inaccessible to clinicians, and errors in practice are repeated and perpetuated as a result of lack of insight into therapeutic functions. Research on couple therapies also lacks focus on recent modalities such as Imago Relationship Therapy (IRT), a formative and recent modality of couple therapy in South Africa and internationally that requires empirical research and evaluation. Studies addressing therapist qualities and skills necessary in dealing with diverse populations such as South Africa are also lacking. The subjective experiences and perceptions of eight Imago relationship therapists practicing in a South African context were thus explored and described within a qualitative paradigm to provide an in-depth account of their role. Semi-structured individual interviews were used to explore their role, and responses recorded and analysed using thematic content analysis. Findings highlighted underlying complexities of this role as a result of evident contradiction, irony, and paradox within participants’ experience. Firstly, the core function of establishing safe connection for the couple proved ironically ‘unconnecting’ and theory-driven in nature, which also provides a sense of safety and reduced responsibility for the therapist. The role of the Imago therapist was also indicated to be a part of participants’ identity and life philosophy. The second theme highlighted the inherently paradoxical nature of the role because perceptions of a ‘non-expert’ and ‘background’ role in fact requires active and expert therapeutic functions as they remain acutely connected to the couple’s process. Thirdly, the intuitive nature of this role was reiterated as participants’ experienced both favourable and limiting therapeutic encounters in a positive and congruent way, which has implications for increased therapeutic growth. Finally, although participants’ experience of their role in South Africa highlighted IRT’s underlying theoretical orientation of universal connection, they did not seem aware of this underlying theory as informing practice. This raises questions about implications on their role given the importance of theory in influencing the way the therapist thinks about the client. Findings generally contribute to narrowing the research-practice gap providing insight into the practice of Imago therapy, which may in turn add to richness of theory.

Research illuminating which therapist techniques are used in care-as-usual couple therapy, and under what circumstances, can contribute to a fuller understanding of how therapy works. The overall goal of the present study was to better understand care-as-usual couple therapy by investigating session-by-session techniques and session content to determine how therapists modify them based on the timing of the session and couples? pre-treatment characteristics. A total of 123 heterosexual couples were examined. Therapists frequently used acceptance techniques and discussion of recent or ongoing conflict or problem. Therapists typically used the same levels of techniques and session contents over a course of therapy. In addition, there were relatively few predictors of change in therapy techniques and session content.

The present study examined predictors of couple therapy dropout in the VA medical centers using six different dropout criteria. The most accurate dropout definitions included using a statistical modeling procedure to determine whether the client's rate of change at the final session was greater than average of change for all clients; clients who were still demonstrating gains greater than the average rate of change at the final session were considered to have terminated prematurely. A total of 177 couples (354 individuals) who sought therapy in the VA medical centers in Charleston, SC and San Diego, CA were examined. With a few exceptions, demographic variables generally did not predict dropout. A couple's relationship adjustment and response to conflict were significant predictors of dropout. The content of therapy sessions predicted dropout only when dropout was defined, at least in part, by client's rate of change at the final session, suggesting that such methods of defining premature termination are the most sensitive to the therapy process. Therapists' characteristics, including gender and level of experience, did not predict dropout across all six definitions of dropout.

Objective: The Exeter Model is an integrative systemic-behavioural and systemic-empathic couple therapy for treating people with depression. ‘Attachment narratives’ is a component of the systemic-empathic approach, which seeks to help the couple understand how past relationships impact on the current relationship with the aim of rebuilding trust and security between the couple. This study sought to examine how attachment narratives in this Model are used by therapists. Method: Narrative Analysis was employed to explore attachment narratives in three couples who had completed therapy in an outpatient clinic where one member of the couple had been referred with depression. Results: Analysis highlighted four specific ways in which therapists used attachment narratives. These consisted of: therapist enabled stories of past relationships to be foregrounded; attachment theory employed to build hypothesis about attachment styles based on past relationships; therapist helped the couple understand how attachment styles maintain unhelpful cycles of relating and introduced alternative relationship narratives enabling improved trust and security. Analysis also demonstrated the structuring of these attachment narratives across the therapy sessions. Conclusion: This study shows that through the therapist paying attention to attachment styles, awareness of unhelpful cycles of relating within couples can be highlighted, and adjustments to how the couple can relate to each other suggested. This exploratory study serves to better inform the use of the Exeter Model.

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. In EFT, relationship distress is conceptualized as resulting from negative affect, emotional disconnection, and unmet attachment needs. Although EFT is recognized as one of the most researched and effective approaches to couple therapy, little research has examined theoretically related characteristics of couples to changes in marital satisfaction throughout EFT. The present doctoral thesis examined this area of literature. Thirty-two couples were provided approximately 21 sessions of EFT. The goal of the first study was to identify intake characteristics related to change in marital satisfaction over the course of EFT. Couples completed self-report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre- and post-therapy and after each therapy session. Individuals higher on self-report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction over the course of EFT. The goal of the second study was to examine intake levels of attachment security and its relationship to the occurrence of the blamer-softening event, a key change event in EFT, and changes in marital satisfaction. Results indicated that the occurrence of a blamer-softening event significantly predicted positive changes in marital satisfaction. Results also suggested that the occurrence of a softening event significantly moderated the relationship between attachment avoidance at intake and change in marital satisfaction from pre- to post-therapy. For couples who completed a blamer-softening event, partners with lower levels of attachment avoidance were more likely to have positive changes in marital satisfaction. However, this relationship was not evident for attachment anxiety. Overall, results from this thesis suggest that attachment security is a key characteristic of couple partners for therapists to consider when implementing EFT. Therapists may benefit from assessing attachment security at the start of therapy to help inform them of the emotion regulating strategies used by couple partners. This information may help therapists to tailor specific interventions such that couples may begin to develop more secure attachment bonds.

Under-utilization, premature termination, and lack of between-session engagement have been discussed in the couple therapy literature in terms of how they negatively impact the course and outcome of couple therapy. The goal of the present research was to investigate the discourses that people use when (1) constructing meaning about the act of engaging in couple therapy; (2) constructing what constitutes a positive couple therapy experience; and (3) constructing the influence of couple therapy on daily living. Discourse analysis, with a particular focus on interpretative repertoires (Potter & Wetherell, 1987), was used as the methodology for the three studies reported here. The data included eight semi-structured interviews with individuals who had participated in couple therapy and postings from three different online discussion forums. In study one, two interpretative repertoires -- the “relationship breakdown” repertoire and the “commitment” repertoire -- were constructed from the interview data. The premise of these repertoires is that couples seek couple therapy when they believe their relationship is broken and when they are committed to remaining in the relationship and resolving the problems. I argue that these interpretative repertoires can help us understand the decision or reluctance to enter couple therapy. In study two, one interpretative repertoire -- “the shoe must fit” repertoire -- was constructed from the interview and online data. This repertoire suggests that a particular “fit” between the couple and their therapist needs to be present in order for the couple to have a positive therapy experience. I argue that this interpretative repertoire facilitates understanding the decision to remain in or drop out of couple therapy. In study three, the interpretative repertoire “therapy life is not real life” was constructed from the interview data. According to this repertoire, couple therapy runs alongside daily life, but rarely influences it significantly. In this study, I argue that the “therapy life is not real life” repertoire helps us to better understand between-session engagement in couple therapy. Conclusions and implications for therapists and researchers are discussed.

Emotionally Focused Couple Therapy (EFT; Johnson, 2004) is an empirically validated approach to couple therapy that uses attachment theory to understand the needs and emotions of romantic partners. In EFT, relationship distress is conceptualized as resulting from negative affect, emotional disconnection, and unmet attachment needs. Although EFT is recognized as one of the most researched and effective approaches to couple therapy, little research has examined theoretically related characteristics of couples to changes in marital satisfaction throughout EFT. The present doctoral thesis examined this area of literature. Thirty-two couples were provided approximately 21 sessions of EFT. The goal of the first study was to identify intake characteristics related to change in marital satisfaction over the course of EFT. Couples completed self-report measures of marital satisfaction, attachment security, relationship trust, and emotional control at pre- and post-therapy and after each therapy session. Individuals higher on self-report attachment anxiety and higher levels of emotional control had greater change in marital satisfaction over the course of EFT. The goal of the second study was to examine intake levels of attachment security and its relationship to the occurrence of the blamer-softening event, a key change event in EFT, and changes in marital satisfaction. Results indicated that the occurrence of a blamer-softening event significantly predicted positive changes in marital satisfaction. Results also suggested that the occurrence of a softening event significantly moderated the relationship between attachment avoidance at intake and change in marital satisfaction from pre- to post-therapy. For couples who completed a blamer-softening event, partners with lower levels of attachment avoidance were more likely to have positive changes in marital satisfaction. However, this relationship was not evident for attachment anxiety. Overall, results from this thesis suggest that attachment security is a key characteristic of couple partners for therapists to consider when implementing EFT. Therapists may benefit from assessing attachment security at the start of therapy to help inform them of the emotion regulating strategies used by couple partners. This information may help therapists to tailor specific interventions such that couples may begin to develop more secure attachment bonds.