Counseling is an integral component of the move towards absolute mental health. The development of tailored counseling programs for the issues that haunt human beings in their various ventures in life is essential as positive mental health is priceless and an asset (Hohenshil, 2010). Psychological interventions for marital disharmony are of diverse nature incorporating different principles and theories. However the picture is not all that rosy considering that all efforts are not always successful. Interventions for marital discord and distress produce changes in behavior for short terms and the discord may repeat after some time (Christensen and Heavy, 1999). This has produced more research taking into consideration therapy in natural settings, development of better interventions, lengthening the therapy and aiming at better outcomes. Couples requiring marital therapy are at the ends of their tether due to painful conflicts, blaming their spouse for most of it. The concept of couple therapy has changed over the past few years from behavioral and cognitive approaches to therapies focusing on emotions, empathy, acceptance and vulnerability (Johnson, 2004). The interventions surrounding behaviors missed out on an important aspect of relationships: emotions. The present study will examine the effectiveness of interventions in the institution of marriage focusing on emotions.
Therapy includes interventions for those who are positively in distress or group and preventive programs for couples (Christensen and Heavy, 1999). Research has indicated more satisfaction with the therapy than without it; “the average treated person is better off than approximately 80% of the untreated” (Anker et al, 2009). Positive outcomes occur only when relationship improves. Couples would still be having some discord. Treatment will cause a highly dissatisfied person to move towards the moderate satisfaction group. The score should change from the dysfunctional zone before treatment to the score in the functional population after treatment. The scores for each spouse must be examined separately. The scales used could be the Marital Adjustment Test or the Dyadic Adjustment Scale (Christensen and Heavey, 1999). It is understood from Jacobson’s study of 1984 that therapy does not ensure that a marital couple is successfully treated and their problems are over. Less than half of the treated couples really benefit. The outcomes of marital therapy last for over 6 months from the termination of treatment. However research follow-up which lasted 1 or 2 years revealed relapses, separation and divorce. The problem of many troubled spouses not approaching for psychotherapy needs to be remembered. A survey by the American Psychologists Association revealed that 87 % of those who did not seek therapy had no insurance, 81% were worried about costs, and 77% had lack of confidence in the treatment (Anker et al, 2009). Dropouts, the non benefiting participants, variable efficacy of therapists and the poor confidence of consumers in the therapy can be summed up as the reasons for the reduced seeking of psychotherapy (Anker et al, 2009).
Behavioral, cognitive behavioral and emotion-focused therapy have been found to show effectiveness. Other therapies which correct power and privilege issues and perform attachment repair are available. This paper will be exploring the effectiveness of the emotionally focused therapy used for ending marital discord.
Four components constitute the research. The first component is the emotionally-focused intervention, the value of which is being ascertained. The evaluative criterion for judging the results of the intervention is the second component. Methodology is the third component; it constitutes the method and reason for collecting and analyzing the data. Results form the fourth part; they inform us and provide evidence contained. The evaluation of the intervention can be at the level of a program or a concrete service or policy; it can also be in the different stages, either implementation or outcome.
Statement of Purpose
The purpose of this project is to conduct/complete a comparative analysis of evaluation research studies of interventions used for changing a state of marital distress into one of marital satisfaction focusing on emotions in the institution of marriage. This paper helps to understand the principles of evaluation research, the effectiveness of the intervention selected for settling marital discord and the use of evidence elicited in the research analysis for the purpose of enhancing competence in practice. A secondary purpose is to recognize and evaluate emotion –focused couple therapy as a “significant psychiatric intervention now because of the disturbing impact of divorce on couples and families” (Johnson, 2004). Being the scapegoats, the children develop externalizing and internalizing problems. This tells on their academic achievement and physiological functions. The therapist needs to be thoroughly prepared to provide the best intervention possible to the clients who are seeking it.
Research problem
Purpose of study
The challenge lies in getting more families to the door of the psychologists and counselors for professional advice. Being a therapist, providing the best of interventions
to the distressed couple so that they continue to have a satisfactory married life without unmanageable problems, the goal is to investigate possible interventions for practice through research. Effective interventions are the main assistance that health professionals can provide. Relationship discord has been found to respond to research-based marital therapies. Research has suggested that middle class, college-educated Caucasians are the ones who seek most help. When emotional affection, communication, and frequent arguments are at stake, counselors are approached with the desire to improve the relationship or the affected worry about divorce or separation (Doss, Simpson and Christensen, 2004 cited in Doss et al, 2009). Attempting to find ways to improve the relationship, the involved persons attend seminars, workshops or retreats to try learnt methods for a solution. Religious organizations and Mental Health professionals also have programs for these worried people. Online assistance is also possible. Doss found that 30 couples of the 77 in his study, who yearned for some assistance, sought marital therapy (2009). 41 couples attended retreats or workshops. Relationship- themed books were a solace to 49 couples. The type and timing of the method resorted to depended on the individual and his relationship features (Doss et al, 2009). The people are less stigmatized by religious settings which happen to be less costly too. Couples who have already been to workshops or retreats have a tendency to appear for therapy a year later. This is especially seen with couples of lower marital satisfaction. Added to this is the problem of communication. Perceived communication problems rather than actual observable difficulties stimulate the couple to seek marital therapy. Depression symptoms are another presentation which exacerbates the already existing problems. Physical violence is another reason for looking for books; these people refrain from marital therapy for fear of the stigma (Doss et al, 2009). Many times, one spouse looks for help.
Problem to be investigated/analyzed
Marital distress is not a psychiatric disorder but a situation which is highly stressful all around and could end in divorce or go onto psychiatric illnesses of depression, bipolar disorder, alcohol abuse and depressed immune system functioning and finally divorce. Children of these broken homes are prone to conduct disorders and depression. Relationship help-seeking was a common resort of newly marrieds within the first five years (Doss et al, 2009). The difficulties with their life lead many to books on relationship and marital therapy as a manner of receiving some information for their use, especially during their first year. These are the outlets for relationship assistance. Distressed relationships have an impact on their functioning and the outcomes could be suicide ideation, low grade perceived health and enhanced impairment in work and social behavior (Whisman and Ubelacker, 2006 cited in Doss et al, 2009). Twenty percent of marriages are believed to be distressed at any time and 40% of new marriages have the distinction of ending up on the rocks.
Significance of the problem
With the number of separations and divorces and the number of children who are affected by the distressing situation rising immensely, it is in the hands of the therapist and psychiatrist to provide ample relief for the distress, ensuring that the duration of marital satisfaction is extended life-long. With the number of behavioral and cognitive behavioral and emotion focused interventions, only research can evaluate the best. Therapists then need to practice what they have studied.
Justification for the investigation
Failing relationships have a terrible impact on family life, especially the children who carry the stigma of a broken home all their life and suffer its repercussions. Most families do not seek help even if involved in a poor relationship. Only 37% seek help of any sort and come to the decision only after six years of worrying about it. Searching for the best evidence based research is the necessity of the moment.
Literature Review
Couples therapy was developed 20 years ago with traditional behavioral interventions (Cordova, 2006). Research has mostly been behavioral and the intervention widely used is behavioral. Partners cultivate the habit of being nicer to each other with improved communication and enhancing their skills of conflict resolution. Traditional behavioral intervention has been listed as an appropriate intervention for marital discord by the Task Force on Promotion and Dissemination of Psychological Procedures, 1995 (Cordova, 2006). However meta-analytic studies show that only 50 % of couples have a long-term benefit of marital satisfaction. Integrative behavioral couple’s therapy was introduced by Christensen and his colleagues in 1995 to improve on the earlier traditional behavioral interventions.
EFT
Emotionally Focused Therapy was started in the 1980s and is more humanistic but having less of the behavioral features. “Emotion is the powerful and necessary agent of change” (Johnson, 2004). Approaches have changed so much that emotion is recognized as playing a key role in “marital happiness, distress and divorce and human attachments” (Johnson, 2004, p 5). Johnson has found a 70-73% recovery after 10-12 sessions of EFT therapy in marital distress in a meta-analysis. This showed a significant improvement of 90%. Johnson also indicates that the relapse rate is insignificant when compared to other methods. The relapse rate was a problem in behavioral therapies while EFT showed less of it.
The facilitation of forgiveness in EFT
Greenberg et al evaluated the “effectiveness of and EFT for couple therapy intervention” for the resolution of emotional injuries (Greenberg et al, 2010). Couples face many life events where they experience certain relational injuries. These injuries may influence their emotional bonds, attachment security and identity validation. If the partners are left abandoned during these episodes, they would harbor the feeling of betrayal especially if the partner has lost the support or reliability. The emotion would be that of unresolved anger or hurt (Greenberg et al, 2010). Injurious events are more severe to a person than mere marital distress and couple dissatisfaction results. On approaching for therapy these emotions are not presented. The therapist may have to elicit it. Unresolved resentment or hurt may have to be brought out through shrewd questioning. Successful resolution of attachment injuries is possible through EFT provided the block to intimacy is overcome in the sessions (Greenberg et al, 2010). A three-stage model of forgiveness in couples’ therapy has been investigated by Gordon, Baucom and Snyder (2000, 2004 cited in Greenberg, 2010). They had the perception that relational betrayals produce interpersonal trauma and recovery is possible through forgiveness as in general traumatic occurrences.
Greenberg believed that forgiveness has to be operationalized in a different manner to achieve relief. Emotional injuries that were remaining unresolved for two years usually block repair of relationship. A combination of negative feelings may be accumulated with an unforgiving attitude and hostility. The therapist has to work around the situation and mellow the partners to the emotion of forgiveness. Facilitating forgiveness requires the admission to the emotional injury first and revelation of the full impact of the hurt rather than making excuses for the partner’s behavior in the sessions (Greenberg et al, 2010). Forgiveness involves two essential processes of resolution of the hurt and anger and the generation of positive feelings of compassion and loving kindness to the injurer. EFT is known to be suitable for dealing with the unresolved emotions which block forgiveness. EFT-C is one of the best and most effective of approaches to marital therapy and for resolution of relationship distress (Greenberg et al, 2010). The effect size has been found to be 1.3 and the recovery rates between 70% and 73% (Johnson et al, 1999 cited in Greenberg, 2010).
Greenberg’s study was “to evaluate the effectiveness of EFT-C in the treatment of couples where one partner had been unable to overcome an emotional injury of at least two years duration” (2010). A comparative analysis was done with 20 couple participants to prove the hypothesis that EFT-C would produce improved outcomes on forgiveness, trust and marital satisfaction than patients who had no treatment (Greenberg, 2010). Affairs, abortions, perceived abandonment and perceived humiliations were among the injuries.11 therapists participated. The steps used in the EFT were cycle de-escalation, restructuring the interaction and consolidation with integration. A treatment manual was developed for the study. The tools used were the Enright Forgiveness Inventory, Forgiveness measure, trust scale, unfinished business empathy and acceptance scale, unfinished business feelings and needs scale, dyadic adjustment scale, target complaints discomfort and change scale, global symptom index, couples therapy alliance scale, and structured clinical interview.
The supervisors adhered to the model closely. All participants had a satisfactory therapeutic alliance (Greenberg, 2010). Results of pre-therapy, post-therapy and follow-ups for injured and injuring partners were obtained. Injured partners made more improvement during the sessions than in the wait-list period. Partners had become more forgiving and trusting. The EFT-C is effective for treating the marital distress of the injured partner. The injurers however did not show as much improvement probably because they started higher on the scale. Deterioration occurred only in trust while the other variables still maintained their improvement over the 3 month follow-up period.
EFT for Couples and Child Sexual abuse survivors
MacIntosh and Johnson (2008) performed a study of the effect of EFT on couples with Childhood sexual abuse survivors. Literature indicates that behavioral marital therapy for couples has been tried where one partner is a childhood sexual abuse (CSA) survivor. It was useful in the training for dissociation, affect regulation and learning to lessen tension -reducing behaviors like substance abuse or self-harm with the development of communications, psychoeducation and behavioral exchange skills. Psychoanalytic perspectives were used by other researchers. Effective and time bound treatments are necessary for CSA adults. MacIntosh and Johnson (2008) performed a thematic analysis of case studies to find experiences of CSA survivors. 7 therapists were involved in the study. 10 couples were the participants and one of the partners had a history of an unwanted sexual touch. No physical violence or substance abuse was involved. 19 sessions of EFT were given. Pre and post-treatment questionnaires were answered. 4 had received 10 years of therapy while others had lesser. Only one CSA survivor had not had any treatment previously. Quantitative measures were also done. The themes identified were emotional flooding, emotional numbing, dissociation, constricted range of affect and affect dysregulation, hypervigilance to attachment figures and sexuality (MacIntosh and Johnson, 2008).
Clinical improvement was seen in 50% of the couples by improvement on the mean relationship satisfaction ( MacIntosh and Johnson, 2008). Only 3 showed deterioration and terminated their relationship. 5 had lesser trauma symptoms and the three who terminated their relationship also agreed to this. This study however raised a doubt as to whether EFT was sufficient for treating CSA survivors whose affect regulation was the area of challenge (MacIntosh and Johnson, 2008). It was noted that didactic learning is the first level of learning for trauma survivors. Affective disturbances can be corrected only through a new and restorative relationship; EFT has this potential but clinical refinements need to be practiced. The therapist must go slowly through his routine. The level of affective challenge must be gradually applied. Using specific methods, the affective changes are gradually processed. Externalization is performed and specific psychoeducation also may be tried in 30-35 sessions. The partners may be allowed into the secret of CSA. Letting go of the information may help the healing process. The therapist’s support is of utmost importance to the CSA survivor (MacIntosh and Johnson, 2008). The conclusion said that the intervention of EFT could be used in CSA trauma couples.
Perceptions of attachment and marital quality
Marriage and family therapy is now taking to an evidence-based path (Hollist and Miller, 2005). Distressed relationships are considered as insecure bonds where health attachment needs cannot be met due to a block in the emotional engagement caused by rigid patterns of interactions. Therapy is given so that a secure bond emerges (Hollist and Miller, 2005). This adds up to saying that attachment forms the theoretical foundation of EFT. It explains and predicts adult love relationships and quality of relationship depends on the level of attachment. The relationship is safe if the security of attachment is strong. Ainsworth has described three attachment styles of children when placed in a strange situation: secure, anxious and avoidant. Supportiveness, trustworthiness, caring and acceptance elaborate the type of attachment that the child has with care-givers (Hollist and Miller, 2005). Satisfying relationships are expected in the future in people who were lucky enough to experience secure attachments in childhood.
Secure attachments are predictive of “successful conflict resolution, relationship independence, commitment, trust and positive emotions in marriage”(Collins, 1996 cited in Hollist and Miller, 2005). Questionnaires were used for data collection in this study. Married people between the ages of 40 and 50 were selected. 632 completed questionnaires were obtained. Participants were married for more than 10 years. Instruments for measurement were the Revised Dyadic adjustment scale with a self-report on the quality of marriage and the Measure of Attachment qualities for measuring attachment. Structural equation modeling was used to reach the conceptual model.
Results indicated that secure attachment did not influence relationship quality in people who were married for 10 years in both men and women as much as they did in the relationship of younger individuals (Hollist and Miller, 2005). An increasing resilience was noted to life’s difficulties as years went by. On the other hand, insecure attachments were affected by life’s stressors. Secure attachments became more secure with life while insecure ones became more insecure. Adults with insecure attachments also managed to remain associated for long implying a false perception of marital quality.
Therapists need to take the cue that secure attachments are significant in marriages of more than ten years duration. The key goal of therapy should be to change insecure attachments to secure ones so that marital satisfaction and quality are increased. The “frequency and intensity” of insecure attachments would enhance marital satisfaction (Hollist and Miller, 2005). EFT is an appropriate model of treatment for insecurely attached midlife couples who seek resolution to problems.
Marital distress with chronically ill children
Parents with chronically ill children have a strong risk of suffering marital distress. A randomized control trial with a 2 year follow-up was done among 13 couples with chronically ill children by Cloutier et al (2002). The assessments were made at post-treatment, 5 month follow-up and 2 year follow-up. It was discovered that the change that occurred with EFT was maintained at both follow-ups and the improvement in some cases was enhanced at 2 years. The chronic illness was to have been diagnosed for a period of 12 months and which required parental medical management of the child with a risk of mortality (Cloutier et al, 2002). The illness was not mentioned. All couples lived with their children. Couples with marital violence, psychiatric history except depression, current desire for divorce, substance abuse, and primary sexual dysfunction in any partner. were excluded. The measures were Dyadic Adjustment Scale, Miller Social Intimacy Scale and Parent Stress Index. This study indicated that EFT intervention effects were maintained over a long duration of 2 years (Cloutier et al, 2002).
Predictors of success
Thirty six couples were participants in a study by Johnson and Talitman (1997). They had cohabited for the past one year, were free of alcohol, had no substance abuse, no psychiatric treatment and no psychological treatment (Johnson and Talitman, 1997). The couples received 12 free weekly 1.25 hour sessions of therapy. The goal of therapy was to “ assess and reprocess the emotional positions underlying each partner’s interactional positions and thereby facilitate a shift in these positions in the direction of increased accessibility and responsiveness” (Johnson and Talitman, 1997). This led to a secure and satisfying bond. Outcomes were not tested. Using the criterion of non distress or recovery, 50% of clients were understood to have recovered or reached satisfaction and this increased to 70% by follow-up. Clinical significant improvement was seen in 79% couples at end of treatment. This rose to 82% by follow-up. 2 couples deteriorated by the Dyadic Adjustment Scale. The effect size was 1.26. The suggestion was that EFT was successful in alleviating distress (Johnson and Talitman, 1997). Pre-treatment levels and post-treatment levels of marital satisfaction were related but follow-up level was not related. Change scores at the termination of therapy were not related to the pre-treatment level of marital distress. Among the 7 severely distressed, 57% recovered and 100% improved. Of the13 moderately distressed, 85% recovered and 85 % improved. Of the 14 mildly distressed, 79% recovered and 71% improved (Johnson and Talitman, 1997).
Facilitating intimacy
Interventions of EFT and Cognitive Marital Therapy were compared for levels of marital intimacy, dyadic trust and dyadic adjustment and with reference to a control group (Dandeneau, 1994). The control group consisted of non distressed couples who wanted more intimacy. Treated couples received conjoint marital therapy (CMT) or EMT for 6 sessions. Measurement was made at post-treatment and after 10 weeks. This CMT was a short-term psychotherapy helping the couples to develop intimacy through cognitive self-disclosure (Dandeneau, 2002). People grow up with cognitive schema in their thoughts and beliefs (personal construct theory). The spouse may not fit into these schemata and the clients must be taught to see the differences in their spouses from the schemata so as to become intimate with them. 36 couples participated. The couples were living together and were doing so for the past 2 years with no separations during this period. 10 therapists participated (Dandeneau, 2002). The EFT post-test appeared to have better results. Both CMT and EFT both increased self-reported intimacy at post-test and at follow-up intimacy and dyadic adjustment. Trust, adjustment and intimacy continued to improve from post-test to follow-up in EFT (Dandeneau, 2002). The results indicated that focusing on a couples’ relationship could produce beneficial effects. Nondistressed couples also reported improvement in intimacy with the interventions.
Framework of the analysis
Concept
The concept of the evaluation studies included in this analysis is based on the use of interventions for couples who are undergoing marital distress centering on emotionally focused couples’ therapy. The purpose of the evaluation is to find an effective intervention which could be used to obtain the maximum results or outcomes. The couple should be able to regain their scope of marital satisfaction which is long lasting and enduring and they must learn how to cope with problems as they arise. The children must live in a happy and comfortable atmosphere at home with the parents and their psychosocial functioning must be excellent. Effect size was the test for effectiveness of the interventions. The concepts or models of studies mentioned have been described here.
The three stage and nine step model in EFT
The intervention of EFT is evaluated for effectiveness in the studies selected. Greenberg’s study used the three stage (Johnson, 2004) and nine step (Johnson and Greenberg, 1988) model. In the first stage of cycle de-escalation, the key step of creating a therapeutic alliance is established (Greenberg, 2010). Step 2 involves the identification and naming the “negative interactional cycle” which caused the distress. The underlying feelings and needs of the partners are accessed in the third step. The therapist then reframes the couple’s problem in terms of the cycle and the new experiences of emotions in step 4 (Greenberg, 2010).
In the second stage of restructuring the interaction, the disowned aspects of the experiences are identified in the step 5. The facilitation of the partner’s acceptance of the spouse’s new experiences of self and emotional responses is step 6. Step 7 involves the expression of specific requirements and desires to restructure the interaction (Greenberg, 2010).
In the third stage, step 8 sees new solutions emerging through facilitation to the old problems of relationship that triggered the couple to therapy. The partners now consolidate their new positions in the relationship and incorporate new perspectives of each other and self into the relationship in step 9 (Greenberg, 2010).
A treatment protocol and manual were developed for this study. The concept of forgiveness was also brought into the therapy before session 6.
Intense analysis of clinical cases in EFT or case study replication
The process of therapeutic change in psychotherapeutic research is not completely possible through the nomothetic approach. Comparing treatment outcomes through clinical case studies would be a better approach especially when EFT is being tried in CSA couples (MacIntosh and Johnson, 2008). Intense analysis of clinical cases provided a thematic analysis. The sessions of couple therapy were audio-taped for later analysis and derivation of theme. Step 1 involves a coding frame work using the approach and research questions. Step 2 involves the derivation of basic lower order themes from the clinical information. Then the data are organized into global themes which can then be derived into theories and models of change in the 3rd step. Six themes were identified.
Attachment and EFT
Securely attached couples had greater marital satisfaction, felt comfortable with emotional intimacy, enjoyed close relationships and had a lesser divorce rate. Avoidant partners hated to be too close with anyone in a relationship. Ambivalent individuals are like secure couples in the relationship but they have the added features of jealousy and extreme sexuality. Aggression was a prominent feature (Hollist and Miller, 2005).
Later the four-category model of attachment was adopted based on different combinations of positive or negative beliefs about oneself and others (Hollist and Miller, 2005). People with secure attachments had positive beliefs about themselves and others. Negative beliefs about self along with positive beliefs about others constituted the preoccupied adults. They believed that others were too good for them and therefore they could not bring themselves to love the other person (Hollist and Miller, 2005).The person with the dismissing style of attachment possessed positive beliefs about self with negative beliefs about the other. These people believe that they are worthy of love but are afraid of being rejected by the other. Those with the fearful attachment style had negative beliefs about self and other. These people avoid social relationships due to anxiety over relating to others (Hollist and Miller, 2005).
Randomized control trial with a long follow-up
This method used the pre-treatment, post-treatment and follow-up measurements to draw conclusions in the EFT intervention in a couple with chronically ill children (Cloutier, 2002).
The experiential and systemic traditions
Pre-treatment and post-treatment evaluations in a randomized control study were also the methods used in Dandeneau’s study of facilitation of intimacy in couple’s therapy (1994). Experiential and systemic traditions are incorporated in EFT (Dandeneau, 1994). The role of affect and intrapsychic experience in changing relationships is evident in the experiential system. The systemic tradition involves the role of communication and interactional cycles. Partners are encouraged to interact to explore and disclose their feelings and needs. The therapist enables the couple to interact more and become more accessible and responsive to each other (Dandeneau, 1994). These efforts at facilitating intimacy are part of EFT.
The same traditions are used in the study of the predictors of successful EFT in marital distress by Johnson and Talitman (1997).
Paradigm in social interventions like EFT
Mertens (2009) has defined paradigm as a way of looking at the world. Thinking and action are guided by philosophical assumptions that form the paradigm. Paradigm is necessary for providing a framework for enabling research decisions and actions. Four major paradigms are categorized for research purposes in education and psychology. The postpositivist, constructivist, transformative and pragmatic paradigms have been identified (Mertens, 2009).The positivist paradigm indicated that the social world could be studied scientifically like the natural world. The empirical objective data applied to human behavior was the focus of positivist research. Postpositivist paradigm arose from the positivist paradigm yet rejected the ideas therein as many aspects of the human experience could not be observable like feeling and thinking. Objectivity and generalizability are important by postpositivists but researchers are to modify their claims as based on probability, not certainty. Postpositivists believe in a single reality; the researcher’s job is to search for that reality. Human limitations curtail the researcher (Mertens, 2009). Quantitative data collection methods are used by the postpositivist paradigm.
Many socially constructed realities are found in the constructivist paradigm (Mertens, 2009). This paradigm is built upon the perception that knowledge is socially constructed by researchers who try to understand the lived experience of the subject. Postpositivists maintain detached relationship with subjects, constructivists encourage dialogue. Qualitative data are primarily collected by the constructivists. These researchers collect qualitative data like interviews and observations.
Social oppression is confronted through the transformative paradigm (Mertens, 2009). This paradigm also promotes cultural diversity and awareness. Social justice is also advocated among diverse groups. Issues of dynamics of power could now be addressed in this paradigm. Historically the experiences and lives of marginalised groups like the women, minorities and disabled persons are included in this paradigm. The transformative paradigm uses quantitative methods of data collection but qualitative methods also can be done.
The pragmatic paradigm believes in a single real world and avoids the metaphysical concepts of truth and reality. Mixed methods research design can be used here and the purpose of the study will determine whether quantitative or qualitative methods can be used. Comparative analysis uses evaluations which go by the postpositivistic paradigm (Mertens, 2009). The framework determine the impact of evaluations are discussed later.
Intervention evaluation research
Evaluation research is a “type of practice that intends to determine the worth, the merit the impact or effect of interventions” (Codas, 2008). The intervention could be a policy, program or service.
Evaluation models
Specific aspects of reality are represented by element, structure and function. Evaluation model constitutes the various and approached. The evaluation process can be modified to suit the variables in a study (Thornton, 2009). Six evaluations models have been identified: the goal model, systems model, impact model, goal-free model, qualitative model and critical model. The behavioral approach is the goal model. The discrepancy between the stated goals and the outcomes is the program success.
In the systems analysis approach, differences in programs or policies are identified. Several evaluative criteria are added to the intervention goals (Thornton, 2009). Three hypotheses guide the impact model: causal, intervention and action. Outcomes are based on facts and causes. The impact model aims at whether a specific intervention caused a particular outcome. The goal-free model is used by researchers to maintain an unbiased approach: goals are not made. Double blind studies maybe done (Thornton, 2009). The qualitative model is used in the constructivist paradigm. The critical model is taken from the transformative paradigm and aims to do social justice; quantitative and qualitative methodologies use the critical model.
Methodology
The quality of several evaluation studies is here determined by comparative analyses. Emotionally focused therapy is an intervention being used in couples therapy. A comparative analysis is done by comparing individual research components. The EFT reduces marital distress. A sample of evaluation studies has been compiled by searching for them in the topics for interventions for couple’s therapy in EBSCOhost’s Academic Search Premier, ProQuest and Psychinfo databases. The search terms couples therapy, marital therapy, emotion focused therapy brought forth several research studies. However the number of evaluation studies were only a handful and insufficient for the purpose of this assignment. Though the intention was to select six evaluation studies of EFT within the previous five years, success was not met due to the limitation of evaluation studies. This was indication itself for more research in this field.
Abstracts
The goal of this study was to evaluate the effectiveness of an emotion-focused couple therapy intervention for resolving emotional injuries. Twenty couples acting as their own waitlist controls were offered a 10-12 session treatment to help resolve unresolved anger and hurt from a betrayal, an abandonment, or an identity insult that they had been unable to resolve for at least 2 years. Treated couples fared slightly better on all outcome measures over the treatment period compared to the waitlist period. They showed a significant improvement in dyadic satisfaction, trust, and forgiveness as well as improvement on symptom and target complaint measures. Changes were maintained on all of the measures at 3 month follow-up except trust, on which the injured partners deteriorated. At the end of treatment, 11 couples were identified as having completely forgiven their partners and six had made progress towards forgiveness compared with only three having made progress towards forgiveness over the waitlist period. The results suggest that EFT is effective in alleviating marital distress and promoting forgiveness in a brief period of time but that additional sessions may be needed to enhance enduring change.
This study explored Emotionally Focused Therapy for couples with childhood sexual abuse survivors (CSA) and their partners. Half of the couples in this study reported clinically significant increases in mean relationship satisfaction and clinically significant decreases in trauma symptoms, and thematic analyses identified numerous areas where trauma survivors were challenged in fully engaging in the therapy process. In particular, trauma symptoms such as affect dysregulation and hypervigilance were identified to play a role in the challenges that survivors experienced in fully engaging in the EFT process. Results of these thematic analyses yielded clinical recommendations for working with CSA survivors and their partners in EFT for traumatized couples. Recommendations for future study were articulated
Based on attachment theory, Emotionally Focused Therapy (EFT) theorizes that attachment styles influence marital quality. Although research supports this relationship among young couples, no research has examined attachment styles and marital quality in midlife marriages. We examined this issue using data from 429 married people between the ages of 40 and 50. Results indicated that insecure attachment styles were associated with marital quality, whereas secure attachment was not. These results suggest that EFT therapists can help midlife couples in distressed relationships move from insecure to secure attachment styles. However the use of EFT to help these couples who have secure attachment styles is questioned.
Couples with chronically ill children are particularly at risk for experiencing marital distress. The study presented here is a 2-year follow-up of a randomized control trial that assessed the efficacy of Emotionally Focused Therapy (EFT) in decreasing marital distress in a sample of couples with a chronically ill child. Thirteen couples with chronically ill children who received treatment were assessed to determine if the significant improvement in relationship distress observed at posttreatment and 5-month follow-up would be maintained at 2-year follow-up. Results demonstrated that improvements in marital functioning were not only maintained, but, in some cases, enhanced at the 2-year follow-up. This uncontrolled follow-up study provides initial evidence of the longer-term benefits of EFT.
Summary
Johnson and Talitman examined client variables expected to predict success in emotionally focused marital therapy (EFT), now the second most validated form of marital therapy after the behavioral approaches.
A study examined the effects of two sets of marital interventions taken from Emotionally Focused Therapy and Cognitive Marital Therapy on levels of marital intimacy, dyadic trust and dyadic adjustment. Both test group scores were significantly higher than controls on the self-report measures of intimacy.
Intervention Analysis- Intervention Matrices
Conceptual variables
Implementation variables
Population variables
Analysis of variables
The matrices exhibit the comparative analysis of the components of conceptual, implementation and population variables.
Conceptual variables
The paradigm of post-positivism applies to all the studies evaluated. The matrix permits an early comparison of research evaluations. This paradigm uses empirical and objective data for observation of human behavior. In all these studies, the intervention of EFT has been studied for effectiveness in marital stress with slightly varying application. Behaviors were quantified into measurable components. Standardized scales like the Dyadic Adjustment Scale, Forgiveness scale, Couple s Therapy Alliance Scale, and Trauma measures were used. Feelings, thoughts and behaviors were translated into measures. Outcomes were then statistically measured. Generalizability was possible with the use of standard measures. The goal model was used for all the six evaluations and the efficacy of the intervention was expressed in effect size. The larger the effect size, the better the intervention. The goals of the studies all had one common feature: that of reducing marital stress. The difference was in the associated relationship with attachment style, CSA survivors, intimacy, chronically ill children and so on. Slightly different therapies were instituted for the interventions though the final aim was to reduce marital distress and increase marital satisfaction. The sessions of therapy varied in number and duration based on the associated feature in each. The evaluations showed plenty of similarity.
Implementation variables
The Dyadic Adjustment Scale was the one scale used in all the evaluations. Each evaluation had additional scales for measurement of more features of behavior. Greenberg’s (2010) study of emotional injuries and role of forgiveness used the Enright Forgiveness Inventory, Forgiveness measure, trust scale and couples therapy alliance scale. MacIntosh’s (2008) CSA study used the Trauma Measures. Measure of Attachment Qualities was the tool used by Hollist (2005) to measure attachment. Cloutier (2002) used the Marriage Adjustment Scale, the Miller Social Intimacy Scale and the Parent Stress Index. Johnson and Talitman (1997) had the emotional disclosure scale apart from using the scales used by Cloutier.
Most of the evaluation studies were conducted in a clinical setting. Cloutier’s study was in a tertiary care paediatric hospital. The length of treatment and the number of sessions with the therapist varied. The follow-ups were at different periods. The longest follow-up was 2 years in Cloutier’s study (2002). Only one study did not have follow-up , MacIntosh, 2008. Since marital distress is a significant feature for interventions, the follow-up period needs to be extended and more studies conducted at various periods of married life to continue the motivation towards a life of marital satisfaction, lesser separations and divorces. The study of Hollist and Miller (2005) is an eye opener in that the perceptions of attachment style have lesser implications on marital satisfaction in people of midlife marriages. People are more adjusted towards this period of marriage. This indirectly implies that marriages need to be handled with care till this period is reached. Efforts to save marriages should focus on younger couples.
Population variables
The number of couples varied from study to study. The least number was 10 couples and the maximum 36 couples in 2 studies. One study had 429 married people and not couples (Hollist and Miller, 2005). Race and ethnicity was not a significant variable. This was probably because differences in race or ethnicity did not matter where marital distress is concerned. Moreover the diversity of the population may not have merited a measure of the ethnicity as the interventions could work for all ethnic groups and allow generalizability.
References
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