Table of Contents

Figure 1
Emotionally Focused Therapy

Therapist leads couple through a 9 step cycle for each issue identified:

• Identify conflict issues

• Identify negative interaction cycle

• Access unacknowledged feelings underlying interaction cycle

• Redefine problem in terms of underlying feelings and attachment needs

• Promote identification of needs in newly defined interaction

• Promote acceptance of partner's experience and new interaction patterns

• Facilitate expression of wants and needs to restructure interaction

• Establish the emergence of new solutions

• Consolidate new positions and gains

For this study, the EFT was modified.  Therapists received training in the specific stresses and needs of families with ill children and also received medical information regarding the illnesses.

Figure 2
Marital Distress Scales Used In 2-Year Follow-Up

Dyadic Adjustment Scale:

• Self-report

• 32 questions

• Scores range from 0 to 151; lower scores indicate problems

• Proven reliable in large studies

• The lower score of the two spouses is often used rather than averaging the scores

Miller Social Intimacy Scale:

• Self-report measure

• Measures intimacy in personal relationships

• Proven reliable in studies

• Scores for distressed couples are significantly different than scores for non-distressed couples

Source:   Cloutier PF, Manion IG, Walker JG, Johnson SM.
Emotionally focused interventions for couples with chronically ill children: a 2-year follow-up.  J Marital Fam Ther. 2002 Oct;28(4):391-8.

 

      Being the parent of a child with a chronic illness is not easy.  The stress and emotion of dealing with the challenge can seem overwhelming at times, so it is not surprising that studies have shown that couples in just such a situation are at risk for marital distress.  However, according to a recent study help may be on the way.
     Paula Coultier, from Children's Hospital of Eastern Ontario, Susan Johnson, from the University of Ottawa, and colleagues have reported that a specific type of therapy, Emotionally Focused Therapy (EFT), was very effective in reducing marital distress among couples with a chronically ill child.
     EFT was developed in the 1980's by psychologist Les Greenberg and one his doctoral students, Susan Johnson (referenced above).  Unlike most couples therapies which focus on improving communication skills through a logical analysis of what is being said, EFT focuses on the emotions that underlay the problems a couple may be having. 
    At the core of EFT is a fairly popular psychological theory, known as Attachment Theory.  Attachment Theory states that when we are born we have an innate need to form a strong, secure, trusting bond - or attachment - with a parent.  If this attachment is not formed, it can affect our relationships throughout life.  EFT extends this theory with the belief that even as adults we need to form a strong, trusting, and secure relationship - or attachment - with a romantic partner.
     Because trust plays a central role, EFT tends to focus on things like vulnerability, insecurity, and dependency.  In fact, contrary to many therapy styles, EFT tries to get people to recognize that they are emotionally dependent upon their spouse.  Once the underlying emotions in a conflict are identified, the negative views and behaviors that result from those emotions can be changed for the better (see Figure 1).
     According to Johnson and her followers, the evidence for the effectiveness of EFT is overwhelming.  In general marital strife situations, they claim EFT is effective more than 70% of time in repairing the relationship.  This is contrast with a less than 50% success rate for other types of therapies (it should be noted that EFT is not recommended in situations involving domestic violence or extreme infidelity).  Given the obvious stress placed on a marriage by caring for a sick child, Johnson and her colleagues wanted to see if EFT could help couples in these situations as well.
     The group identified 32 couples with a chronically ill child who were suffering from marital distress and wanted to participate in the study.  The couples were randomly assigned into two groups; one group received 10, 90 minute EFT sessions every 1-2 weeks, while the other group - which acted as a control - did not receive any therapy.  In order to participate in the study, both spouses had to agree, their child had to have been ill for at least 12 months and require ongoing medical care, and there could be no history of violence, substance abuse, depression, or desire for divorce by either person.
    At the time of the study, the average age of the participants was 37 for the men and 35 for the women.  The couples had been married on average for 9.8 years and averaged 2.2 children.  The types of illnesses they were dealing with included cancer, cystic fibrosis, spina bifida, and autoimmune disorders to name a few.  The researchers used several well accepted measures, such as the Dyadic Adjustment Scale (DAS) and the Miller Social Intimacy Scale (MSIS) to measure the level of marital distress (see Figure 2).  The researchers then used a statistical technique to group the results into categories: recovered, improved, no change, or deteriorated.
     The research team established a baseline measure for each couple and then evaluated them right after the treatment and 5 months later.  The original results were published several years ago in the Journal of Consulting and Clinical Psychology.  They then performed a follow-up study 2 years later to see if the therapy had had a lasting effect and published those results in the October, 2002 issue of the Journal of Marital and Family Therapy. 
     The initial study found a statistically significant percentage of the therapy couples either recovered or improved their relationship versus the control group.  At the two-year follow-up, not only had most couples maintained this, but some actually had improved even more (see Figure 3).  Unfortunately, adequate follow-up data for the control group was not available.
     To put their results into real-world perspective, the researchers also looked at how many couples from each group ended up separating.  In the group which received therapy, only 1 couple had separated after 2 years, whereas in the control group 5 of the 13 couples who had been contacted had separated (38%).
     The authors believe that EFT is effective in these situations because it is specifically designed to enhance, or build, a secure, trusting attachment between spouses.  In times of great stress, such as a child being ill for a long time, tremendous strain can be put on a relationship and trust becomes vital.  If a couple is secure in their relationship, they can rally together and focus on the needs of the child.  If the relationship is not secure, then one or both parents will engage in negative behaviors  and make the situation even worse.
      Despite the strong results, this research does suffer from several limitations.  As part of the study design, the therapists were given specific training on how to deal with parents of chronically ill children and were also given medical information specific to the diseases in question.  This additional training, combined with the medical information, may in and of itself have been responsible for the study's positive results, as opposed to the emotional focus of the therapy.  In scientific terms, this is known as a confounding variable, because there is no way to tell which (the medical info/training or the EFT or both) resulted in the couple's improvement. 
     A second, and fairly serious, consideration is the fact that one of the study authors is the co-creator of EFT, the very technique being studied.  Susan Johnson has been active in promoting her therapy technique through books, tapes, and workshops.  A more independent review of the effectiveness of EFT would carry more weight.
     However, despite these limitations, it is difficult to ignore the dramatic results - especially the difference in separation rates - of the study.  Clearly, dealing with a sick child is hard on any couple, and according to this study, those who feel it is hurting their marriage may want to consider some type of counseling..

--Rick Labuda   

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Key Points

1. Having a child with a chronic illness can place a tremendous strain on a marriage

2. EFT - a type of therapy which focuses on building a secure bond between spouses - has been shown to be effective in treating general marital distress

3. Study involved 32 couples with an ill child and marital distress; 16 couples received EFT, 16 did not

4. Found that there was a significant improvement in the relationship between the couples who received EFT versus the ones who didn't

5. The positive effect was still evident 2 years after the study

6. Only 1 of the 16 EFT couples separated, whereas 5 couples in the control group separated.

7. Study has several limitations, so more research is necessary to validate the effectiveness of EFT

Figure 3
2-YR Follow-Up For EFT Group