Clinical Psychology

behavioral marital therapy (Jacobson & Margolin,
1979; Stuart, 1980; Weiss, Hops, & Patterson,
1973) and emotionally focused couples therapy
(Johnson, Hunsley, Greenberg, & Schindler, 1999).

Behavioral Marital Therapy. The beginnings of
behavioral marital therapy(BMT) are often traced to
the work of Richard Stuart (1969). (Again, despite
the use of the termmarital, BMT does not require
that the partners be married.) Stuart’s treatment of
marital dysfunction involved the application of
reinforcement principles to couple’s interactions.
A major component of his treatment was a tech-
nique called contingency contracting; spouses were
trained to modify their own behavior to effect a
specific desired change in their mate’s behavior.
Over the years, BMT has broadened to include
a number of additional techniques. Support-
understanding techniques aim to increase positive
behaviors emitted by partners, increase collabora-
tion within the couple, and increase positive feel-
ings in each partner. For example, each partner
generates a list of behaviors that, if produced by
his or her mate, will bring pleasure. Next, each
partner agrees to perform three of the behaviors
from her or his partner’s list before the next session.

Problem-solving techniquesinvolve training couples in

positive communication skills so that effective deci-

sion making and negotiating are possible. For

example, couples are given a list of basic rules of

positive communication skills and then“practice”

these skills within the session. The clinician inter-

venes if she or he thinks it will be helpful (e.g.,

clarifying the appropriate communication skills,

modeling alternative ways to communicate that

are more positive). These and other BMT strategies

are described in more detail in a number of sources

(e.g., Gottman, Notarius, Gonso, & Markman,

1976; Jacobson & Margolin, 1979; Stuart, 1980).

Emotionally Focused Couples Therapy.

Emotionally focused couples therapy(EFT)isabrieftreat-

ment that seeks to change partners’problematic inter-

actional styles and emotional responses so that a

stronger and more secure emotional bond can be estab-

lished (Johnson et al., 1999). This treatment approach

assumes that negative affect and associated destructive

interactional styles create marital distress. Further, it is

believed that a more secure attachment to one’spartner

is necessary to stabilize a dyadic relationship.

Johnson et al. (1999) have outlined the nine

treatment steps in EFT (see Box 15-4). The first

BOX15-4 Focus on Clinical Applications: The Nine Steps of Emotionally Focused Couples Therapy (EFT)

Cycle De-escalation.

Step 1. Assessment—creating an alliance and explicat-

ing the core issues in the couple’s conflict using an

attachment perspective.

Step 2. Identifying the problem interactional cycle

that maintains attachment insecurity and relationship

distress.

Step 3. Accessing the unacknowledged emotions

underlying interactional positions.

Step 4. Reframing the problem in terms of the cycle,

the underlying emotions, and attachment needs.

Changing Interactional Positions.

Step 5. Promoting identification with disowned needs

and aspects of self and integrating these into relation-

ship interactions.

Step 6. Promoting acceptance of the partner’s new

construction of experience in the relationship and new

responses.

Step 7. Facilitating the expression of specific needs and

wants and creating emotional engagement.

Consolidation/Integration.

Step 8. Facilitating the emergence of new solutions to

old problematic relationship issues.

Step 9. Consolidating new positions and new cycles of

attachment behavior. (p. 70)

From Johnson, S. M., Hunsley, J., Greenberg, L., & Schindler, D.,

“Emotionally focused couples therapy: Status and challenges,”Clinical

Psychology: Science and Practice, 6, pp. 67–79. Copyright © 1999

American Psychological Association. Reprinted with permission.

GROUP THERAPY, FAMILY THERAPY, AND COUPLES THERAPY 451