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The Hold Me Tight Program for Couples Becoming Parents: a Mixed Methods Study

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The Hold Me Tight Program for Couples Becoming Parents: a Mixed Methods Study Wilfrid Laurier University Scholars Commons @ Laurier Theses and Dissertations (Comprehensive) 2018 THE HOLD ME TIGHT PROGRAM FOR COUPLES BECOMING PARENTS: A MIXED METHODS STUDY Debbie Wang Wilfrid Laurier University, [email protected] Follow this and additional works at: https://scholars.wlu.ca/etd Part of the Clinical and Medical Social Work Commons, Developmental Psychology Commons, Family, Life Course, and Society Commons, Marriage and Family Therapy and Counseling Commons, Maternal and Child Health Commons, Other Mental and Social Health Commons, Public Health Education and Promotion Commons, Social Psychology and Interaction Commons, Social Work Commons, and the Women's Health Commons Recommended Citation Wang, Debbie, "THE HOLD ME TIGHT PROGRAM FOR COUPLES BECOMING PARENTS: A MIXED METHODS STUDY" (2018). Theses and Dissertations (Comprehensive). 2012. https://scholars.wlu.ca/etd/2012 This Dissertation is brought to you for free and open access by Scholars Commons @ Laurier. It has been accepted for inclusion in Theses and Dissertations (Comprehensive) by an authorized administrator of Scholars Commons @ Laurier. For more information, please contact [email protected]. THE HOLD ME TIGHT® PROGRAM FOR COUPLES BECOMING PARENTS: A MIXED METHODS STUDY by Debbie Wang, Master of Social Work, Wilfrid Laurier University, 2000 Bachelor of Social Work, McMaster University, 1992 Bachelor of Arts (Psychology), the University of Tennessee, 1986 DISSERTATION Submitted to the Faculty of Social Work Wilfrid Laurier University in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Social Work Waterloo, Ontario, Canada © Debbie Wang, 2017 ABSTRACT Attachment theory has made substantial contributions to the understanding of close relationships. The purpose of this study was to inquire whether an attachment-informed psychoeducational program is a feasible and effective intervention for couples expecting their first child. The overarching question was: Is an attachment-informed relationship enhancement program, such as Hold Me Tight® (HMT), helpful to couples in strengthening their relationship and increasing their confidence in becoming first-time parents? The research question was addressed using a mixed-methods approach. In the first phase, the Hold Me Tight® program developed by Dr. Sue Johnson was modified for use with couples becoming parents for the first time. The second phase involved implementation of the modified program and the assessment of its helpfulness. Twelve couples (N=24) participated in the Hold Me Tight® program for Couples Becoming Parents study with zero attrition. The program, intended to help couples better understand their relationship with each other and create the best possible emotional foundation for their child, was well received. Findings indicate the participants gained a better understanding of their own attachment behaviour towards their partners as well as their partners’ behaviour towards them in times of need; such increased awareness is expected to strengthen their emotional connection. Many of the couples requested a “booster workshop” after the birth of the baby. While the changes over time on scores derived from the quantitative measures were not statistically significant, the qualitative data suggested that the HMT program may have had more effect on the men than the women. Many of the men said the program helped them feel more connected with their partners, and following the program, it was observed that many men were more able to share their vulnerable feelings (e.g. fear and inadequacy) about parenting in the presence of their partners. These behaviours suggested that the men experienced an increase in feelings of security in the i relationship with their partners. This finding was supported by marginally significant improvement (p= .052) between pre- and post–program assessment in the males’ scores on The Brief Accessibility, Responsiveness, and Engagement (BARE) Scale, which assessed their perception of their partners’ attachment behaviours. Contrary to what was expected, proportionally more men than women scored above the thresholds for concern on the scale designed to screen for depression and anxiety (Edinburgh Postnatal Depression Scale, EPDS). Evaluations and feedback provided by both facilitators and participants will facilitate future program improvement. The in-class conversation exercises were found by most participants to be the most valuable of all the activities; this reaffirmed that the greatest strength of the HMT program is the emotionally-focused conversations. The results of this study inform practice by recognizing the need for more attention to the parental relationship and the mental health of both parents, the wisdom of utilizing attachment core concepts to support healthy relationships, and the need for early interventions that may strengthen the couple relationship and foster psychological wellbeing for the entire family. The insights from this pilot study will inform a future study of the effectiveness of this intervention using larger samples and more diverse participants. ii ACKNOWLEDGEMENTS Embarking on this PhD journey has been part of a self-actualization process for me. I am privileged to have had the support I needed to help me thrive. The academic learning at Laurier has been intellectually stimulating and most satisfying. This memorable experience was enriched by the tireless effort and unwavering support that I received from my advisor, Dr. Carol Stalker. Her scholarly mindset, respect for research, and caring attitude for her students have left an imprint on me that I hope to emulate. Special thanks also go to the rest of my dissertation committee: Dr. Kristine Lund who believed in me, shared my vision, and gave me her full attention when I needed it. Dr. Marshall Fine who widened my research with various perspectives and kindly agreed to remain on my committee even after his retirement. Dr. Tat- Ying Wong, MD, generously provided me with consultation and guidance. His knowledge and expertise in Emotionally Focused Therapy, his experiences in conducting Hold Me Tight® programs and having published the first outcome study with Chinese couples, and his remarkable editorial skills were all very helpful in supporting all phases of this study. My appreciation also goes to Dr. Nick Coady, the Dean of Social Work at the time of my admission. He connected me with Dr. Carol Stalker and later offered me the opportunity to co-author with her the chapter Attachment Theory for the textbook, Theoretical Perspectives for Direct Social Work Practice, Third Edition. I am grateful for the faculty, staff, and close colleagues at the Faculty of Social Work. Together we created a safe and secure environment to nurture minds and build supportive friendships. My sincere gratitude goes to Dr. Sue Johnson for allowing me to modify her Hold Me Tight® program for this pilot study. I am indebted to Greg and Gillian, the program facilitators, as well as the twelve expectant couples who took part in this research. Without their iii participation and generosity of their time, it would not have been possible to conduct this study. I am thankful to Waterloo Lutheran Seminary at Laurier and Langs Community Health Centre in Cambridge for offering their facilities to conduct the workshops. The two volunteer couples, Sharon and Dave as well as Trina and Steve were most helpful behind the scenes for set-up, takedown, and providing nutritious meals and refreshments for the group participants. Attachment theory to me has been more than a theory but a real life experience. I am blessed to have close family and friends who got me through difficult times when I lost physical and emotional stamina. Their love and friendship sustained and helped me not merely to survive but thrive. The idea of having an attachment-informed relationship program for couples becoming parents was motivated by the hope that our two sons, Adam and Andrew, would benefit from this one day. It is also my way to pay it forward for the love I have received that made me who I am today. Finally, with heartfelt gratitude, I dedicate this dissertation to those who have served as my secure attachment figures along life’s journey: My Heavenly Father My late grandparents, Mr. & Mrs. Wu My beloved parents, Teng-Po Wang & Guei-Yun Wu Eddie and Marsha Hooper The late Maria deFaria Grace R. Uloth And my loving husband, John Pham, PhD iv TABLE OF CONTENTS Page Abstract …………………………………………………………………………………….. i Acknowledgements ………………………………………………………………………… iii Table of Contents …………………………………………………………………………... v List of Tables ……………………………………………………………………………….. xii List of Figures ………………………………………………………………………………. xiii INTRODUCTION …………………………………………………………………………. 1 Problem Statement ………………………………………………………………………….. 2 Situating the Self …………………………………………………………………………… 4 Research Purpose and Approach ……………………………………………………............ 6 Organization of the Dissertation ……………………………………………………………. 8 LITERATURE REVIEW ………………………………………………………………… 9 Attachment Theory and Key Construct ………………………………………………….... 9 Overview of Historical Development ………………………………………………. 10 Attachment Relationship through Affectional Bonds ……………………………… 12 Attachment as a Behavioural System ………………………………………………. 13 Internal Working Models of Relationships ………………………………………… 14 Individual Differences in Attachment ……………………………………………… 15 Mentalization: Reflective Functioning and Affect Regulation …………………….. 19 Healthy Dependence for Optimal Functioning …………………………………….
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