Emotionally Focused Couples Therapy and Individual Psychology: a Dialogue Across Theories

Emotionally Focused Couples Therapy and Individual Psychology: A Dialogue Across Theories

Paul R. Peluso and Heather Maclntosh

Abstract

The purpose of this article is to demonstrate the link between the major theoretical tenets of Emotionally Focused Therapy (Johnson, 1 996) and Individual Psychology (Ansbacher & Ansbacher, 1955) in the practice of couples therapy. The two theories are similar in many theoretical and practical ways' These areas of convergence and collaboration are outlined, as are the unique contributions that each approach has to offer practitioners of the other.

Psychodynamic theories of personality have persisted over the decades beginning with Sigmund Freud. While many theorists subsequently refined or replaced Freud's initial theory, one element has remained consistent throughout psychodynamic thought: Human behavior is governed by patterns that are developed from early experiences (Bankart, 1 997). Two theories of personality arising from the psychodynamic perspective are Individual Psychology, developed by Alfred Adler in the 1920s and 1930s, and Attach- mentTheory, developed initially by John Bowlby in the 1940s and 1950s. Proponents of each of these theories try to use their concepts to explain an individual's methods of relating to others, viewing the world, and guiding their behaviors (Adler as cited in Ansbacher & Ansbacher, 1956; Bowlby, 19BB). Adlerian clinicians refer to these governing behaviors or personality dynamics as the lifestyle, while attachment theorists describe these dynamics as Attachment Styles. Yet few comparisons have been made between these two major constructs (e.8., Jones & Lyddon, 2003; Watkins,1997; Watts & Shulman, 2003). Recently, there has been an effort to investigate the applicability of lndividual Psychology with various cognitive and constructivist theories in order to integrate the commonalties between the two, broaden the exposure of clinicians and researchers to Adlerian concepts, and correct many of the mistaken notions about lndividual Psychology held by those who use other approaches (Carlson, 1991; Sperry,2003; Watts & Critelli, 1997; Watts & Shulman, 2003). In fact, Peluso, Peluso, Kern, and White (2004) reviewed the theoretical constructs underlying the similarities of the two approaches' Specifically, they found consistency in both approaches in their primary constructs as well as treatment approaches.

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At the same time, arguably, the most dynamic, modern theoretical approaches to have emerged in the last 20 years have used Bowlby's At- tachment Theory. Emotionally Focused Therapy (EFT; Johnson, 2A02, 2003) has proved that these construcr can be applied in a coherent therapeutic context and that they can be empirically shown to have a positive effect. The major areas of convergence between the two theories are that both include a coherent and stable view of the self and the world (and others) and both acknowledge the importance of social interaction for the expression of these patterns (Peluso et al., 2004). Below, we outline the major theoretical tenets of EFT and lndividual Psychology as they relate to couples therapy.

Adlerian Theorv and Couples Therapv

Adler (as cited in Ansbacher & Ansbacher) wrote that individuals ac- tively participate in the creation of the main personality factor in Individual Psychology, the lifestyle. This subjective creation of reality is shaped from a very early age as a result of interactions within the family unit. According to Adler, it is from this subjective view of life (which he called the "schema of apperception") that the individual constructs a "private logic," that is, the collection of attitudes and reactions the individual has about life and his or her place in it. This process takes place by the age of 6 (with some variability due to individual and/or cultural differences). At this stage of development, individuals make decisions about their place in the world, what behaviors or strategies they will need to employ in order to belong in a social group, and how this belonging to a social group will help them get basic physical and emotional needs met. The social feelin g (Gemeinschattsgefiihll that the individual innately has, and the extent to which it gets expressed, is tied into the overall family atmosphere and the conclusions that the individual draws from it. Hence, the family, as the prototypical social group for the child, plays a crucial role related to the development of this "private logic" and eventual lifestyle. This lifestyle becomes the response set for life, and it is the common thread that weaves an individual's thoughts, feelings, and actions into a coherent pattern (Ansbacher & Ansbacher, 1956).In addition, once it is set in place, the lifestyle remains relatively stable through adulthood (Peluso et al.,2OO4).This is not to say that the lifestyle is static and unchanging but that it represents the stable and predictable aspects of a person throughout his or her life. ln fact, Adlerian practitioners believe that individuals can learn how to make their particular lifestyle work better for them either through life experiences or psychotherapy (Ansbacher & Ansbacher; Peluso,2006). Of course, the purpose of Individual Psychology is to provide a system of understanding human behavior and development in order to help those Emotionally Focused Therapy 249

individuals who are either suffering from serious mental illnesses or having difficulty mastering the basic tasks of life. As such, the lifestyle is probably the most crucial element in Adlerian psychotherapy. lt is central to the origin and maintenance of the problem (via the "psychology of use") as well as the development and implementation of the solution. The lifestyle flows from the client's perceptions and experiences of the world (especially in the family of origin) and is manifest in the client's behavior, or movement in the world. lt is also evinced in the client's relations with others in terms of the quality and quantity of relationships (Peluso, 2006). ln terms of partner selection and couples treatment, from an lndividual Psychology perspective, partners are chosen based on the compatibility of lifestyles, goals, and belief systems. The couple comes together and forms a relational dyad that is influenced by each partner and creates a system whereby the individual choices of each partner have a unique bearing on the functioning of the system. The thoughts, feelings, and attitudes all influence the behavior of either person as well as the direction of the couple system. Dreikurs {1946) believed that when there is stress or discord, those elements in one's partner that attracted one become the same behaviors that create problems. This is why, according to Adlerian theorists, the choices that a couple makes are not accidental and are (ideally) directed toward the goal of communication and respect as equals (Carlson & Dinkmeyer, 1999). How- ever, this does not always materialize, as individual private logic, goals, and lifestyle dynamics can guide the system into either function or dysfunction. Hence, the behavior that is exhibited by a couple, even if it is destructive on the surface, may actually represent a creative attempt at negotiating a balance between each partner's needs. Almost all Adlerian therapy uses some variation of the four-stage model outlined by Dreikurs (1967), which consists of (a) relationship building, (b) investigation, (c) interpretation, and (d) reorientation. In the relationship building stage, it is incumbent upon the therapist to create a solid therapeutic alliance with the couple, demonstrate fairness in dealing with both partners, and provide a secure base from which to work. In the next phase, investigation, lifestyle analysis of each person is conducted and,includes an examination of family-of-origin dynamics (psychological birth order, family atmosphere) and early recollections. From this analysis, the couple's private logic and goals can be determined. Interpretation allows the therapist to juxtapose the styles of life of both partners and reflect how the dynamics and behavioral choices of each partner are contributing to the disruption in the marital system. The insight into the couple's relationship allows the therapist to begin interventions and help the couple to make some different choices in relating to one another. The reorientation phase is the aspect of therapy where the couple, under the guidance and encouragement of the therapist, 250 Paul R. Peluso and Heather Maclntosh

creates an action plan based on the result of the lifesgle assessment and in light of the presenting problem. The couple makes specific changes in their interactions with each other and evaluates the effect on the relationship. Termination is usually based upon mutual agreement between clients and therapist once the main goals of therapy have been accomplished (Carlson & Sperry, 2000). Adlerian couples therapy is neither deterministic nor fatalistic. Instead, at any time, either partner can effect change by making different choices and thus affecting the system. ln Adlerian therapy, each member of the couple must take responsibility for his or her own behavior. Once he or she knows how mistaken goals or lifestyle dynamics create problems in the relationship, then that person must take the initiative and make the effort to change his or her responses. The Adlerian therapist looks for the creativity in the solution and attempts to marshal the same resources toward a more equitable and constructive solution (Carlson & Dinkmeyer, 1999; Carlson & Sperry, 2000). However, the ability to make changes within a system requires insight, courage, and a sense of humor about one's self and life. Thus, the therapist must act as encourager, detective, and sometimes humorist as the couple is guided through the therapeutic process toward a more egalitarian and just solution to their problem (Sperry Carlson, & Peluso, 2006). In the course of couples treatment, Adlerian therapists may use several interventions to help uncover these underlying goals and ultimately give the clients the courage to be able to change their behavior on their own. Several of these interventions include "The Question," paradoxical intention, "spitting in the client's soup," catching one's sell and assigning homework. In addition, because Adlerian theory relates to many different systems of psychotherapy, Adlerian psychotherapists are able to use new techniques without necessarily aban- doning their own theoretical framework. Many times the technique that is "borrowed" is actually a revisitation of an original Adlerian technique (e.g., the miracle question, the push-button technique). However, several Adle- rian theorists have begun to incorporate new modalities of treatment (such as attachment theory) and integrate them well within an Adlerian context (Peluso et a|'.,2004; Sperry et al.; Watts & Shulman, 2003).

Emotionally Focused Therapv for Couples

EFT was developed in the early 1980s in response to an absence of standardized and validated, nonbehavioral clinical approaches to couple distress. Primarily, the field up to that point had focused on behavioral and cognitive change while leaving the role of emotion largely unexplored both in theory and practice. EFT is a form of couples therapy which integrates Emotionally Focused Therapy 251

experiential and systemic approaches in the process of therapeutic change. EFT has been empirically validated and presently is recognized as one of only two empirically validated extant couple interventions (Alexander, Holtzworth-Munroe, & Jameson, 1994; Baucom, Shoham, Mueser, Daiuto, & Stickle, 1998). Numerous studies have validated EFT through outcome-based clinical research methods. Couple distress has been the primary focus of these studies as measured by the Dyadic Adjustment Scale (DAS; Spanier, 1926). ln a review of the EFT research it was found that in nine studies there was significant improvement in DAS scores compared to both waiting list controls and to couples' pretreatment DAS scores (Dandeneau & Johnson, 1994; Des- 'l 'l saulles, 991 ; Creenberg & Johnson, 1 985; Johnson & Talitman, 992; Walker, Johnson, Manion, & Cloutier, 1996). ln 7O-75o/" of the EFT treated couples, criteria for recovery were met (i.e., they were no longer relationally distressed). lt has demonstrated both clinical effectiveness and relatively high and stable treatment effects (Johnson, Hunsley, Creenberg & Schindler; l9g9). EFT has been investigated extensively and has been found to be effective with diverse populations including depressed women (Dessaulles, l99t; Johnson, 1998) and families experiencing chronic stress or coping with a chronically ill child (walker et al., 1996). Case studies have been presented on the use of EFT with couples coping with one partner who has survived severe trauma and has symptoms of Post Traumatic Stress Disorder (Johnson et al., 1999). EFT emphasizes the role of affect in therapeutic change. Additionally, the role of communication and rigid interactional cycles, such as blame- defend or pursue-withdraw in maintaining dysfunctional interactions are emphasized. Critical elements in relationship distress are hypothesized to be the absorbing states of negative affect, such as anger or fear (Johnson & Whiffen, 1999). EFT melds experiential (intrapsychic), systemic (interpersonal), and humanistic theoretical approaches (Johnson, 1996). Through unveiling the shrouded emotional needs and identifying negative interactional cycles that maintain each partner's interactional stance, these interactional patterns can begin to change (Johnson, 199S). Not only is the expression of needs facilitated, but there can be the creation of new responses on the part of each partner. Johnson suggested that emotional expression and communication are primary forms of self-regulation which enable people to identify that which is important to them and to their partners, thus allowing couples to meet each other's emotional needs better. Emotional expression is also a regulator of behavior both toward oneself and onet partner (Tronick, 1989). The process of change in EFT has been demarcated into three stages covering nine treatment steps (seeTable 1). EFT Stage One has four steps. 252 Paul R. Peluso and Heather Maclntosh

Table 1 Stages of Emotionally Focused Therapy for Couples

Stage Step/Description

L Assessment and 1. Create an alliance and delineate conflict Delineation of issues in the struggle. Problematic Cycles/ 2. ldentify the negative interactional cycle. De-escalation 3. Access unacknowledged feelings and attachment needs. 4. Reframe problem in terms of underlying emotions and needs. ll. ReengagemenU 5. Promote identification with disowned needs Softening and aspects of self. 6. Promote acceptance of partnert experience. 7. Facilitate the expression of unmet needs and wants. lll. Consolidation 8. Facilitate the emergence of new solutions. 9. Consolidate new positions.

step 1 delineates the conflict and includes an assessment of the core issues and conflict using an aftachment perspective. The therapeutic alliance is developed and the unveiling process is begun. Step 2 involves identifying the negative interaction cycles, such as pursue-withdraw or attack-defend. Both of the individual's presenting concerns are made relational through the identification of these cycles. Step 3 involves delving into the unacknowledged emotions underlying these self-reinforcing interactional patterns. The therapist begins to identify and validate the primary emotional responses. Step 4 reframes the problems in terms of the cycle, the underlying emotions, and attachment needs. The second stage, ReengagemenVsoftening, has three steps. Step 5 pro- motes identification with disavowed needs and facets of the self that have been withheld in relationship interactions and integration of these elements into the relationship. Step 6 involves the promotion of acceptance of the partner's new ways of being and responding in the relationship. Step 7 is the facilitation of the expression of specific needs and wants and creating emotional engagement. During the Reengagement/Softening stage, key interventions support the couple in expressing vulnerability with the result of the emergence of new relational cycles which create a large shift in the relationship positions. hrtner A expresses needs and vulnerabilities, trusts the other more, feels that the other can be accessible and responsive, and accepts limitations. hrtner A is more empathic, less hostile, and able to ask for comfort from the other. hrtner B is also more engaged and empathic, trusts the other more, and accepts limitations. Partner B is more accessible and responsive and feels that the other is more approachable (Johnson, 1996). The final stage, Consolidation/lntegration, has two steps. Step 8 develops new solutions to old relationship problems and Step 9 involves consolidating new positions and new cycles of attachment behavior (Johnson, 1996).

Individual Psvchologv and Attachment Theorv

Constructivist and cognitive therapists who have looked for a theoretical grounding for these approaches have also embraced Attachment Theory as amajor underpinning to explain their impact on clients (watts, 2003). A cursory overview of the basic tenets of the theory reveals some striking similarities between Individual Psychology and Attachment Theory (Peluso et al., 2004; Weber, 2003). The major areas of convergence between the two theories are that each includes a coherent and stable view of the self and the world and that both acknowledge the importance of social interaction for the expression of these patterns. Some of these are presented below. The two main theoretical constructs in Attachment Theory are the attachment style and the internal working models of self and others. They are intertwined, as one influences the development of the other. The attachment style refers to the relational behaviors that occur between the individual and the primary caregiver in order to get basic needs met (initially) and then to develop a scheml (or response seO for interacting with the wprld (and others) around them (Peluso et al., 2004). The development of the attachment style has been described as a "womb" for the "psychological birth" of the iniant and necessary for the health of a child (Hughes, 1997). Creenberg and Speltz (1988) described the mechanisms for developing attachment style as follows: It provides an explanatory framework that carefully elaborates the developmental changes both in the infant and in the dyadic interaction. These developmental changes involve progression through hierarchically organized levels from: (a) behavioral interaction (attachment behaviors); to (b) the organization of behavior systems; to (c) the development of representation models of both self and other and the manner in which such models both influence and are influenced by observable behavior. (p. 179) Hence, it is reasonable to think of the development of lifestyle and the development of attachment as being similar (Peluso et al., 2004). lnitially, just as the development of attachment is thought to begin with the primary 254 Paul R. Peluso and Heather Maclntosh

behavioral interactions between the child and parent, Adlerian theorists believe that the lifestyle originated in the behavioral combinations that a child tries in order to find a place in the family to get his or her needs met. ln the next phase of development, attachment behaviors become more organized into a working model of self and others, just as the private logic of the child-the methods for solving problems and confronting the tasks of life-is organized intq a schema of apperception and eventually the lifestyle. From this working model, the individual defines the quality anrl nature of his or her affective, behavioral, cognitive, and physical development (Creenberg & Speltz, 19BB; Hughes,1997). Finally, as the individual matures, an internal working model of the world is developed from the attachment style, just as the lifestyle is set and employed with friends, school, work, family, and other social settings (Ansbacher & Ansbacher, 1956; Bowlby, 1988; Creenberg & Speltz, 1988). Hence, it is also reasonable to conclude that there are many overlaps between Individual Psychology and Attachment'l-heory. This link- age can mutually benefit both approaches, but for the purposes of this discussion, it seems to provide some independent validation for the concept of lifestyle (Peluso et al., 2004).

EFT and AttachmgntTheorv

The proponents of EFT view attachment as a theory well suited to adult love relationships and one which addresses the gaps in existing paradigms of adult love. lt allows for the needs and emotions of partners in such relationships to be understood within a framework that has received strong empirical support. Attachment theorists postulate that humans are innately driven to develop and maintain strong affectional bonds to significant others (Bowlby, 1988). In couple relationships, secure attachments are represented by relationships that are reciprocal and affectionate and where both partners feel close, safe, and nurtured (Johnson, Makinen, & Millikin, 2001). Secure bonds are characterized by accessibility and responsiveness of partners toward each other. These secure bonds allow couples to help each other with the regulation of emotional distress. EFT clinicians and researchers then envision the couple relationship as an attachment bond whereby distressed relationships are viewed as insecure bonds (Johnson etal., 1999). lt has been suggested thatthese insecure bonds do not allow for the satisfaction of each partner's aftachment needs for comfort, security, and closeness because of compelling negative emotional responses and constricted interactional patterns that arise and block emotional connection and engagement between partners. Thus the main focus of the EFT approach to couples therapy is on underlying emotional panerns Emotionally Focused Therapy 255 and on relational interactions with the goal of reorienting, resolving, and transforming negative interactional patterns which will then allow for the fostering of a secure aftachment between partners. Johnson (2002) argued that when no secure base is available to a partner in a relhtionship, attachment behaviors such as protesting and clinging, avoidance, or withdrawal would be provoked and exaggerated. She further argued that this process would evolve until neither partner would be able to be responsive or accessible to the other. This unresponsiveness would then continue to provoke increased insecurity until both partners became unable to sustain emotional engaSement and the partners would then become emotionally misattuned with each other. Johnson expanded upon the conceptof attunement in parent-child dyads by suggesting that in adult relationships, attunement is the sensitive, moment- to-moment being with a partner as he or she experiences and expresses an emotion. This attunement would be demonstrated through the exhibition of behaviors that suggest the ability to empathize and share their partner's emotional experience. In conclusion, Johnson argued that as insecure attachment styles become rigid and polar, the insecurity would manifest itself in the inability to be open and trusting with their partner whom, she argued, represents the foundation of the secure bond with others. This insecurity would then result in avoidance from engagement with each other, which would then make modification of aftachment styles difficult until eventually, both partners withdraw and the relationship is in jeopardy.

Similarities between EFT and Individual Psvchology

Clearly, there are several areas of overlap between the two approaches. These can be broadly classified as areas of theoretical overlap and areas ol clinical overlap.In terms of theoretical overlap, the similarity to attachment theory has already been made above and elsewhere (Peluso, 2006; Peluso et al., 2004), but a direct theoretical link between EFT and Individual Psychology includes a reliance on client schemas, the primacy of the need to belong, interaction of developmental forces (goal-directedness) and the social environment. Specifically, both EFT and Individual Psychology rely heavily on a schema (or the lifestyle) for understanding the organization of the individual's view of themselves and the world around them. These schemas are developed from strategies that allow the individual to meet belonging needs that originate in the relationships with the family-of-origin. In Individual Psychology, the lifestyle results from the individual's perceptions of the environment, the behaviors that he or she employs, and the quality and quantity of relationships, while in EFI, the attachment style is shaped 256 Paul R. Peluso and Heather Maclntosh

by the person's expectations of self and others and the quality & quantity of relationships (Ansbacher & Ansbacher, 1964; Bowlby, 1969; Johnson,2002; Lombardi, Melchior, & Murphy, 1996). Emotionally Focused Therapy and Adlerian therapists both share the idea that each individual operates with a specific goal or set of goals in mind, and these drive behavioral strivings. AdJer (as cited in Ansbacher & Ansbacher, 1956) stated that all behavior has a goal, which may be facilita- tive or destructive to the relationship. These are based on their subjective perceptions (or private logic), which color their construction of reality (lifestyle). This teleologicalor goal-directed approach allows therapists to look for the personal meaning to a person's (or a couple's) behavioral interaction. Thus, understanding of the client's goal via movement is a key to unlocking the couple's conflict (Carlson & Sperry, 2000). Similarly, EFT theorists view the goals of a couple's behavior as driven toward meeting the basic attachment needs (security and exploration of the environment) in order to fulfill '1988; their potential in life (Bowlby, Johnson, 2OO2). A final area of theoretical overlap between Individual Psychology and EFT is in the emphasis of the social context for behavior. According to Adler (as cited in Ansbacher & Ansbacher, 1956), people are social beings, and thus any problems are created socially (with other people). The main construct is called "social interest" or "community feeling" which is seen by Adferians as a gauge for whether the individualb lifestyle is usefulor use- /ess (Jones & Lyddon, 2003). As a result, the couple relationship is a social system that is either positively or negatively affected by input from either member. When it is an equal and balanced relationship, the couple dyad allows for the creation of a healing and fulfilling forum for each partner. Like- wise, when it is not a collaborative relationship, the partners in a couple end up hurt and dissatisfied. This concept is very similar to how EFT conceptual- izes the coupling process. Couples who join together in order to meet each other's attachment needs create opportunities for healing and restorative relationship. Again, when the relationship does not meet these needs, new hurts can trigger old trauma-based attachment behaviors that progressively distress the relationship (Johnson ,2002). f n terms of areas of clinical overlap, again EFT and Individual Psychol- ogy share much in common. Specifically there is a shared emphasis on understanding the nature of past experiences playing a role in present trou- bles (i.e., family-of-origin dynamics, past relationships, fears, expectations, and patterns of behavio0. Both EFT and lndividual Psychology practitioners strive to build solid therapeutic alliances, develop a secure base for the couple to explore their dynamics, and demonstrate fairness. Lastly, clinicians from both approaches use empathy, demonstrate respect for the client, and value the client as the expert regarding their own lives. Even in the practice of couples therapy, both approaches have similar processes. In terms of assessment, lndividual Psychology clinicians identify ihe clientt private logic while EFT clinicians identify negative interaction cy' cles based upon unmet attachment needs. While EFT has nine steps (arrayed along three stages) and lndividual Psychology has four stages (Dreikurs, ig6il, they are quite similar. Specifically, the first EFT stage (assessment and delineation of problematic cycles/de-escalation) incorporates elements of the relationship building, investigation, and even some portion of the interpretation stages of Adlerian therapy. The second EFT stage, reen8age- meni and softening, aligns well with the interpretation stage, and the third EFT stage of therapy, consolidation, is analogous to the re-orientation stage in Individual Psychology. Lastly, the goals for therapy are also remarkably similar. Adler (as cited in Ansbacher & Ansbacher,1964) wrote that if a person did not 8et a Sood start in life and did not have good developmental opportunities in childhood (from the family), he or she could use other role models in adulthood as sources of support. The therapist then can act as one of these role models and encourage the client to make new choices when interacting with his or her partner. In EFI this dynamic is analogous to creating a restorative experience in therapy with the couple. This experience can develop a change in the couple's experience of attachment to one another because of the new experience. In this case, the therapist is not an attachment figure per se/ but a facilitator of partner as attachment figure while the couple puts their attachment to one another in context. In both cases (lndividual Psychology & EFT), the emphasis is placed on redirecting the couple's focus from dependence on the therapist toward reliance on one another to get their needs met.

Unique Aspects of Individual Psvchologv and Emotionally Focused Therapv: A Mutual Dialogue

Emotionally Focused Therapy contributions to lndividual Psychology. Just as it was valuable to look at similar theoretical constructs to those es- poused by Adler and other lndividual Psychology theorists for empirical validation, it is valuable to look at other approaches and branches of psychology for methodological guidance as well. Clearly researchers in aftachment thlory have conducted extensive research within the developmental and sociai psychology literature which has validated many of the underlying theoretical constructs. In addition, EFI which has attachment theory as one of its underlying constructs, has also been subjected to validation through a number of empirical outcome studies to investigate its effectiveness '1996, (Creenberg & Johnson, 1985; Johnson, 2003; Johnson & Denton, 258 Faul R. Peluso and Heather Maclntosh

2002).lt has been found to be effective with couples relative to other treatment approaches. In head+o-head studies with Traditional Behavioral Couples Therapy, EFT was found to be more effective in reducing marital distress (Johnson & Creenberg, 1995). While EFT is but one example of empirically validated approaches, several factors warrant its singling out for discussion here. First are the theoretical overlaps between attachment theory and f ndividual Psychology (Peluso, 2001; Peluso et al., 2004; Weber, 2003). Second is the systematic fashion in which Johnson and her colleagues have gone about creating a research paradigm, which systematically established the effectiveness of EFT. All of this may serve as guide for possible research of Individual Psychology constructs, particularly the lifestyle, as well as studies of clinical usefulness (Peluso, 2006). Recent research suggests that the bridge between the theoretical and the clinical in EFT and attachment theory is a challenging one to validate empirically. Two recent EFT studies found very little change in attachment as measured by self-report scales (Maclntosh & Whiffen, 2005; Makinen, 2005). Researchers argued that the clinical characteristics of the particular population studied and the stability of attachment over time could be possible explanations for these limited findings. An earlier study directly assessing the impact of EFT on attachment found some gains in attachment at post- treatment as measured by two self-report measures based on Bartholomew's dimensional model of aitachment, but these gains were not maintained at the 4 month follow-up (Sims, 2000). There are three possible explanations for this failure to find a significant impact of EFT therapy on self-reported attachment. The first is simply that attachment is a stable construct that is resistant to therapeutic change. while EFT may, in fact, be challenging attachment based assumptions in relationships and while key attachment behaviors do seem to change in change events, such as softenings (Johnson, 1989), these are not having a lasting effect on the general self-reported attachment ratings of participants. The second possible explanation is that EFT does not have an inrpact on attachment and that the interventions in EFT that are hypothesized to affect the attachment schema of partners are having an effect on some other construct of intrapsychic or interpersonal functioning. Another possible explanation is that EFT is having an impact on attachment that cannot be measured using a self-report measure of attachment cognitions. lt may take some time and substantial repetition of new behaviors and relational experiences to shift a budding procedural, implicit learning of attachment security into a longer- term change in explicit cognitive schemata of attachment. civen that this is an important theoretical issue that has the potential to call into question the theoretical underpinnings of EFI it will be important to test this assumption using newer methodology for measuring attachment, Emotionally Focused Therapy 259

based on behavior rather than cognitive self-reports. Crowell, Treboux, Cao, and Fyffe (2002) have developed a new methodology for studying adult attachment in romantic relationships using behavioral observation. This is an approach with promise that bears consideration in future studies. In sum, it is clear that developing empirical research strategies with which to assess the theoretical validity and clinical efficacy of any clinical intervention is a challenge to which EFT has risen but certainly not mastered without struggle. lt behooves clinical researchers from all theoretical orienta- tions to rise to this challenge to prevent the narrowing of the profession to those short-term, manualized interventions where empirical inquiry is less complex and far speedier. Adlerian contributions to EFT. ln many ways, Individual Psychology has much to gain frcim the work that EFT clinicians and researchers have achieved. Likewise, there are several assessment and intervention techniques that may seamlessly blend in with EFT (particularly when used with couples), which may answer some of the concerns above. Specifically, these are assessment (lifestyle interview, early recollections), intervention techniques (e.g., the "miracle question," acting "as i('), and theoretical ("psychology of use"). Assessment is not only an important stage in the treatment of couples, but it is an ongoing process as well (Carlson & Sperry 2000). Lifestyle assessments conducted today by Adlerians are not too different from what Adler did 70 years ago (see Appendix A). These assessments can be in-depth or modified to fit a shorter time span, but they essentially give the therapist important data about how each person in the couple found a way to belong in the family-of-origin and get his or her emotional needs met, discover what challenges (real or perceived) with which each had to contend, and assess the overall level of discouragement (Sperry et al., 2006). In addition, lifestyle analyses can provide clinicians with important information related to current functioning. For EFT therapists, this kind of interview technique (or some of the questions) can also be adopted to gather attachment schema data. Using early recollections is another diagnostic tool that helps the Adle- rian therapist to understand the private logic and lifestyle dynamics of the client. Early recollections are discrete earliest memories that the client can recall from when he or she was under the age of 10. lt is a projective technique that is designed to elicit the client's view of himself or herself, others, and the world around him or her. There are several guidelines for collecting the memory: first, the memory must be a single, one-time event' Second, it must have two parts specifically articulated: (a)What was the most vivid part of the memory, and (b) how did the client feel during the recollection. Cen- erally anywhere from three to eight memories are collected (Carlson, Wafts, & Maniacci, 2006). For Adlerians, these recollections are not as much about 260 Paul R. Peluso and Heather Maclntosh

the past as it happened, but what the client feels about the present. The underlying assumption is that the individual chooses particular memories that best reflect their current struggle and that include the client's preferred solution that fits his or her lifestyle. Often, the themes of the recollection serve as "early warning" systems, saying to the client "Hey! Remember the last time this happened, you felt bad. Be on guard!" Another common theme is the "Life is best when . . . ," where the memory expresses the client's "ideal" state of affairs, or how he or she would want things to be. lt is very instructive for the couple to be able to talk about goals, wishes, and dreams and how each of them can help the other fulfill them. Other aspects of the memory that are helpful include the degree of activity of the individual in the memory, who blse is in the memory the gender of the people in the memory and the feelings that are produced by the recollection (see Clark, 2002). Adlerian therapy is not heavily reliant on techniques, but several practitioners (from Adler to the present) have created some useful techniques that have been adopted by practitioners from other approaches. Most notably is The Question (which has been used by solution-focr.rsed therapists as the "miracle question"). The client is prompted to imagine that he or she no longer suffers with the particular symptom or problem and then asked what they could do that they are not able to at present. The client's answer is an indicator of how the particular problem or symptom is being used to avoid the responsibilities of life (hence, the puipose or goal of the behavior). Once the therapist exposes the socially useless purpose of the behavior, a more socially useful alternative is suggested. lf it is adopted by the individual, the symptom can frequently be dismissed by the client (Sperry et al., 2006). Another technique that Adler frequently used was acting ',as if,, (Carlson & Dinkmeyer, 1999). In this technique, clients are asked to target a particular set of behaviors that they wish to change within themselves (e.g., "l want to be more assertive") and then choose someone (real or fictional) who embod- ies this. Then, the client is told that when he or she wants to perform the new behavior, they are supposed to act as if they were that person they are imagining. This is a technique that constructivist theorists have used and expanded upon. Watts and Peluso (2005) further expanded this technique with couples. EFT clinicians can use it to tap into the client's unmet aftachment needs and perhaps produce more lasting self-reported changes to attachment behavior. Lastly, Individual Psychology is a "psychology of use." This was Adler's '1956) (as cited in Ansbacher & Ansbacher, concept that all behavior has a purpose and is used to meet a goal. As a result, the themes or dynamics of an individualt lifestyle are not considered to be "good" or "bad" but ,'useful" or "not useful." Thus, a client's use of behaviors that arise out of his or her particular lifestyle can make things in the relationship go smoothly Emotionally Focused Therapy ?6'l or poorly. Adler was one of the first theorists to recognize the role of stress in the expression of certain behaviors. Specifically, he believed that if the individual were not distressed, the lifestyle dynamics would not be readily apparent (particularly in their negative expressions) and that the individual would either choose more useful behaviors or be more flexible and accom- modating to the needs of others (Ansbacher & Ansbacher; Peluso, 2006). lt is only when the individual is confronted with stressful situations that demand too much of him or her that the lifestyle dynamics can become rigid and problematic (from overuse or underuse). Hence, the goal of therapy is not to change the lifestyle dynamics of the couple per se, but rather to provide insight into these dynamics and have the clients choose more useful expressions of these dynamics when they are under stress. Therefore, focusing the couple on their particular stress level may help to release some of the tension and tendency for destructive behavior. For EFT clinicians, the "psychology of use" may help explain the challenging research findings above. Specifically, attachment style, like lifestyle, may be hard to change. EFT's success, however, may be the result of increas- ing the couple's awareness of the dynamic interplay of their attachment style-related behaviors (particularly when under stress), and creating new, more useful behaviors that are not destructive to the relationship. The couple learns to appreciate how their particular attachment style is beneficial to each person, at some level (hence, a psychology of use), how it shapes their perspective of the relationship and how it can contribute to their difficulties. The couple is then encouraged to recognize when they are stressed, to look at their own behavior-whether it is useful or not useful-and to choose alternative behaviors for gefting their needs met that are more useful. To il- lustrate this further, we present a case study below.

Case Example

Kate and Al were married for 7 years when they came for couples therapy. They dated for about 2 years before getting married. In fact, she states that in the beginning she was in the "power position," as Al pursued her. They both described their courtship as "rocky," fighting over "stupid things," and each person admitted that they had some doubts about getting married. Their presenting problem that they have come for counseling around is "communication issues." Kate stated that while Al is a good provider, he is often demanding of her and becomes withdrawn "when I don't do things perfectly." Al stated that Kate is often "moody" and "flies off the handle" when he tries to suggest a "better way" of doing things. He states that he loves Kate, but that recently he has felt exasperated and embarrassed by Kate's behavior. The final straw came when Kate and Al went away on a vacation. 262 Paul R. Peluso and Heather Maclntosh

They got into a very heated argument in their hotel room over whethel they were ready to have children or not. Hotel personnel had to come to their room to ask if everything was all right because other guests had complained about the shouting. Al flew home three days early from the vacation, and they did not speak to one another for over a week. ln their respective families of origin, Al was an only child, while Kate was the youngest child and only daughter with three siblings. Al's parents are still married, whereas Kate's parents got divorced when she was 7 years old. She described her parent's divorce as "messy" and described the chaos of being whisked away from her home in the middle of the night by her mother, after she had been in a "screaming fight" with her father. lt was revealed later that her father had had an affair with her mother's best friend at the time. She described her relationship with her father as "non-existent" and that she tried to keep a relationship going with him after the divorce, but that she gave up trying in her late teens. She has not spoken to him since before her wedding. She depicted her mother as "clinging" and "whiney," but admitted that she has become closer to her as she has gotten older. Al described his family-of-origin as "peaceful" and "orderly." His father was a relatively successful accountant; and his mother had a part-time job as the school secretary in the elementary school he attended. He portrayed his father as "kind" but aloof and uninvolved in his life and his mother as "cold" and "severe," ruling the household with an "iron fist." He stated that he had had a close relationship with his maternal grandfather who lived nearby, but that his sudden death when Al was 12 was "devastating" to him. ln terms of EFI this couple has ended up in a pursue-withdraw negative interaction cycle where Kate's anxious and insecure att:rchment with Al drives her to pursue him to soothe her anxiety that he will not be there for her and will not provide her with what she needs to feel safe in this relationship. When her primary attachment relationship (with Al) is threatened, she feels anxious to the point of panic and attempts to control the situation (and Al) in order to reduce her anxiery However, she is unable to convince herself that the threat is gone (or nonexistent). Because one cannot disprove a negative (i.e., Al telling her, "l'm not angry with you, I just wish that things weren't so chaotic!"), the scenario becomes a setup for the relationship to fail under the pressure. Without intervention, Kate may continue to pLrrsue Al until he moves into a permanent state of withdrawal and either leaves (thus proving her fear that her attachment relationship was in jeopardy) or, out of frustra- tion, completely withdraws from her entirely sometimes (a fate worse than leaving). Alternatively, Kate may simply tire of her fruitless pursuit and, in exhaustion and hurt, withdraw also, thus leading to the withdraw-withdraw stance that is associated with high levels of couple relationship failure without intervention. Emotionally Focused Therapy 263

Al is a conflict avoider and is confused and hurt by Kate's inability to trust that he is there for her. Their initial ambivalence continues to be ex- perienced as an attachment injury for Kate as Al has never really entered in and this couple has not resolved the impact of their doubts and fighting on the stability of their attachment relationship. This is a difficult couple com- bination that results in a ,classic "pursuer-distancer relationship." lt is easy to see that he has begun to pull away from Kate as her negative interactions toward him escalate. One potentially fatal trap for the couples therapist is that it would be easy to feel sympathy for Al and take his side. EFT therapists typically avoid this mistake by concentrating on the patterns of interaction as elements of the couple's overall attachment styles, which are healthy and adaptive, but become problematic at times. Assessing the cycle of interactions which clearly delineates that each partner's response and behaviors in the dyad are a direct result of their experience of their parther clarifies that there is no one to blame and no one position is "better" or less "pathologi- cal" than the other; a dance is a dance and both partners are intimately tied to the movements of the other. EFT treatment would, of course, take Al and Kate through each of the nine steps of EFT. The Stage One steps are designed to identify and disman- tle the negative interaction cycle. The couple may negotiate and contract around ways to help Kate feel more secure and not judged, while respecting Al's need to feel accepted and understood by her. Once each understands the other's aftachment needs and keeps the conflict around children and other high conflict topics, then first-order change will have been achieved, though not all treatment goals will have been met. Stage Two will require more substantial issues to arise, and one could speculate that Al's potential ambivalence about committing may arise here. It will be important for Kate to soften her stance toward Al and provide some understanding and reassurance. This would be a demonstrable second-order change, as Kate would be able to neSotiate with Al (rather than meekly complying, or becoming rageful at him). For his part, Al would soften toward Kate and see her emotional expressions as a form of communication of her need for connection and security, rather than a childish outburst, which would help "legitimize" her needs in his eyes. Lastly, through the steps of Stage Three, the couple's newly learned ways of interacting and expressing their emotional needs to one another will be crystallized and refined' As mentioned above, Adlerian couples therapy would look at similar information (family constellation, presenting concern, etc.), but would also collect early recollections in order to determine some of the lifestyle themes that were influencing their present conflict. (While an Adlerian therapist would usually collect four to eight early recollections, we present only two per participant here as examples.) 264 Paul R. Peluso and Heather Maclntosh

Kate's early recollections. (a) lt was Christmas morning, and I am 4ryears old. Everyone was around me, and I remember opening a big box and finding the doll house that I had been wanting. Everyone was cheering and I was so happy and excited that I got what I wanted. (b) Mom and I were looking at houses after the divorce (age 7). The houses were dreary and de- pressing. Morn was trying to be positive, but I was not happy. She showed me what was supposed to be my room, and it smelled musty. I yelled, ,,1 want to live in our house, I don't want to move!" Mom started to cry and ran out of the room. I felt bad, but was still so angry. Al's early recollections. (a) | remember I was 5 years old and had a ter- rible toothache. I went to my mother to ask her for help, but she was on the phone. I guess that I was annoying to her because she yelled at me and sent me to my room. I had tears in my eyes because the pain was so bad, but she just told me that I was being a "baby" and that "Big boys don,t cry.,, (b) | am at my grandfather's farm on a vacation, when I was 6 years old. We were riding on a tractot and he was lefting me drive it on his lap. We were riding along, when suddenly I lost control and got too close to a ditch. The tractor got caught in the muddy bank of it and became stuck. I was nervous, but my grandfather laughed and said not to worry, that by the time the ground dried later in the day, we'd be able to get the tractor out. We spent the morning lying on the grass, looking up at the clouds and telling stories. lt is one of my favorite chi ldhood memories. Taking this information, an Adlerian couples therapist would attempt to draw some hypotheses about each person's lifestyle and provide some insight to the couple about what their early recollections have to say about their current conflicts. Katet lifestyle might be summarized by

lf I am not in the middle of things, I am not happy. I need to be included and appreciated. However, when I try to get my way, people get hur! but if I don't try to meet my needs, I get hurt.

As a result, she becomes oversensitive to the perception of being treated unfairly. At the same time, she is uncertain about how to balance being comforting to Al and being treated fairly by him. In terms of his strengths in the relationship, Kate is warm, sensitive, and attending, often doing things for Al that he does not know that he needs. Al's lifestyle might be summarized as

I cannot rely on others to meet my needs, so I must rely on myself. When I try to get others to take care of me, I will only be disappointed.

In terms of his relationships, Al does not understand emotional outbursts, particularly from women, and has difficulty understanding it when people do not see things his way. In terms of his strengths in the relationship, Al is self-reliant, steady, and can comfort Kate when she is upset. What he wishes Emotionally Focused Therapy 265

for is a lack of conflict and for problems not to be blamed on him but to be solved together. An Adlerian couples therapist would start with reflecting these insights to the couple to see how accurate they were (and modify them, if necessary). Once they seem comfortable with the interpretations, then the therapist would help the couple to incorporate these insights into their behavior, choose new methods of relating to work on (homework), and generally seek ways for them to increase their social interest in each other.

Conclusion

The purpose of this paper has been to link the major theoretical tenets of EFT and Individual Psychology in the practice of couples therapy. In many respects, the two theories are similar in many theoretical and practical ways. These areas of convergence and collaboration have been outlined. In addition, each approach, in its uniqueness, has much to offer practitioners of the other. We hope that these additional areas in which each approach can support the other can be further developed and researched to provide practitioners of each approach with better ability to help couples in need.

Note

The authors would like to acknowledge the assistance of Susan Johnson, Ed.D., for her contributions to earlier versions of the manuscript.

References

Alexander, J. F., Holtzworth-Munroe, A., & Jameson, P. (1994). The process and outcome of marital and family therapy: Research review and evaluation. ln A. E. Bergin & S. L. Carfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 595-612). New York: Wiley. Ansbacher, H. 1., & Ansbacher, R. R. (Eds.). (1964). The Individual Psy- chology of Alfred Adler. New York: Harper & Row. Bankart, C. P. (1997). Talking cures: A history of Western and Eastern psy ch oth erapr'es. Pac i f ic Cove, CA : B rooks/Co I e. Baucom, D., Shoham, V., Mueser, K. T., Daiuto, A. D., & Stickle, T. R. (1998). Empirically supported couple and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology, 66,53-BB. 266 Paul R. Peluso and Heather Maclntosh

Bowlby, J. Attachment and loss. Vol. Attachment. London: Hogarth Press. Bowlby, j. (1988). A secure base. NewYork: Basic Books. Carlson, J. (1991). On beyond Adler. lndividual Psychology, 47(2),2-10. Carlson, J., & Dinkmeyer, D. (1999). Couple therapy. In R. E. Watts & J. Carlson (Eds.), Interventions and strategies in counse:ling and psychotherapy (pp. B7-1 00). Philadelphia: Accelerated Ddvelopment. Carlson, J., & Sperry, L. (2000). Adlerian therapy. ln F. M. Dattilio & Bevi lacqua (Eds.), Comp arative treatment for rel ationshi p dysfu nction 1 02-1 15). New York: Springer. Carlson, J., Watts, R. E., & Maniacci, M. (2006). Adlerian therapy:Theory and practice. Washington, DC: American Psychological Association. Clark, A. ). (2002). Early recollections. New York: Brunner-Routledge. Crowell, J., Treboux, D., Cao, Y., & Fyffe, C. (2002). Assessing secure based behavior in adulthood: Development of a measure, links to adult attachment representations and relationship to couples' communications and

reports of relationsh ips. Devel opmental Psychol ogy, 3 8, 67 9-693 . Dandeneau, M., & Johnson, S. M. ('1994). Facilitating intimacy: lnter- ventions and effects. Journal of Marital and Family Therapy, 20, '17-3i. Dessaulf es, A. (1991 ). The treatment of clinical depression in the context of marital distress. Unpublished doctoral dissertation, Clinical Psychology, University of Ottawa. Dinkmeyer, D. C., Jr., & Sperry L. (2000). Counseling and psychotherapy: An integrated, lndividual Psychology approach. (3rd ed.). Englewood Cliffs, NJ: Prentice Hall. Dreikurs, R. (1946). The challenge of marriage. NewYork: Hawthorne. Dreikurs, R. (1967). Psychodynamic psychotherapy and counseling. Chicago: Alfred Adler Institute. Eckstein, D., & Baruth, L. (1996). The theory and practice of lifestyle assessment. New York: Kendall/Hunt. Creenberg, L. S., & Johnson, S. M. (1985). Emotionally focused couples therapy. ln N. S. Jacobson & A. S. Curman (Eds.), Ihe clinical handbook of marital therapy. New York: Cuilford Press. Creenberg, M. T., & Speltz, M. L. (1988). Attachment and the ontogeny of conduct problems. In J. Belsky & T. Nezworski (Eds.), Clinical implica- tions of attachmenf (pp. 177-218). Hillsdale, NJ: Lawrence Erlbaum. Hughes, D. A. (1997). Facilitating developmental attachment. North- vale, NJ: Jason Aronson. Johnson, S. M. (1989). Integrating marital and individual therapy for in- cest survivors: A case study. Psychotherapy, 26,96-103. Johnson, S. M. (1 9961. The practice of emotionally focused marital ther- C reati n g con n ecti o n. N ew York : B ru n ner/Mazel. Emotionally Focused TheraPy 267

Johnson, S. M. (1998). Emotionally focused couples therapy: Straight to the heart. ln J. Donovan (Ed.), Short term couples therapy. New York: Cuilford. Johnson, S. M. (2002) . Emotionally focused couples therapy with trauma survivors: Strengthening aftachment bonds' New York: Cuilford Press. Johnson, S. M. (2003). Couples therapy research: Status and directions. In C. P. Sholevar (Ed.), Textbook of family and couples therapy (pp.797- 814). Alexandria, VA: American Psychiatric Publishing. Johnson, S. M., & Denton, W. (2002). Emotionally focused couple therapy: Creating secure connections. In A. S' Curman & N' S. Jacobson (Eds'), Ctlnicat haidbook of couple therapy (pp. 221-250). New York: Cuilford Press. Johnson, S. M., & Creenberg, L. S. (1995). The emotionally focused approach to problenrs in adult attachment. ln N' S. Jacobson & A. S. Cur- nian (Eds.), Clinicat handbook of couples therapy (pp. 121-141)' New York: Cuilford. (1999). Johnson, S, M., Hunsley, .1., Creenberg, L', & Schindler, D' Emo- tionally focused couples therapy: Status and challenges. Journal of Clinical Psychology-Science & Practice, 6, 67-79. Johnson, S. M., Makinen, J., & Millikin, J. (2001). Attachment injuries in couple relationships: A new perspective on impasses in coriples therapy. Journal of Marital and Family Therapy, 27, 145-1 55' Johnson, S. M., & Talitman, E. (1997). Predictors of success in emotionally focused marital therapy. Journal of Marital and FamilyTherapy, 23, 1 35-1 52. Johnson, S. M., & Whiffen, V. E. (1999)' Made to measure: Adapting emotionally focused couple therapy to partners attachment styles. C/inical Psychology-Science & Practice, 6, 366-381, Jones, J. V., & Lyddon, W. L. (2003)' Adlerian and constructivist psy- chotherapies: A constructivist perspective' In R. E. Watts (Ed'), Adlerian, cognitive and constructivist therapies: An integrative dialogue (pp. 3B-58)' New York: Springer. Kern, R. M. (1988). The lifestyle questionnaire inventory. Unpublished manuscript, Ceorgia State University, Atlanta. Lombardi, D. N., Melchior, E. J., & Murphy, J. G. (1996). The ubiquity of life-style. tndividual Psychology: Journal of Adlerian Theory, Research & Practice, 52(1), 31 -41 . Maclntosh, H., & Whiffen, V. (2005)' 20 years of trauma. Journal of I nterpersonal Violence, 20(4), 488493. Makinen, J. (2005). Resolving attachment iniuries in couples: Relating process to outcome. Unpublished doctoral dissertation, Clinical Psychology, University of Ottawa. 268 Paul R. Peluso and Heather Maclntosh

Mosak, H.H., & Shulman, B. (1988). Lifestyle inventory. Muncie, lN: Accelerated Development. Peluso, P. R. (2001). Measuring lifestyle and attachment An empirical investigation linking individual psychology and attachment theory. Disserta- tion Abstracts lnternational: Section B: The Sciences & Engineering, 62(B-B), 3789. Peluso, P. R. (2006). The lifestyle. ln S. Slavik & J. Carlson (Eds.), Read- ings in the theory of lndividual Psychology. (pp. 294-304). New york: Routledge. Peluso, P. R., Peluso, J. P., Kern, R. M., & White, J. F. (2004). A Com- parison of Attachment Theory and Individual Psychology; A review of the literature. Journal of Counseling & Development, B2(2),139-145. Sims, A. (2000). Working models of attachment: The impact of emotionally focused therapy. Unpublished doctoral dissertation, Clinical psychology, University of Ottawa. Spanier, C. (1976). Measuring dyadic adjustment. Journal of Marriage and the Family, 38,15-28. Sperry L. T. (2003). Commonalities between Adlerian psychotherapy and cognitive therapies: An Adlerian perspective. In R. E. Watts (Ed.), Adlerian, cognitive and constructivist therapies: An integrative dialogue (pp. 59-70). New York: Springer. Sperry 1., Carlson, J., & Peluso, P. R. (2006). Couples therapy: tntegrating theory, research, & practice (2nd ed.). Denver, CO: Love Publishers. Tronick, E.Z. (1989). Emotions and emotional communication in in- f ants. American Psychologi st, 44, 1 1 2-1 1 9. Walker, J. C., Johnson, S. M., Manion, 1., & Cloutier, p. (1996). Emotion- ally focused marital interventions for couples with chronically ill children. Journal of Consulting and Clinical Psychology, 64,1029-1036. Watkins, C. E. (1 997). An Adlerian reaction in the spirit of social interest: Dialogue worth reckoning with. Journal af Cognitive Psychotherapy, l l(3), 211-2't 4. Watts, R. E. (2003). An introduction to the dialogue. In R. E. Watts (Ed.), Adlerian, cognitive and constructivist therapies: An integrative dialogue (pp. t-e). NewYork: Springer. Watts, R. E., & Critelli, J.W. (1997). Roots of contemporary cognitive theories in the individual psychology of Alfred Adler. Journal of Cognitive Psychotherapy 1 1 (3), 1 47 -1 55. Watts, R. E., & Peluso, P. R. (2005). lmaginary team members: A couples counseling perspective. The Family Journal: Counseling and Therapy for Couples and Families, t3(3), 332-335. Watts/ R. E,, & Shulman, B. H. (2003). Integrating Adlerian and constructivist therapies: An Adlerian perspective. In R. E. Watts (Ed.), Adlerian, cognitive and constructivist therapies: An integrative dialogue (pp. 9-37). Emotionally Focused Therapy 269

New York: Springer. Weber, D. A. (2003). A comparison of Individual Psychology and Attach- ment Theory. The Journal of lndividual Psychology, 59(3),246-262.

Aopendix A

Sample Lifestyle Assessment Questions

1. Who is in your family (siblings, etc.)? 2. Describe the nature of your parents' relationship. 3. Choose five words that describe your relationship with your mother as a ch ild. 4. Choose five words that describe your relationship with your father as a child. 5. Which of your parents was your personal favorite? Who were you most like? Mother or father? 6. Which child was your mother's or father's favorite? 7. Did you ever feel rejected as a child? How old were you when you first felt this way? 8. When you misbehaved, who disciplined you? 9. To what extent did you accept, reject, or modify the family motto and other family values? 10. Why do you think that your parents behaved as they did during your childhood? 'l 1. Were there any other significant people in your childhood? 1 2. Did you experience the loss of a parent or close loved one as a child? 13. What were some of your childhood fears or traumas? 14. Were there any changes in your relationship with your parents after childhood? 15. What were your parents' ambitions for the children? 16. What is your relationship with your parent(s) now as an adult? 'l 7. How do you respond now, in terms of feelings, to separations from your children? 18. lf you had three wishes for your child for 20 years from now, what would they be?