A COMMUNICATION SKILLS TRAINING COMPONENT IN AN EMOTIONALLY FOCUSED COUPLES THERAPY by PAUL S. JAMES B.A., McMaster University, 1975 M.Div., Vancouver School of Theology, 1982 M.A., The University of British Columbia, 1984 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF EDUCATION in THE FACULTY OF GRADUATE STUDIES Department of Counselling Psychology We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA April 1989 © Paul S. James, 1989 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or .her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of do IAVI 3-0 \\C v\a - Vjy <^V> o \ o 0 \ The University of British Columbia Vancouver, Canada Date 0 u. 1 y DE-6 (2/88) ABSTRACT The purpose of this constructive outcome study was two-fold: first, to investigate the effectiveness of two treatments, an Emotionally Focused couples therapy (EFT) and an Emotionally Focused therapy plus a communication skills training component (EFT+CT), compared to a wait-list control group; second, to investigate whether or not the addition of a communication skills training component (CT) would enhance the effectiveness of an Emotionally Focused couples therapy (EFT). Forty-two moderately distressed volunteer couples were assigned randomly to one of two treatment conditions or to a wait-list control group. Couples in the EFT condition received 12 one-hour sessions; couples in the EFT+CT condition received eight hours of EFT and four hours of CT. Treatments were administered by 14 therapists, seven of whom were nested in each condition by random assignment. Ratings of therapists' interventions confirmed the treatment integrity of EFT in both treatment conditions and the treatment integrity of the CT component in the EFT + CT condition. Tests of equivalence showed that both treatment conditions were equivalent on pre-test levels of the dependent variables, demographic variables, therapist characteristics, and the quality of couples' working alliance with their therapists. The first hypothesis was supported for certain outcomes but not for all. Both treatments achieved superior gains at post-test compared to the wait-list control group on a global measure of marital adjustment and a measure of target complaint improvement. The EFT+CT group also achieved superior gains at post-test on a measure of communication compared to the wait-list control. Although there were trends toward both treatments achieving superior gains on ii measures of intimacy and passionate love at post-test compared to the wait-list control, these measures failed to reach significance. Results indicated that the second hypothesis was not supported. There were no significant differences between EFT and EFT + CT at the post-test or four-month follow-up on a summary measure of marital adjustment or its four components (i.e., consensus, affectional expression, cohesion, satisfaction), nor on measures of communication, intimacy, and passionate love. The only significant difference was that the EFT condition maintained its gains in target complaint improvement at the four-month follow-up more effectively than the EFT+CT condition did. iii TABLE OF CONTENTS Abstract ii Table of Contents iv List of Tables viii List of Figures x Acknowledgements xi Chapter I: Introduction 1 Background of the problem 1 The problem 3 Purpose of the study 7 Chapter II: Literature Review 9 Emotionally Focused couples therapy (EFT) 9 Description of EFT 9 Treatment steps 22 Effectiveness of EFT 25 Relationship enhancement (RE) communication skill training 27 Background 27 Description of RE 31 Effectiveness of RE 41 Communication training (CT) component 50 Construction of an EFT-Compatible CT component 51 Sequencing of the CT component 52 Duration of the CT component 54 Complementarity of EFT and the CT component 56 Description of the CT component 57 Conceptual hypotheses 59 Chapter III: Methodology Of The Study 61 Design of the study 61 Subjects 62 Treatments 64 Therapists 66 Implementation checks of treatment integrity 68 Instruments 73 Outcome instruments 73 Therapy Process Variables 79 Subject Variables 81 Other measurement procedures 81 Administration of outcome measures 82 Operational hypotheses 82 Data analysis procedures 83 Preliminary analysis 83 Analysis of treatment effects 85 iv Analysis of descriptive data 88 Clinical significance of treatment effects 88 Structured interview 92 Chapter IV: Results and Data Analysis 93 Results of preliminary analyses 93 Testing assumptions of group equivalence 93 Testing the integrity of treatments: Implementation checks 95 Results of analyses of treatment effects 96 Analyses with the couple as the unit of analysis 96 Analysis 1A: Comparison of EFT vs. Control and EFT + CT vs. Control at pre-test and post-test on the Dyadic Adjustment Scale (DAS) (total score), Communication Scale (CS), Psychosocial Intimacy Questionnaire (PIQ), and Passionate Love Scale (PLS) 97 Analysis IB: Comparison of EFT vs. Control and EFT + CT vs. Control at post-test on Target Complaints (TC) 100 Analysis 2A: Comparison of EFT vs. EFT + CT at pre-test, post-test, and follow-up on the Dyadic Adjustment Scale (DAS) (total score), Communication Scale (CS), Psychosocial Intimacy Questionnaire (PIQ), and Passionate Love Scale (PLS) 101 Analysis 2B: Comparison of EFT vs. EFT + CT at pre-test, eight weeks, post-test, and follow-up on the Dyadic Adjustment Scale (DAS) subscales (DAS-Consensus, DAS-Affectional Expression, DAS-Cohesion, DAS-Satisfaction) 102 Analysis 2C: Comparison of EFT vs. EFT + CT at post-test and follow-up on Target Complaints (TC) 103 Summary of analyses with the couple as the unit of analysis 105 Analyses with the individual as the unit of analysis 107 Analysis 2A: Comparison of EFT vs. EFT + CT at pre-test, post-test, and follow-up on the Dyadic Adjustment Scale (DAS) (total score), Communication Scale (CS), Psychosocial Intimacy Questionnaire (PIQ), and Passionate Love Scale (PLS) with the individual as the unit of analysis 107 Analysis 2B: Comparison of EFT vs. EFT+CT at pre-test, eight weeks, post-test, and follow-up on the Dyadic Adjustment Scale (DAS) subscales (DAS-Consensus, DAS-Affectional Expression, DAS-Cohesion, DAS-Satisfaction) with the individual as the unit of analysis 109 Analysis 2C: Comparison of EFT vs. EFT+CT at post-test and follow-up on Target Complaints (TC) with the individual as the unit of analysis 109 Summary of analyses with the individual as the unit of analysis . Ill Results of analyses of descriptive data 112 Clinical significance of treatment effects 112 Percentages of couples improved and no longer distressed 113 Percentages of couples deteriorated 114 Structured interview 116 Part A: Clients' reactions in EFT and EFT + CT to1 the EFT treatment 116 Part P>: Clients' reactions in EFT+CT to the CT component . 117 Chapter V: Discussion of Results 120 First research hypothesis: Effectiveness of both treatments compared to the wait-list control 120 Second research hypothesis: Differential effectiveness of EFT compared to EFT+CT 123 Effectiveness of this study as a replication of EFT 129 Additional considerations in evaluating treatment 133 Limitations of the study 136 Generalization of the study 138 Conclusion 140 Future research 141 References 144 Appendix A 157 Emotionally focused couples therapy manual (EFT) 158 Emotionally focused treatment framework 159 Session one: Assessment 160 Steps of treatment 162 Termination session 172 Operational definitions 172 Therapist intervention of evocative responding 174 Communication training (CT) component manual 178 Introduction to the CT component 179 Session one of the CT component 181 Session two of the CT component 188 Session three of the CT component 192 Session four of the CT component 194 Therapist activities 196 Audio tape demonstration of CT communication skills 215 Practice home session report (Guerney, 1977) 219 Communication Training Manual For Couples 220 Skill of expression 221 Skill of empathic responding 227 Mode switching 241 Maintaining your communication skills 242 Appendix B 244 EFT Implementation Checklist 245 Part A: EFT interventions (Johnson, 1984) 245 Part B: nonEFT interventions 248 Cognitive-Behavioral interventions 248 Integrated Systemic interventions 249 Communication training interventions 251 CT component Implementation Checklist (Guerney, 1977) 261 Part A: CT interventions 261 vi Part B: nonCT interventions 272 Standardized follow-up procedure (Johnson, 1984) 277 Post-treatment structured interview 278 Appendix C 281 ANOVA tables of demographic and therapist variables 281 ANOVA tables of Couples Alliance Scale 283 Tables of means and standard deviations of dependent measures 285 vii LIST OF TABLES Table 1: Summary MANOVA of Analysis 1A: EFT vs. Control and EFT+CT vs. Control at Pre-Test and Post-Test on the Dyadic Adjustment Scale (DAS) (Total Score), Communication Scale (CS), Psychosocial Intimacy Questionnaire (PIQ), and Passionate Love Scale (PLS) 97 • Table 2: Summary ANOVA of Analysis 1A: EFT vs. Control and EFT+CT vs. Control at Pre-Test and Post-Test on the Dyadic Adjustment Scale (DAS) (Total Score), Communication Scale (CS), Psychosocial Intimacy Questionnaire (PIQ), and Passionate Love Scale (PLS) 98 Table 3: Summary of Planned Nonorthogonal Contrasts of Analysis 1A: EFT vs. Control and EFT+CT vs. Control at Post-Test on the Dyadic Adjustment Scale (DAS) (total score) and Communication Scale (CS) 99 Table 4: Summary ANOVA of Analysis IB: EFT vs. Control and EFT + CT vs. Control at Post-Test on Target Complaints (TC) 100 Table 5: Summary of Planned Nonorthogonal Contrasts of Analysis IB: EFT vs. Control and EFT + CT vs. Control at Post-Test on Target Complaints (TC) 100 Table 6: Summary MANOVA of Analysis 2A: EFT vs.