The Attachment Injury Resolution Model in Emotionally Focused Couple Therapy: A Psychotherapy Process Study of In-Session Client Performances and Therapist Behaviours

Attachment injuries occur as a result of aversive interpersonal events in which a partner is betrayed, or abandoned during a critical moment of need for support and care, and as such, relational trust is seriously violated (Johnson, Makinen, & Millikin, 2001). The incident creates long-lasting emotional injuries and ruptures the couple's attachment bond. An indelible imprint is left on the relationship when the incident becomes a marker for the other's dependability and trustworthiness. An injured partner's recollection of the injurious incident often triggers a traumatic reaction in-session (Johnson et al., 2001). Within Emotionally Focused Couple therapy (EFT), such injuries are often the cause of therapeutic impasses, moments in which the therapeutic process is halted (Johnson et al., 2001; Millikin, 2000). The Attachment Injury Resolution Model (AIRM) has been developed to specifically address these impasses. The clinical process of repair within the AIRM is also akin to a forgiveness and reconciliation process in couple therapy. The articles in this dissertation contribute to both theoretical and empirical knowledge about how clients change as they resolve an injury and therapist behaviors that facilitate this change process. In the first article, which is theoretical in nature, attachment theory is used to shed light on the nature of partner's emotional responses post-injury, and the process of relational repair and renewal in the aftermath of an injury. The forgiveness and reconciliation process is placed within the context of attachment. Healing attachment injuries involves emotionally processing the deep hurts, fears, anger and sadness related to the rupture of an attachment bond. Restoring emotional accessibility and responsiveness to these emotional expressions is viewed as crucial to the forgiveness and reconciliation process. This process facilitates the renewal of an emotional connection and restores relational trust in the aftermath of the injury. This article also builds upon previous scholarly efforts by placing the AIRM within the context of the theory of change in EFT, which includes a synthesis of experiential, systemic, and attachment theory (Johnson, 2004). EFT clinical theory provides a systematic framework to explain how couple clients change as they resolve an attachment injury. Unprocessed emotion responses related to an injurious incident evolve into rigid, emotional signals and negative interaction patterns that block emotional engagement related to the injury. Partners engage in a predictable and constricted manner of emotional processing when caught in an injury-specific negative interaction cycle (i.e., pursue-withdraw). An injury-specific cycle may emerge as a consequence of the injury or reinforce a pre-existing negative, rigid interaction cycle in the relationship and contribute to attachment insecurity. Emotional engagement related to the injury is thus impeded (Johnson, 2004). Client change involves shifts in emotional processing of the injurious incident. In terms of the client change process, the first four stages of the AIRM involve a de-escalation of an injury-specific cycle. Injured partners are supported to unpack secondary emotion responses (i.e., anger, hostility, feelings of betrayal) and de-escalate negative interaction cycles to potentially access and explore deeper, more primary emotions (i.e., fears of abandonment, loss, sadness) related to the rupture of the bond caused by the injury. Client change leading to attachment injury resolution is captured in subsequent steps in an injury-specific softening event. The injured partner increasingly risks more vulnerable emotion and need expression to an increasingly accessible and responsive withdrawn partner. Reparation of the ruptured bond requires that the offending partner be emotionally accessible and responsive to these primary emotional experiences and attachment needs related to the injury (Johnson et al., 2001). The offending partner's responsiveness serves as a traumatic antidote, and marks the completion of a new bonding event in the relationship, which promotes greater relational trust. Article 2 presents empirical findings from a psychotherapy process study of the AIRM. A task analytic research methodology (Greenberg, 1991) has guided numerous research studies in both the development (Millikin, 2000) and empirical substantiation of the AIRM in both process (Makinen & Johnson, 2006; Naaman, Pappas, Makinen, Zuccarini & Johnson, 2005) and outcome research studies (Makinen & Johnson, 2006). According to this methodological framework for clinical model development (Greenberg, 1991), ongoing empirical investigations of the AIRM was warranted. Three research objectives were identified for the study found in Article 2. The first objective was to enrich previous knowledge about the client change process by enriching empirical description of the client change process. The second objective of this study was to validate the AIRM. The third objective of this study was to identify therapist behaviors associated with client performance tasks at each stage of the model. (Abstract shortened by UMI.