Emotionally Focused Couples Therapy with Parents of Children

Emotionally Focused Couples Therapy with Parents of Children on the Autism Spectrum A Research Study DAFT Conference 18 th May 2018 Sarah Mc. Connell, M. A. , LMFT-S, LPC-S, UKCP Registered Psychotherapist

Agenda • • • Autism and how it affects couples Typical Stressors and Typical Problems Our research – Goals and Overview Study I Results Study II Results Research Challenges/Limitations

Autism & Couples

Why did we do the study? Dr William Bolman (ASA's 37 th National Conference on Autism Spectrum Disorders (July 13 -15, 2006) “There were so many demanding issues to deal with that inevitably normal family structure and balance became focused around the needs of the child with autism. Thus, marital relationship time disappeared and with it went the sharing, mutuality, and working out of joint issues that promote marital survival. In the absence of this essential aspect of two people sharing a life and creating a joint future, parents found themselves falling back on traditional role responsibilities. Dads went to work and earned money while moms stayed at home and tried to become experts on autism! The inevitable result was that of growing apart,

“……. sometime around age five to ten years the marital deficits and inadequacy of the traditional roles began to show evidence of strain and even open dissatisfaction. Dads became frustrated at the demands of their wives to “play with” a son or daughter who didn't know how to play, and moms became frustrated at the lack of involvement of their mates. In retrospect, this appears to be the time that the existing intramarital separation starts the couples on a path towards formal separation and divorce. ” Bolman, 2006

Typical Stressors & Problems

Typical Stressors Ramish, 2010 • • • Obtaining a correct diagnosis Problem behaviors (aggressive and violent) Financial hardship Unpredictability about the future Negative reactions from society and family members Frustration (missing “normal” way of life) Spouse is on a different “wavelength” Difficult access to professionals and agencies Depression and anxiety in both partners

Study I: Methodology • A thematic analysis was conducted to identify unique themes linking individual couple reports of relational distress to unique stressors associated with raising a child with an ASD. • Video recordings from the first three sessions of each couple were collected and transcribed • The transcripts were coded by two graduate students not associated with providing treatment • The coders made note of unique recurring themes, patterns, and references that captured the experience of parenting a child with an ASD diagnosis. • These codes were distilled into themes and a list of final themes were identified through coder consensus.

Study I Results 1. The woman often feels alone and responsible for autistic child (medical treatment and care taking) 2. Husband emotionally unavailable 3. Relationship put on shelf - Loss of connection 4. Survival Mode • Diagnosis changed everything - immediacy • Couple relationship defined by autistic child • Exhaustion

Study I Results 5. Wanting a more mature relationship 6. It’s now or never 7. Constant state of anxiety 8. Need to mourn 9. Us against the world - Isolation from everyone - No one would volunteer for this - No one understands what they’re going through - Lack of social support

Brief Overview of EFT

Overview of EFT Authors Dr. Leslie Greenberg Psychologist, York University, Toronto. Mainly EFT w/individuals. Leading process researcher. EFT w/ind. empirically validated. Dr. Susan Johnson Psychologist, University of Ottawa. Student of Les in early 1980’s. Interested in couples therapy and attachment theory. Leading proponent of EFT use with couples. BB

Major Reviews • Empirically Supported Couple Therapy EFT is one of only two empirically supported treatments for couples therapy (Snyder, Castellani, & Whisman, 2005). • Meta-analysis EFT studies demonstrate a 70 – 73% rate of improvement and an effect size of 1. 31 for the four outcome studies composing the EFT meta-analysis (Johnson, 2003). • Robust Approach EFT applied to a variety of treatment conditions: Depression, Post-partum Depression, Chronic Illness, Eating Disorders, Infidelity / Attachment Injuries, Trauma Exposure.

Foundations of EFT Humanistic/Experiential Orientation (Rogers, 1951; Perls, 1973) • Focus on affect, intrapsychic element. Systemic Orientation (Minuchin & Fishman, 1981) • Interpersonal patterns • Enactments Attachment Theory (Bowlby, 1988; Hazan & Shaver, 1987) • Offers a theory of relationship; a theory of “Love” (Karen, 1998)

Goals of EFT: 2 nd Order Change • To expand re-organize key emotional responses–the music of the attachment dance. • To create a shift in partners' interactional positions and initiate new cycles of interaction. • To foster the creation of a secure bond between partners.

Treatment Process Stage 1: Cycle De-escalation (Steps 1 -4) Stage 2: Restructuring Interaction / Accessing Vulnerability (Steps 5 -7) Stage 3: Consolidation of More Secure Patterns. (Steps 8 & 9)

Study II: Goals & Overview

Previous research • EFT with the parents of chronically ill children (Gordon Walker, J. , Johnson, S. , Manion, I. & Cloutier, P. , 1996; Cloutier, P. , Manion, I. G. , Gordon Walker, J. & Johnson, S. (2002) • Parents of chronically ill children are at greater risk of experiencing marital distress • 13 couples with chronically ill children received EFT treatment, post-treatment, 5 month and 2 year follow up. • Significant difference in marital satisfaction between control group and EFT at post tx and 5 month follow up • Significant difference in separation rates between EFT (6% 1 of 16 of treatment group), and control group

Previous Research Ramish, 2010 Addresses the importance of couple therapy to parents of autistic children. • Agreement among researchers that parents of children with autism experience high levels of emotional distress. • No previous research on efficacy of couple therapy specifically for parents of children with ASD • Family therapists can help these couples access and develop resources that provide them with a source of support

Goals of our Research • Decrease couple relationship distress with this population • First stage of integrating EFT for this population of couples • Add to current couples therapy literature in serving specific populations exposed to non-normative stressors • Begin building empirical support for effective couples therapy with this population

Our Pilot Study • 12 sessions of Emotionally Focused Therapy with each couple (75 minutes each) • Conducted by four MFT Student therapists • Live Supervision supplied by Brent Bradley, Ph. D • Phoned Pre-Screener determines eligibility • Six Measurements are administered at Pre, Post, and six month follow-up • Post Session Questionnaire is completed by each partner at the end of each session • Couples are offered a $20/session stipend to help alleviate the costs incurred from participation (i. e. : petrol, babysitting, etc. ) as well as $50 ($25/person) for completing follow-up measurements

Methodology Advertising/Promotion • Schools, Caregiver Support Groups, University, Autism Speaking Engagements (Autism Speaks), word of mouth, etc. Contact through research line or email address Pre-Screener Conversation • 10 questions to determine eligibility • All final approvals made by PI (Brent Bradley) Test Battery Appointment Made • Informed Consent • Pre-test measurements (DAS, MSIS, KSI, ECR-R, RTS, CI) • DAS is the final determinant for eligibility

Methodology 12 Sessions Begin • Post Session Questionnaire administered to each partner at the end of each session Final Session • Includes initial battery of measurements and Post-Therapy Questionnaire Six Month Follow-Up • Includes initial battery of measurements and Post-Therapy Questionnaire

Results

Repeated measures ANOVA • A repeated measures ANOVA was used to examine the effects of EFT treatment on several measures of couple adjustment, attachment, and trust. • A significant treatment effect was found on Dyadic Adjustment hp 2 =. 87, F(1, 6) = 39. 80, p <. 01. • Couples reported higher levels of marital satisfaction at post treatment and this change approached statistical significance hp 2 =. 46, F(1, 6) = 5. 11, p =. 07. • Husbands and wives reported significantly higher levels of marital intimacy hp 2 =. 53, F(1, 6) = 6. 77, p <. 04. • Couples reported significant reductions in attachment insecurity at post treatment hp 2 =. 49, F(1, 6) = 5. 77, p <. 05 with the primary reduction in partner’s ratings of anxious responses hp 2 =. 81, F(1, 6) = 26. 03, p <. 01. • Reductions in ratings of avoidant responses were observed at post treatment but these differences were not significant.

Evaluation Dyadic Adjustment Scale Mean Pre Test Husbands 109 Wives BB Post Test Husbands 116 Wives 121 SD 100. 00 96. 29 Range 8. 76 9. 79 86 - 78 -109 108. 00 5. 89 97 - 112. 71 5. 50 103 -

Dyadic Adjustment Scale Husband 115 113 111 109 107 105 103 101 99 97 95 Wife 113 108 113 109 100 96 Pre Test Post Test hp 2 =. 56, F(2, 5) = 7. 82, p =. 03. 6 Mo. F/UP

Miller Intimacy Scale Husband Wife 145 143 141 140 138 135 130 125 131 126 120 Pre Test Post Test hp 2 =. 35, F(1, 6) = 3. 15, p =. 08. 6 Mo F/Up

Kansas Marital Satisfaction Scale Husband Wife 20 19 18 18 17 16 14 14 12 Pre Test Post Test hp 2 =. 38, F(1, 6) = 3. 68, p =. 06. 6 Mo F/Up

ECR – Anxious Dimension Husband Wife 70 65 60 61 55 50 45 43 40 41 37 35 39 34 30 Pre Test Post Test hp 2 =. 43, F(1, 6) = 4. 57, p =. 07. 6 Mo F/Up

ECR – Avoidant Dimension Husband Wife 70 65 60 59 55 50 45 46 43 40 40 40 35 30 Pre Test Post Test hp 2 =. 17, F(1, 6) = 1. 58, p =. 32. 6 Mo F/Up

Limitations & Future Research • Sample Size – pilot of seven couples • No waitlist control group Future Research • Larger sample size • Test for increased couple satisfaction impact on acting out behaviors of ASD child. • Continue to inform EFT approach to this specific population

Future research needs • Family conflict may increase ASD symptomatology (Kelly et al , 2008) • Very little research has examined the potential effects of family interactions with children of ASD. (Kelly et al, 2008) • Support within the marital relationship has been found to be related to better personal and marital adaptation in families with young developmentally disabled boys (Bristol, Gallagher, & Schopler, 1988) and to life satisfaction among parents of children with autism (Milgram & Atzil, 1988). • Family therapists can help these couples access and develop resources that provide them with a source of support to help them buffer against inherent stresses that come from their responsibility of caring for a child with autism. (Ramish, 2010) • High levels of parental stress are associated with an increased likelihood that the child with ASD will be placed out of the home. (Mancil, Boyd & Bedesem, 2009) • Parenting stress appears to be a much stronger predictor of future child behavior problems than the opposite. (Osborne & Reed, 2009)

Summary • There is a high need for couples therapy with this population • EFT addresses many of the specific needs of couples with Autistic children • More research is needed to address the specific needs of couples facing these kind of stressors • This research is continuing

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