Table Of ContentEMOTIONALLY FOCUSED COUPLE
THERAPY WITH TRAUMASURVIVORS
The Guilford Family Therapy Series
Michael P. Nichols,Series Editor
RecentVolumes
EmotionallyFocusedCoupleTherapywithTraumaSurvivors:
StrengtheningAttachmentBonds
SusanM.Johnson
NarrativeMeanstoSoberEnds:TreatingAddictionand
ItsAftermath
JonathanDiamond
CollaborativeTherapywithMulti-StressedFamilies:
FromOldProblemstoNewFutures
WilliamC.Madsen
CoupleTherapyforInfertility
RonnyDiamond,DavidKezur,MimiMeyers,ConstanceN.Scharf,
andMargotWeinshel
Short-TermCoupleTherapy
JamesM.Donovan,Editor
TreatingtheToughAdolescent:AFamily-Based,Step-by-StepGuide
ScottP.Sells
StrengtheningFamilyResilience
FromaWalsh
TheAdolescentinFamilyTherapy:BreakingtheCycle
ofConflictandControl
JosephA.Micucci
WorkingwithFamiliesofthePoor
PatriciaMinuchin,JorgeColapinto,andSalvadorMinuchin
LatinoFamiliesinTherapy:AGuidetoMulticulturalPractice
CeliaJaesFalicov
Emotionally Focused
Couple Therapy with
Trauma Survivors
Strengthening Attachment Bonds
SUSAN M. JOHNSON
THE GUILFORD PRESS
New York London
© 2002 Susan M. Johnson
Published by The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
www.guilford.com
Paperback edition 2005
All rights reserved
No part of this book may be reproduced, translated, stored in
a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, microfilming, recording,
or otherwise, without written permission from the Publisher.
Printed in the United States of America
This book is printed on acid-free paper.
Last digit is print number: 9 8 7 6 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Johnson, Susan M.
Emotionally focused couple therapy with trauma survivors :
strengthening attachment bonds / Susan M. Johnson.
p. cm. — (The Guilford family therapy series)
Includes bibliographical references and index.
ISBN 1-57230-735-8 (hc.) ISBN 1-59385-165-0 (pbk.)
1. Marital psychotherapy. 2. Attachment behavior. 3. Psychic
trauma—Patients—Family relationships. I. Title. II. Series.
RC488.5 .J589 2002
616.89′156—dc21 2001056916
To all the couples who, as John Bowlby put it many years
ago, have worked so hard to educate me—especially to
those who, having seen the worst in their fellow human
beings, still hope and struggle to trust and connect.
About the Author
Susan M. Johnson has a doctorate in counseling psychology and is a
registered psychologist in the city of Ottawa, Canada. She is one of the
originatorsandthemainproponentofemotionallyfocusedcouplether-
apy. This approach, which is also used with families, integrates exper-
iental and systemic perspectives and has been extensively empirically
validated. Dr. Johnson is Professor of Psychology at the University of
Ottawa and Director of the Ottawa Couple and Family Institute. She is
also Research Professor in the Marital and Family Therapy Program at
Alliant International University in San Diego, California. In 2000, she
received the American Association for Marriage and Family Therapy
Outstanding Contribution to the Field Award. She is a well-known
internationalpresenteroncoupletherapy,adultattachment,emotionin
psychotherapy,andworkingwithtraumatizedcouples.(Note:Formore
information on emotionally focused couple therapy on the Internet, go
to www.eft.ca.)
vi
PPrreeffaaccee
Preface
T
he field of couple therapy is entering a new era. No beginning
couple therapist now has to walk into his or her first session without a
sense of what the significant landmarks are in the vast and confusing
landscape of relationship distress. Research tells us, for example, that
the inability to offer comfort or stay emotionally engaged is at least as
important as, if not more important than, how many times a couple
fights or whether they resolve their arguments. The beginning couple
therapist now also has a theory of love and relatedness to draw on in
the form of attachment theory. It can be argued that before this theory
was applied to adult relationships, the therapist had very sparse re-
sourcesintermsofatheoryofadultlovetoguidegoalsettingandinter-
vention.Attachmenttheoryoffersthetherapistamapoftheterritoryof
adult love relationships. We also have models of intervention that have
been specified and tested.
ThisisaverydifferentfieldfromtheoneIentered20yearsago.As
it becomes clear that the quality of our attachment relationships has an
enormousimpactonoureverydaylives,ourphysicalandmentalhealth,
and how we see ourselves, it makes sense that couple interventions are
beginning to address issues that used to be the exclusive territory of the
individual therapist—issues such as depression and, as presented in this
text, disorders of posttraumatic stress.
The ultimate message of systems theory is that an individual’s ad-
justment problems are best seen and understood in the context of that
individual’s interactions with others, especially in the context of his or
her patterns of interaction with family and loved ones. This book is
vii
viii Preface
completely consistent with this systemic tradition and focuses on the
power of close relationships not only to ignite or maintain such adjust-
ment problems, but also to heal them. John Bowlby, the father of at-
tachment theory, believed that the development of love was the crown-
ing achievement of human evolution. It is also, if expressed and
accepted, the logical antidote to the helplessness and sense of isolation
and betrayal that are the essence of so many traumatic experiences.
However,ifyouhadaskedmeafewyearsagowhethercouplether-
apy could really make a difference to the partners in a distressed rela-
tionship in which one partner was struggling with posttraumatic stress
disorder, particularly when this disorder was complex and chronic, I
probablywouldhaveexpresseddoubt.Iwouldhavefeltdauntedbythe
scale and complexity of the task. The traumatized couples with whom
my colleagues and I worked in the marital and family clinic of the Ot-
tawa Civic Hospital changed my mind. Trauma survivors showed me
that they were more than willing, even if they had been terribly
woundedbysignificantothers,tofighttheirfearsandtostruggletocre-
ateanewkindofconnectionwiththeirpresentpartners.Thesepartners
also showed me that they were capable of more generous and compas-
sionate understanding and care than I had imagined possible. More-
over, a new sense of felt security in this couple relationship seemed to
open a direct route to individual healing for the survivor.
At the same time my client couples were educating me, the trauma
literaturebegantofocusevermoreonthepowerofemotionalbondsto
significant others to soothe anxiety and create resilience. But this focus
on the role of such bonds did not seem to extend to the area of clinical
intervention, except perhaps in the context of the therapeutic relation-
shipbetweenanindividualtherapistandhisorherclient.Thisbookin-
tegrates the recent work on adult attachment, the recent links between
attachmentandhealingdelineatedinthetraumaliterature,ourevolving
understanding of the nature of traumatic stress, and clinical interven-
tions in couple therapy.
After an introductory chapter, the first half of the book offers a
brief review of the nature of trauma, the nature of attachment, and the
relevance of an attachment perspective for trauma survivors and their
partners. Chapter 4 addresses assessment issues with traumatized cou-
ples. Chapter 5 outlines interventions across different stages of treat-
mentwithcouplesfacingtrauma.Thesestagesare,first,thecreationof
stability and de-escalation of trauma symptoms and relationship dis-
tress; second, the restructuring of interactions so as to create the secure
bonding that fosters individual and relationship healing; and, finally,
Preface ix
the integration of these changes into the life of the couple and each
partner’s engagement with the effects of trauma. (Note: The general
web site for emotionally focused couple therapy is www.eft.ca.)
The second half of the book consists largely of clinical case studies
of couple therapy with couples facing particular traumas. These cases
include couples who are fighting for their relationships while dealing
with the aftermath of trauma arising from combat, the trauma of men-
tal illness and physical illness, and violence and sexual abuse in previ-
ous relationships. There is also a chapter on what my colleagues and I
call attachment injuries or relationship traumas. These injuries involve
incidents in which a partner’s lack of responsiveness at a time of ex-
treme need was in itself traumatic and defined an attachment relation-
ship as unsafe, so that it could not provide a haven in times of stress.
These relationship traumas also create impasses in the creation of more
secure bonds in couple therapy. The final chapter considers the role of
the therapist and the challenge and promise of working with couples
facing trauma.
Iwouldliketothankmycolleagueswhoworkedonmyteamatthe
Civic Hospital and at the Ottawa Couple and Family Institute for their
support, enthusiasm, and creativity. I would also like to thank my stu-
dents at the University of Ottawa, Department of Psychology, for con-
stantly asking questions and bringing me clinical dilemmas, then help-
ing me find the answers to those dilemmas. Thanks also to the editors
at The Guilford Press, Jim Nageotte and Mike Nichols, for their
support. I am particularly grateful to my friend and colleague Lyn
Williams Keeler, MA, who was the primary author of Chapter 9 of this
book and was the therapist in the case. Lyn specializes in the treatment
of combat posttraumatic stress disorder and has a wealth of experience
in working with veterans. She presents regularly at the conferences of
the International Society for Traumatic Stress Studies. I must also say
that without the loving support and constant help and encouragement
of my husband, John Palmer Douglas, writing this book would not
have been possible. Most of all, however, this book is written as a trib-
ute to my clients, who constantly humble and amaze me with their
courage and strength and who constantly teach me, not just about how
weshapeourmostimportantrelationships,butaboutwhatitmeansto
be human. Throughout the book I refer to the helplessness and terror
thatsurvivorsoftraumafaceeverydayas“thedragon”—anarchetypal
imageofhumankind’sdeepestfearsandareminderthatweallhavepo-
tential to be heroes and to face those fears.
