Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies PDF
Preview Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies
EMOTIONALLY 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.
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