Pragmatic Case Studies in Psychotherapy

"The Commitment of a Lifetime": The Role of Emotionally Focused Couple Therapy in Strengthening Attachment Bonds and Improving Relationship Health in Later-Life Couples—The Teletherapy Case of "Alice" and "Steve"

Drew Mendelson — Mon, 22 Jan 2024 00:00:00 -0800

A healthy marriage is a crucial protective factor for adapting to the challenges of late life. Emotionally Focused Couple Therapy (EFCT) is an attachment-based model of psychotherapy that emphasizes here-and-now processing of emotion in a safe holding environment; enhanced understanding of the patterned interactions between self and other; and a non-pathologizing, growth-oriented approach toward couples’ difficulties. This case study examines the benefits of EFCT for addressing issues specific to late life, including existential concerns such as aging, illness, and mortality; caregiving burdens and stress; cumulative relational trauma over the lifespan; and forgiveness and healing from emotional injuries.

The case study involved a 20-session, teletherapy treatment of a couple named "Alice" and "Steve," aged 74 and 75, respectively, with Steve suffering from advanced Parkinson’s Disease. The couple presented with hopelessness and resentment about their caregiving situation, unresolved traumas from early childhood fueling their relationship’s sore spots, and unprocessed grief and fears concerning losses at the end stage of life. The EFCT-guided treatment focused on promoting transformational and corrective experiences of secure attachment bonding. Throughout therapy, Alice and Steve cultivated coherent, positive perspectives of their marriage and related hardships by engaging in reminiscence; embraced their longings for each other by relinquishing their defenses against loss and mourning; and strengthened the legacy of their marriage by exploring their shared values and vision of family life.

At the end of therapy, the clients retrospectively completed several standardized, quantitative measures assessing aspects of emotional and relational health. Their responses evidenced their heightened emotional awareness and acceptance, increased marital adjustment and satisfaction, and improved attachment security over the course of the therapy. This case study highlights EFCT as a potent therapeutic intervention for fostering relationship health in later-life individuals to reduce the public health risks associated with social disconnection and loneliness in the aging population.

Emotionally Focused Couple Therapy with a Late-Life Couple: From Despair to Integrity

Karen Riggs Skean, Elisabeth Brown — Mon, 22 Jan 2024 00:00:00 -0800

This commentary discusses the therapy of "Alice" and "Steve," a late-life married couple using Emotionally Focused Couple Therapy (EFCT) with a special emphasis on navigating Erik Erikson’s final psychosocial stage, that of Integrity vs. Despair. The support and validation offered the couple by a university-based student clinician allowed the couple to rewrite the narrative of their relationship in ways that helped them connect and be present for each other in a time of illness and impending loss. Implications for the benefits of teletherapy for expanding access are discussed.

The Successful Integration of Emotionally Focused Couple Therapy (EFCT) and Multicultural Theory: Drew Mendelson’s Psychotherapy with "Alice" and "Steve"

Shalonda Kelly — Mon, 22 Jan 2024 00:00:00 -0800

In reading Drew Mendelson’s case study, I am inspired and hopeful about the possibilities for our field to address diversity. Although there are many things to admire and discuss about Mendelson’s work, and many implications that it has for clinicians, I am choosing to focus this commentary solely on aspects of diversity, something that Mendelson clearly thinks and cares about, and something that the field is still learning how to integrate into treatment. I will discuss how Mendelson shared his knowledge of the challenges that later-life couples face, recognizing age as an aspect of diversity that needs more attention. Then I will discuss the couple that Mendelson treated and analyze how Mendelson used cultural competence to assess the role of diversity in their lives and to bridge differences between him and the couple and between the two partners. Given that Mendelson used Emotionally Focused Couple Therapy (EFCT) with this case, I will review the aspects of EFCT that appear to be quite useful for working with diverse couples, as well as a set of fatal flaws that hinder the ability of EFCT and other Western treatments to address diversity fully. Based upon those observations, I conclude with the reasons why I believe that Mendelson successfully integrated EFCT and multiculturalism to tailor treatment to the couple, "Alice" and "Steve."

Reflecting on the Themes of Aging, Caregiving, Narrative, and Multiculturalism in the EFCT Case of "Alice" and "Steve"'

Drew Mendelson — Mon, 22 Jan 2024 00:00:00 -0800

In this article, I respond to commentaries by Drs. Karen Skean and Elisabeth Brown (2024), and by Dr. Shalonda Kelly (2024) on my presentation of the case of "Alice" and "Steve" (Mendelson, 2024), a later-life couple I treated using Emotionally Focused Couple Therapy (EFCT). Skean and Brown (2024) meaningfully address the role of EFCT in redefining a relationship narrative within the contexts of caregiving, illness, and loss, drawing from Erik Erikson’s final psychosocial stage of integrity vs. despair and highlighting the benefits of teletherapy for broader access. Kelly (2024) thoughtfully acknowledges both the possibilities and limitations of integrating EFCT and multiculturalism in treating diverse couples, noting areas where the therapist can bridge differences in partners’ worldviews; power; experiences and contexts; and felt sense of distance. In the following response, I reflect on their emotionally and intellectually compelling commentaries and offer feedback to foster discussion on the adaptation of EFCT to work within our clients’ unique generational and cultural frameworks.