The role of attachment in a time-limited marital therapy: Implications for practice and treatment

Abstract

The present study investigates the role of attachment in a time-limited marital therapy. The study explores Brief Contextual Modular Psychotherapy (BCMT). This approach to practice provides a model that integrates principles and techniques from the major psychotherapies. BCMT can be distinguished from other brief therapies by its theoretical integration, its six-session time limit, its specific clinical focus, and its techniques for dealing with dissatisfaction and distress. The therapy sets out practice modules—six-session treatment plans—for a diverse range of presenting issues such as the anxiety disorders, depression, trauma, loss and grief, marriage and the phobias. BCMT emphasises the collaboration of the therapist and the client. A community-based psychological counselling centre has practised BCMT for over ten years, applying it in cases of wide diversity and maladjustment. Prior to this research, a comprehensive analysis of the theory underlying the BCMT model or the theory of change it endorses had not been carried out. The study provides a detailed description of the conceptual and treatment elements of the marital module developed in the treatment manual for BCMT. The study explores how the construct of attachment provides an organising framework or metaperspective for theory construction and therapeutic intervention in the clinical application of this time-limited marital therapy. To achieve this objective, one de-facto and four married couples participated in the time-limited therapy. They completed a questionnaire on adult attachment and also a self-report questionnaire to assess the effectiveness of the therapy. Narrative analysis was used to assess the praxis or the experience of participating in the therapy. The results show that the integrated model provided a treatment method for differing expressions of marital disturbance and psychopathology.;Three of the five couples and eight of the ten participants reported positive treatment outcomes. The research sample included the paraphilias, a major depressive episode with postpartum psychosis, the narcissistic borderline syndrome and childhood sexual abuse. The study supports the association between the role of adult attachment styles and intrapsychic responses in conflicted intimate relationships. From the point of view of clinical applications of attachment theory, the research highlights how theoretical ideas can be integrated, specific clinical methods can be incorporated and certain treatment perspectives can be derived from one another. Several implications for the treatment process flow from this integration. The integration of attachment theory in BCMT demonstrates how the therapeutic process progressed through three separate yet interrelated stages: past, present and future. In addition, it led to the identification of three stage-related mourning processes associated with the time-limited therapeutic process: protest, despair and detachment. From a clinical perspective, the research finds that the theoretical and treatment model does not need to be restricted to marital therapy. The findings suggest that the integrated model could be applied across a wide range of presenting issues. By defining the theory of personality and psychopathology and the therapeutic change processes associated with it, the integration of attachment theory results in BCMT taking its place in the literature as a theory of psychotherapy.