feminist/emotionally focused therapy practice model: An integrated approach for couple therapy, The
Emotionally focused therapy (EFT) is a well-developed, empirically tested practice model for couple therapy that integrates systems, experiential, and attachment theories. Feminist family therapy theory has provided a critique of biased assumptions about gender at play in traditional family therapy practice and the historical absence of discussions of power in family therapy theory. This article presents an integrated feminist/EFT practice model for use in couple therapy, using a case from practice to illustrate key concepts. Broadly, the integrated model addresses gender roles and individual emotional experience using a systemic framework for understanding couple interaction. The model provides practitioners with a sophisticated, comprehensive, and relevant practice approach for working with the issues and challenges emerging for contemporary heterosexual couples.
The trend toward integrative approaches in couple and family therapy has virtually taken over the field (Lebow, 1997). A flexible approach that integrates a feminist understanding of gender, a systemic understanding of couple interaction, and attention to the emotions of each partner is timely. Therapists have been increasingly challenged to assist contemporary couples in their struggles with both traditional gender learning and feminist ideals about the behavior of women and men in intimate relationships. Emotionally focused therapy (EFT) introduces systemic and emotional perspectives as they relate to a couple’s presenting problems (Greenberg & Johnson, 1988; Johnson, 1996). Feminist family therapy theory has exposed the ways in which individual couple problems are often disguised problems of gender and power constructed by society (Beecher, 1986; Goldner, 1985a, 1985b; Hare-Mustin, 1986, 1991). An integrated feminist/EFT model provides a comprehensive, flexible framework that takes into account individual emotional experience, the relationship system, and sociocultural gender learning. Further, the integrated model recognizes and utilizes the interconnectedness of these multiple levels in therapy with couples.
RATIONALE FOR INTEGRATION
EFT is a hospitable host for the infusion of feminist family therapy principles. It is a well-developed, clinically and empirically tested practice model with one of the best research bases in the family therapy literature (Greenberg, Ford, Alden, & Johnson, 1993; James, 1991; Johnson & Greenberg, 1985, 1988; Johnson & Talitman, 1997). Emotionally focused therapy is helpful for couples that are moderately distressed and exhibit the classic pattern of male withdrawn/female pursuing and in which no violence is currently taking place (Johnson & Talisman, 1997). It is already an integrated model, incorporating two broad and significantly different schools of therapy theory. The first, experiential therapy, is concerned with each individual’s emotional and intrapsychic realities and the ways in which he or she gives meaning to that experience. Drawing on attachment theory, EFT conceptualizes partners’ needs and strong emotional responses as normal, healthy, and adaptive and not as a result of personality deficiencies or other pathology (Greenberg & Johnson, 1988; Johnson, 1996).
The second major theoretical tradition on which EFT is based is a systems theory conceptualization of entrenched interactional patterns occurring between partners. The systemic perspective in EFT is somewhat modified insofar as systemic patterns are seen as both resulting in and being created and perpetuated by the powerful emotional experiences of each partner. Thus, negative interactional patterns create an emotional response in each partner, which in turn compels the partner to respond in a negative way, thereby recreating and reinforcing the negative pattern (Greenberg & Johnson, 1988; Johnson, 1996). Emotionally focused therapy’s theoretical bases and resulting principles of practice have been developed into a nine-step practice model (Greenberg & Johnson, 1988; Johnson, 1996; Johnson & Greenberg, 1995).
Emotionally focused therapy avoids many of the practices for which feminist thinkers have criticized traditional, systemic family therapy theorists and practitioners. Indeed, EFT is an inherently feminist approach in several respects. First, EFT’s utilization of attachment theory and resulting understanding that it is healthy to seek connection in intimate relationships resonates strongly with feminist self-in-relation work (Jordan, Kaplan, Miller, Stiver, & Surrey, 1991; Miller, 1997). In this way EFT assumes women’s traditional ways of relating are healthy and normative. Second, as EFT calls for an expanded repertoire of experiences and behaviors for both men and women, the model has the ability to challenge and expand traditional, restricted, and polarized gendered behaviors and heal some of the damage inherent in traditional gender socialization (Gilligan, 1982; Pipher, 1994; Pollack, 1998; Real, 1995). Finally, in its incorporation of emotion and individual experience, EFT avoids pathologizing women’s ways of being in relationships. It fills in the gap inherent in pure systemic approaches frequently criticized by feminist theorists in which the individual is conceptualized as simply one component of the system with no agency of his or her own.
Through its use of attachment theory, EFT posits that the desire for and seeking out of intimacy and interdependence with another is a basic, normal, and healthy human need. Healthy attachment to the partner fosters continued adult development, while behavior on the part of one partner that threatens the attachment will produce reactions in the other in an attempt to reestablish connection. Angry blaming is viewed as an attempt to reestablish closeness (although it typically has the opposite effect), whereas withdrawal is seen as an attempt to avoid unpleasant exchanges, thereby containing interaction and maintaining couple stability (Johnson, 1996). These negative couple behaviors have historically been conceptualized as pathological within systems frameworks. (In particular, women’s behaviors of pursuing and angry complaining have been viewed as more problematic than men’s withdrawal.) In the integrated model, these behaviors are conceptualized as adaptive rather than dysfunctional intentions on the part of each partner, providing a different framework that fundamentally alters how we understand and intervene with couples manifesting this classic pattern.
Relational feminists have been critical of traditional psychological theory, which promotes separation, individuation, and autonomy as the milestones for normal human development. These writers point out that such characteristics are male norms against which women have been judged and found to be pathological, immature, and dependent. The Stone Center feminists and other feminist developmental theorists argue that women follow a different but still normal and healthy developmental path, one that is characterized by interdependency, connection, and mutuality in intimate relationships (Gilligan, 1982; Miller, 1976, 1997; Surrey, 1991). It is interesting that EFT implicitly appears to take this argument one step further by arguing that both men and women possess a strong, inherent drive to be connected and experience interdependence with intimate others. This is a feminist belief indeed, rejecting as it does the historical prizing of men’s ways of relating and positing that closeness, caring, and the open expression of vulnerabilities are healthy ways of relating in intimate relationships, while separation and excessive independence, distance, and autonomy may be inherently threatening. Thus, EFT privileges women’s traditional ways of relating as healthy and normal and encourages men in therapy to learn to relate in this traditionally more feminine way.
Furthermore, EFTs’ interventions in restructuring a couple’s interactions and facilitating new emotional experiences give therapists the tools to help break the cycle of limited, gendered relating. While men may learn to explore their vulnerabilities and express their emotions for the first time, women (while they too may express vulnerabilities) can learn to clarify and ask for what they want or need from a partner. Notably, a woman’s issues with power inequities in the relationship can be taken up effectively through EFT interventions. The therapist can throw his or her weight behind a woman’s anger or feelings of being “one– down” in the relationship through heightening or rephrasing, to use two examples of EFT techniques. In this way taboo, gender-based marital issues are put on the table. The feminist/EFT model makes gender visible and, therefore, changeable for couples. This will be demonstrated in the application of the model to the case example below.
Feminist and EFT approaches both emphasize naming the heretofore unnamed: EFT focuses on accessing, naming, and putting out for examination the shameful, painful feelings of each partner; feminist approaches advocate naming gender and power issues in the relationship. Both involve different kinds of consciousness raising, of bringing into clients’ awareness disowned parts of the self, whether emotional and/or based on gender learning.
Emotionally focused therapy has filled a gap in the marital therapy field. Its components challenge the traditional “objectivity” that has permeated the male-dominated field of family therapy, first in systemic approaches and, more recently, in the cognitive and behavioral schools of thought (Greenberg & Johnson, 1988). In incorporating an emotional/experiential component, it also answers the feminist critique that a huge, rich expanse of human experience and meaning is overlooked by systems theory. Feminist criticism has focused on the absence of a language of attachment and intimacy so familiar to women (Bograd, 1988) and on the obliteration or pathologizing of women’s voices and experiences. Emotionally focused therapy provides a language for articulating emotional experience and the desire for attachment. It shifts the focus of the “problem” from overattachment, enmeshment, or fusion on the part of women in the traditional therapy literature to that of disconnection between partners and resulting threats to attachment. This is a radical shift, and one consistent with feminist practice principles.
As EFT offers tools for examining and changing gender learning, a feminist perspective effectively transforms and broadens EFT. Notably, a feminist perspective exposes the ways in which systemic, interactional patterns between men and women in intimate relationships are created and perpetuated on the basis of gender (Goldner, 1985a; Hare-Mustin, 1994). Feminist developmental research has shown that individual emotional experience is influenced, even constructed, by the ways in which we learn and live in the world as a man or as a woman (Chodorow, 1978; Gilligan, 1982; Surrey, 1991). Thus, the feminist/EFT practitioner is able to take account of gender in assessing and intervening with interactional patterns, emotions, and behaviors as they are played out in the distressed relationship.
Where feminist approaches and EFT differ is around an analysis of gender. Despite its resonance with feminist principles, EFT remains a decontextualized approach, examining as it does the individual and the couple relationship as entities disconnected from the larger culture. Emotionally focused therapy is missing a theory of how and why women and men come to relate and respond in certain ways, a theory that is essential when working with individuals relating within a social institution-marriage-with such powerful, gendered social prescriptions. The feminist family therapy literature has demonstrated that when gender is not critically and explicitly addressed in the mind and actions of the therapist, therapy becomes biased and value laden, with patriarchal assumptions dominating (Goodrich, 1991; Walters, Carter, Papp, & Silverstein, 1988). This results in a continued hierarchical, unequal relationship with men in a power position and negative, even damaging effects on women. So, for example, a traditional family therapy approach might be considered successful when conflict within the couple relationship is diminished. If, however, the conflict has been reduced because the woman has decided to “keep quiet” about the issues that are bothering her, the reduction of conflict is clearly an unacceptable outcome from a feminist point of view. The feminist literature has shown that women have a well-learned tendency to make personal sacrifices within their couple relationships by caretaking their male partners both emotionally and in practical terms, making this kind of outcome likely without an explicitly feminist therapeutic framework (Gilligan, 1982).
Finally, as we will argue below, without a feminist or critical perspective on gender, therapists may in fact “miss the problem.” Many young couples presenting for therapy today are struggling precisely with issues of shifting, contradictory gender roles. The presenting problem is gender, and therapists need to have both a theoretical grasp of gender and power in relationships and a therapeutic tool kit with which to address them.
To sum up the theory underlying integration: The feminist/EFT integrated model involves the combination of a circular conceptualization of the negative interactional cycle, a feminist account of the gendered emotions and behavioral patterns that each partner brings into the relationship, and an ecological perspective on the powerful cultural influence of marriage-based gender roles in the present. The fact that EFT is a “gender-free” model simultaneously renders it problematic from a feminist perspective and allows the introduction of a feminist analysis. Integration therefore introduces the social/cultural into the therapeutic conversation and deepens our understanding of the powerful impact of traditional gender definitions on couple dynamics, including both the emotions and the systemic positions of each partner.
The integrated model presented here functions at two levels. First, the model introduces issues of gender and gendered couple roles as an additive component to the EFT framework as they specifically relate to the couple’s presenting issues. Second, and most important, the model applies EFT techniques with an implicitly feminist understanding of the ways in which both interactions and emotions are gendered. This integration effectively transforms both approaches and creates a dynamic, flexible model for working. The model is particularly well suited to address the challenges faced by contemporary couples regarding contradictory role and behavioral expectations for men and women in intimate partnership.
This article focuses exclusively on heterosexual relationships. Although EFT and feminist approaches can be used with gay and lesbian couples, this article addresses the difficulties of intimacy that result from attachment across gender. With respect to the use of the term gender, we acknowledge that significant diversity exists within this seemingly monolithic category. Nevertheless, gender as a category exists in relative terms in most, if not all, cultures. Thus, while gender will look different in each couple encountered in clinical practice depending on culture, age, class, family-of-origin learning, and other factors, it will also look the same in many respects. Our use of the category gender therefore reflects the implicit understanding that gender is cultured and is constituted both differently and similarly across social groups.
CHALLENGES FACING COUPLES
Heterosexual couples are living in a new social and economic world very different from the one in which traditional family and couple therapy and theory was constructed. Couples frequently present for therapy with problems that result from an unconscious or unwilling adherence to aspects of the traditional gender roles of “husband” and “wife” (Ellman, 1991; McGoldrick, 1991) while still demonstrating a strong desire to be in emotionally connected, stable couple relationships. Feminist critique has pointed out that early family therapy, based on the American nuclear family of the 1950s, did not reflect or serve other family forms (Hare-Mustin, 1986; Walters et al., 1988). Traditional family therapy also remained oblivious to the profound impact of feminism on the material and social conditions of women’s lives (access to education, the job market, birth control, and political process; Goldner, 1985a), and on the emotional lives of men (Real, 1995). These limitations render traditional approaches inadequate to serve heterosexual couples of today.
At present we are in a transition period from traditional to egalitarian relationships (Walters et al., 1988). In this context, young couples are simultaneously expected to do things differently and to do things the same vis-a-vis gender (Heyn, 1997). Clients are presenting for therapy with varying degrees of consciousness about the effects of gender politics and gender roles on their intimate relationships. The women’s movement began a transformation in public consciousness about gender, shifting intimate conversations and giving women a language with which to challenge the unequal distribution of domestic work (Hochschild, 1989; Luxton, 1980), the unacceptability of violence and emotional abuse (Walker, 1984; Yllo & Bograd, 1988), and the power exerted by men in the family by virtue of their role as breadwinner (Avis, 1991; Goldner, 1985b; Goodrich, Rampage, Ellman, & Halstead, 1988). As clients are increasingly presenting with this “new” consciousness, clinicians need to have at least as sophisticated a grasp as their clients on gender politics as they are currently constituted in intimate partnerships.
In addition to the continued transformation in gender ideology, today’s couples are fighting to survive in an economy of downsizing and diminishing wages, maintaining two jobs or careers while raising children, commuting longer distances to work, and living far from extended family members and supports. Couples are living, working, and raising families in a state of exhaustion and in greater isolation than ever before (Carter & McGoldrick, 1999). Further, more couples are choosing to remain common-law and never marry and to partner across cultural, religious, and racial demographics with different (and often conflicting) gender prescriptions (Crohn, 1998). This “new couplehood” with its strains and vicissitudes therefore demands new, more dynamic approaches to the problems at hand. A feminist-informed couple model enables us to address these socially and politically derived issues particularly insofar as they are linked to gender.
In addition to sociocultural changes, the emotional landscape of couplehood appears to have shifted. Notably, the primacy of emotional connection has intensified. Couples are placing an ever-increasing emphasis on intimacy, friendship, and partnership. Accompanying this emphasis is the relatively new phenomenon of couples working on their intimate bond on an ongoing basis in order to render it as healthy and nurturing as possible. This has occurred for a number of reasons. First, with the rise of popular psychology, lay people now have access to the language, concepts, and larger social support for considering, fully experiencing, and communicating about their emotional lives and the health and quality of their relationships. Expert knowledge is more accessible to the public than ever before, on television and in bookstores, and individuals are actively taking up and using this knowledge in their personal lives. Second, the changes in the social landscape are affecting the emotional bond of couples as well as the material conditions of their lives. With job mobility, parental divorce, family dysfunction, and disconnection from parents and other family members, individuals are looking for a person who will provide them with support, nurturing, understanding, and care; the qualities associated with “home.”
However, like gendered role prescriptions, the new and the old continue to operate with respect to emotions, too. Feminism has begun to transform the emotional landscape for women and men (Gilligan, 1982; Pollack, 1998). Increasingly, men are expected to connect with and communicate about their emotions more readily, although many still struggle to do so. Women are becoming more assertive and self-confident. Nevertheless, powerful gender prescriptions continue to operate, and there continue to be different ways of experiencing and expressing emotions across gender.
Thus, couples today must manage the tension between role-based prescriptions from the past and a new couple ideal of friendship and partnership in the context of connection (Heyn, 1997). There is a strong desire on the part of many young couples to “do things differently than our parents did,” although the pull into old (often gender-based) family-of-origin rules persists. Couples today are pioneers. While no clear-cut paths or role models exist in this new journey, a strong commitment to the journey itself remains.
FEMINIST FAMILY THERAPY THEORY
The history of the relationship between feminism and family therapy (particularly systems theory) has been turbulent and characterized by polarization (Goldner, 1992; Libow, Raskin, & Caust, 1982). Most early feminist family therapy literature critiqued the sexist, value-laden theory and practice of leading family therapy theorists. In constructing this critique, some of the early feminist literature was characterized by a kind of either/or thinking in which the wife/woman was conceptualized as victimized, powerless, controlled, and overinvested in the relationship and the husband was viewed as all-powerful, controlling, unwilling to give up his status, and occasionally violent. Given the newness of the field and the profound sexism inherent in much of the traditional family therapy literature, it was crucial that feminist writers initially adopted this position. Recently, however, feminist practice theory has begun to render a more complex, critical understanding of gender and power and how these are played out in the couple relationship. Feminist work is beginning to expose how power and control in an intimate dyad is shifting, complex, and contradictory (Goldner, 1992).
In addition, feminist family therapy has begun to be developed as a distinct practice model (Goldner, 1998; Knudson-Martin & Mahoney, 1996; Leslie & Clossick, 1996; Schneider & Schneider, 1991; Sheinberg & Penn, 1991; Snyder, Velasquez, & Clark, 1997) and to be integrated with systemic and other approaches (Goldner, 1991, 1992; Haddock, Zimmerman, & MacPhee, 2000). The practice theory is evolving, becoming highly sophisticated and less polarized, political, and categorical. For example, in recent years, feminist family therapists have developed couple therapy approaches for addressing violence in intimate relationships (Almeida & Durkin, 1999; Berns, Jacobson, & Gottman, 1999; Bograd, 1999; Bograd & Mederos, 1999; Goldner, 1999).
Feminist research into family life has documented the ways in which gender is a central organizing feature of couple relationships, pointing to the validity and importance of addressing gender issues in therapy (Hare-Mustin, 1986; Heyn, 1997; Hochschild, 1989; Luxton, 1980). A growing body of empirical evidence also demonstrates that adherence to stereotypic gender roles is damaging to both men and women. Traditional men often experience restricted emotionality, dissatisfaction in intimate relationships, and higher levels of anxiety and depression, while their female counterparts experience lower self-esteem, higher anxiety and depression, and reduced life satisfaction (see Snyder et al., 1997, for a brief literature review). With respect to successful feminist clinical outcomes for couples, the focus is different and the bar set somewhat higher than in traditional approaches. Rather than a reduction in conflict or emotional distress, the feminist focus is on second-order change in the relationship; that is, a fundamental shift in power dynamics, ideology, and structure of the relationship.
Feminist family theory posits that marriage is not a relationship between equals, an assumption held by traditional family therapy theory. Rather, men and women are on unequal footing vis-a-vis power as a result of the larger social context in which we live. Further, the prescriptions of marriage are very different for women than for men, although traditional gender-role constraints within heterosexual couplehood are damaging to both sexes and to the relationship itself. Gender must be a key component of assessing and treating heterosexual couples (Goldner, 1985a), as gender is a primary, if not the primary, basis on which our social institutions (notably marriage) are based (Hare-Mustin, 1986).
Furthermore, all family therapy is value laden. If family therapists are not actively addressing gender and power issues, they are inadvertently maintaining and reentrenching traditional (i.e., unequal) gender relations. Thus, therapy must involve a critical examination of gender ideology within and outside of marriage and of nuclear family ideology, examining this ideology in its past and present historical, social, political, and economic contexts (Goldner, 1985a; Hare-Mustin, 1986). This critical perspective involves an understanding of the ways in which family arrangements, behaviors, relationships, and emotions are gendered. To do this, feminist family therapists emphasize the importance of bringing into the therapy room bigger and different ideas about gender, or what Hare-Mustin (1994) calls “marginalized discourses.”
It is interesting, however, that, as in the case presented below, contradictions are now emerging whereby dominant discourses about gender may have become unacceptable to articulate but may still be operating within a given couple. Thus traditional ideologies may be operating for one or both partners but go unacknowledged in the therapy room because of their new unacceptability in a changing society. As a result of the women’s movement, even the most traditional couples have an awareness of the fallacy of gender stereotypes and stratified gender roles. Where a couple may in the past have unselfconsciously articulated traditional beliefs about a gendered division of labor, today’s couples are struggling with the same issues but not voicing them so readily. Family therapists must understand this contradiction and “dig” for the belief systems at work. This requires a sophisticated theoretical understanding of gender ideology as well as a high level of practice skill in excavating belief systems that have gone underground but are still powerfully at play in couple relationships, these “marginalized dominant” discourses.
Similarly, at the practice level, therapists need to understand the mechanisms by which gender is playing itself out but is disguised as something else. For example, disagreements about domestic labor (a primary source of conflict for many couples) can be framed as personality differences in statements such as, “She just notices dust more than me,” or “He just doesn’t worry as much about these things as I do,” or “I’m just more of an organizer than he is.” In these instances men and women both internalize and individualize the dominant ideologies, often unaware that other couples are having similar gender-based experiences. Couples who present for therapy lie somewhere on a continuum in achieving equality and symmetry in their relationships. Much may have already shifted for couples with respect to money, domestic labor, child care, and emotional work, and much may still be traditionally arranged. But the traditional inner working models of gender are by and large still powerfully at play for heterosexual couples today (Heyn, 1997). Therapists need to probe, challenge, and question in order to assist couples in examining the continued internalized legacy of the 1950s nuclear family paradigm and its impact on their problems in the present.
Finally, the feminist project has been to name that which has gone unnamed, notably in meaning making and attaching language to women’s historically invisible experiences, particularly in the family (Hare-Mustin, 1994). In a family therapy context, therapists need to name what is happening for this generation of women and men in couple relationships. What does it mean that women have increased power as a result of participation in the workforce but continue to bear the lion’s share of domestic labor? What does it mean that many men are experiencing greater intimacy with their partners and children as a result of their liberation from restrictive social taboos on emotional expression, and yet these same men withdraw emotionally when faced with conflict? Heterosexual couplehood today is a mess of contradictions.
Feminist Family Therapy Practice Principles
Despite differences in approach among feminist family therapy theorists, six broad theoretical principles underlying feminist family therapy have been identified (developed from Beecher, 1986; Bograd, 1988; Goldner, 1985a; Goodrich, 1991; Luepnitz, 1988; Parker, 1997; Whipple, 1996). They are as follows: First, the therapist-client relationship is nonhierarchical and is characterized by openness and a sharing of information about the models) used in, and the process of, therapy. The therapist is not viewed as an expert but, rather, as a resource and support person. Second, gender is explicitly discussed as a topic in therapy sessions as it relates to the couple’s presenting problem. This discussion may take different forms; for example, questioning the source of gender messages for individual clients or making connections between personal or relationship difficulties and gender-based internalized models and subsequent behavior. Third, the therapist promotes a balanced, egalitarian couple relationship and believes that such a relationship (as opposed to one that is male dominated and gender stratified) is healthier and more fulfilling for both women and men (a belief supported by the literature cited above). This belief is tempered by the goal of helping the couple/client define and construct their relationship on terms with which they are comfortable. Fourth, empowerment is a central goal of therapy. This involves helping the couple to define and make changes in their relationship, particularly to help them to challenge traditional gender roles, and helping women in particular to make changes in their lives. Fifth, women and women’s ways of relating are respected and affirmed. The therapist avoids pathologizing women and reinforcing traditional gender stereotypes that privilege male standards as the norm, as traditional family therapy has often done. Sixth, power in the relationship is assessed, made explicit, and where appropriate, shifted in interventions with the couple. Questions about who makes more money, how domestic work and responsibility are allocated, and how decisions are made are three areas that reveal core power issues in the relationship.
THE FEMINIST/EFT INTEGRATED MODEL
Using a clinical case example, the theoretical tenets and interventions of an integrated feminist/EFT model will be outlined using the nine steps of EFT and six feminist family therapy practice principles as a framework.
Sophie, 33, and Burke, 30, have been married for 1 year. They lived together for 2 years before their marriage. Since their wedding, the couple has begun experiencing conflict. Typically, they argue heatedly over a seemingly insignificant household matter, become angry and withdraw from one another, and remain upset and distant for several hours or even days. These unresolvable conflicts have been occurring more frequently and building in intensity over the last several months.
Sophie has identified several issues in the relationship. In particular, issues of money, time, and the couple’s individual interests have become problematic. Because Burke is a lawyer and Sophie is a freelance journalist, she feels that he places more importance on his endeavors than on her own. Sophie helped Burke financially over the last few years while he was in law school. As a result they have agreed that this year Sophie will quit her administrative job because Burke is now making a comfortable income. This decision has freed Sophie to focus on her writing. Instead, however, Sophie has found herself taking on more and more domestic work and investing considerable time and energy in supporting Burke in his career-support that she feels is not reciprocated. The two have drifted from each other emotionally and are leading separate lives, manifested in Burke’s making little effort to socialize with her friends or family. The situation is particularly stressful for Sophie as she identifies as a feminist and feels angry and confused as to how the relationship has come to be organized along traditional gender lines.
For his part, Burke is confused by the issues about which Sophie feels so strongly and appears deeply pained by her distress. He himself has no issues with the relationship; however, he acknowledges that they are having problems, manifested in their increasingly frequent fighting. Burke does not understand why Sophie gets so angry and upset with him and often feels in a bind in which he wants to do what would please Sophie but often ends up angering her instead. He does not want to lose Sophie and thus has agreed to come for counseling.
Step 1a: Forming a Therapeutic Alliance
The role of the therapist in EFT resonates with feminist practice principles. Johnson (1996) rejects the traditional power-based role of the family therapist as expert, teacher, or strategist, instead positing a more egalitarian role as a process consultant and, occasionally, choreographer. In contrast to the intellectualized, more objective stance of many traditional family therapists, the therapist in EFT is emotionally engaged in the process through the connection to each partner, even to the point of using his or her own emotions to guide interventions. The feminist family therapy alliance historically has tended to be more didactic in teaching and challenging about gender roles and gender/power issues (e.g., money) as they are playing out in the relationship. These approaches have been illustrated by feminist leaders in the field, notably Carter (1993) and others (see Parker, 1997).
The feminist/EFT integrated model provides the therapist with a different, more empathic stance in addressing gender/power issues. Specifically, she or he introduces ideas and reframes about the gender processes occurring for a couple through the EFT interventions of identifying interactional patterns and accessing and expressing disowned emotions. Thus, the therapist uses gender learning as a gentle reframe or as a point of entry into painful, distressing, disowned emotions. Simultaneously, she or he uses emotions as a way to access and challenge deeply held beliefs about gender. The therapeutic alliance of the integrated model facilitates and lubricates these crucial processes. The close bond resulting from the empathic connection of the therapist to each partner places the therapist in a better position to challenge gender learning. This occurs in two ways. First, a higher level of trust is engendered through the EFT-based emotional connection that the therapist has made with each partner, making the introduction of a gender analysis more likely to be accepted. Second, this less direct approach effectively avoids the activation of clients’ defense mechanisms. At the same time as the focus on emotions facilitates a feminist/gender analysis, the introduction of socialized gender learning as a framework for understanding a client’s inner emotional experience can help ease some of the fear, vulnerability, and confusion of experiencing and expressing deep emotions.
Both feminist and EFT approaches must contend with paradoxes regarding the power of the therapist. Emotionally focused therapy simultaneously posits that the client is an expert on her or his emotional experience and that the therapist must be able to actively structure interactions between partners later in the therapy process. Although the feminist family therapist believes in the importance and health of egalitarian, nonhierarchical relationships, she or he must explicitly use her or his power in order to unbalance the current gender-based power relationship in the couple with whom she or he is working. These paradoxes can comfortably coexist within the integrated model insofar as these relatively directive interventions are experienced by clients in a feminist way as the therapist’s “power to” rather than as “power over” (Goodrich, 1991). This occurs as a result of the EFT interventions that keep the therapist close to the experience of each partner. Directive interventions therefore make sense to the client, as they evolve out of what the partners have discovered and are experiencing internally, rather than being imposed from without.
The feminist/EFT therapist requires a broad range of dynamic clinical skills. She or he must attend to multiple, complex levels of couple functioning during the assessment stage and use the interconnectedness of these levels in interventions. She or he must be able to connect with and hold the deep, painful feelings of each partner, assess and intervene in the systemic patterns occurring within the relationship, and hold a macrolevel perspective in introducing theoretical concepts about gender learning and roles. Thus, the feminist/EFT therapist works using diverse theories and approaches in an integrated, sophisticated way.
Step 1b: Delineating Conflict Issues in the Core Struggle
A primary assumption underlying the integrated model is that couples most often present for therapy when rigid, traditional gender roles are no longer working, particularly for the woman. Conflict issues may be expressed by the couple as obvious problems of gender and power (e.g., money or housework). In other cases, they may be projected onto seemingly unrelated points of contention for the couple, which, after further exploration, will usually reveal some embedded gender/power issues. The nature and degree of entrenchment of gender role and power issues should therefore be assessed at this stage.
Two of the conflict issues for the couple above, as articulated by Sophie, clearly involved feminist issues, namely, money and domestic work. As Sophie’s outside pursuits have dwindled over the past year, she finds herself doing more work around the house, including cleaning and meal preparation. Burke, in turn, is suddenly successful, busy, and established and is investing less time and energy in the household and the relationship. As a result of their financial arrangement, Sophie has suddenly lost her financial independence and feels threatened and angry when Burke makes a financial investment without consulting her. The couple’s articulation of these conflict issues made clear that Burke and Sophie had fallen into polarized, traditional gender roles, with their accompanying imbalance of power.
A third conflict issue articulated by Sophie was that of “time.” This did not initially appear to be feminist/gender issue but, on further probing, revealed a gender-based imbalance in the relationship. Sophie talked at length about how much time she spent discussing Burke’s work and visiting with his family, while he no longer appeared to have time to eat dinner with her, go out with her friends, or see her family. From a feminist perspective, the issue does not involve simple differences in time spent on the relationship. Rather, Sophie has taken on disproportionate responsibility for both practical and emotional work, while Burke has abdicated responsibility for the household and the relationship. Within the span of a year, their feminist– informed, egalitarian, common-law relationship has been transformed into a 1950s-style marriage, characterized by highly differentiated and unequally valued gender roles.
The integrated model examines the core conflict issues from a historical, critical, feminist perspective. Within the traditional gender roles being played, the therapist is aware that the old roles have created and are perpetuating a withdraw/pursue systemic pattern and that attachment issues (also related to gender-based differences in comfort with different kinds of attachment) are clearly being triggered for both partners. Thus, the feminist analysis provides the framework for understanding core conflict issues at this stage, and EFT interventions will later be used to address them.
Step 2: Identifying the Negative Interactional Cycle
The process of identifying a couple’s negative interactional cycle is a systems-based EFT assessment tool (Greenberg & Johnson, 1986; Johnson, 1996). Emotionally focused therapy also examines the emotions of each partner as they contribute to the maintenance of the cycle (this will be dealt with further below). The feminist perspective examines the degree to which systemic positions have been created by, and reinforce, traditional gender roles. This is accomplished primarily through the clinical exploration of past gender learning that each partner brings into the relationship. The gender component of the interactional cycle is as follows: If a woman enters a romantic relationship with the expectation that such an intimate relationship is and should be characterized by mutual understanding and mutual responsibility (Surrey, 1991), it makes sense that when she does not experience this mutuality in the relationship she will attempt to engage her partner so that her original expectations are met. Anger, blaming, criticism, and pursuit-behaviors we frequently see women adopting in distressed relationships–can be understood in this context. Similarly, the confusion that many men exhibit may reflect their response to their female partner’s distress in light of their belief that they are adequately performing their gender role by providing the instrumental needs of the relationship. Feelings of inadequacy, shame, or anger may result, and the behavioral outcome of this response can be defensiveness, stonewalling, and withdrawal, the classic systemic positions of men (Gottman, 1999).
Emotionally focused therapy interventions at this stage involve tracking and reflecting back to the couple what happens in the negative interactional sequence, both behaviorally and emotionally for each partner. In the integrated model these reflections also include some observation about the gendered nature of their interactions. The EFT components of this feedback deepen the therapeutic alliance through the development of clients’ trust that the therapist understands each partner’s individual experience and the cycle occurring in the relationship. The feminist-informed feedback reduces distress by normalizing some of what the couple is experiencing from a gender perspective and offering a possible explanation for what has happened to the relationship.
In the case presented here, classic gendered positions were evident in the core cycle. A pursue/withdraw negative interactional cycle was in full swing and had become somewhat entrenched. Initially, Sophie used positive, proactive strategies in an attempt to engage Burke. As a result of his nonresponse, Sophie’s pursuing behaviors have increased in frequency and have become more coercive and angry. This, in turn, has dramatically increased Burke’s withdrawal. Through exploration at this stage, we were able to identify the gulf that exists between Sophie and Burke’s underlying (gendered) belief systems and resulting ways of relating. Sophie was able to identify that she believes in the importance of openness, emotional sharing, and closeness in her relationship, while Burke has identified that he believes a certain level of independence is good for a relationship. Burke also identifies that he tends to communicate for rational, pragmatic reasons and not to talk about feelings. With encouragement from the therapist to view these as common differences that result from gender socialization, these insights provided Sophie and Burke with a framework for beginning to understand the problems occurring in the relationship.
Step 3: Accessing Unacknowledged Emotions
According to EFT, unacknowledged emotions underlie the positions in the negative cycle. These emotions include fears, vulnerabilities, and unexpressed resentments (Johnson, 1996). The feminist/EFT model enables the therapist not only to explore the hidden, primary emotions of each partner but also to examine the ways in which these emotions are gendered and how much has been denied and distorted as a result of gender socialization. The integrated model recognizes the difficulty of relating in new ways for men and women, not only because of the entrenched patterns in the relationship but also because of powerful gender training that produces strong emotions in each partner that need to be examined and expressed. Thus, a strong, clear link exists between individual emotions (which are seemingly personal, unique, and individualized, but in fact are largely socially constructed) and gender-based societal expectations of appropriate inner lives and behaviors for men and women.
Sheinberg and Penn (1991) argue that emotions become disowned because of conflict between how we feel we should behave as a man or woman and our psychological reality. This results in feelings of “gender failure.” Thus, they argue, men often believe that they feel too needy, too dependent, too sensitive, whereas women believe they are being too assertive, too angry, too independent. Men and women feel most vulnerable about the expression of feelings associated with the other gender, resulting in feelings of inadequacy that they will be unable to meet their partner’s needs. This emotional process results from the opposition/polarization of gender whereby men are expected to experience and exhibit one set of emotions and characteristics and women are supposed to manifest their polar opposites (Hare-Mustin, 1986).
Furthermore, under patriarchy, the emotions and characteristics associated with women are trivialized and devalued, contributing to a whole host of mental health problems for women that result from a lifetime of silencing and producing strong cultural backlash against men who exhibit “feminine” traits. Men have had their emotional lives so effectively shut down through traumatizing, destructive socialization practices that they are uncertain as to what they feel, let alone how to express it (Real, 1995). Women often have a rich emotional life but struggle to express their needs and wants in clear, assertive, unambivalent, functional ways (Lerner, 1985). Thus, gender learning constricts and limits a fully connected emotional life in relationships for both men and women. The integrated model uses EFT in a conscious way to help both partners expand their limited, gendered emotions (as demonstrated below). In turn, these transformed emotions are used in subsequent EFT steps to change behaviors and systemic patterns in the couple relationship.
The feminist/EFT model views power and control as an integral part of both partners’ emotional processes. We have observed in our clinical practice ways in which men’s emotional needs often become transformed into dominant discourses and/or power plays in an attempt to get these needs met. One young, Italian-Catholic husband, for example, recently expressed that he experienced his wife’s unwillingness to cook for him as evidence that she does not care about him. In this case, the focus was on exploring the deep feelings of need and vulnerability on his part (nontraditional emotions for men, and a very different kind of interaction for this couple). From a feminist perspective, however, this could itself be a power play to keep the wife cooking for him. This is where the shift to a feminist frame becomes crucial. The therapist in this case reflected on the socially constructed notion that a good wife, a wife who cares, cooks for her husband. The couple can explore from here what other ways of caring exist for them that feel good for both partners and that are not based on an outside social ideal that is no longer serving them or their relationship.
Women’s emotional lives, too, have been conditioned to act as internal mechanisms of social control, which effectively keep women behaving in traditional ways as part of their gender role. It is common in clinical practice to see women who are overcome with guilt and shame when they attempt to, or even consider, expressing their needs or wants in relationships. Feelings of not being deserving are powerful for many women and often keep them from getting their emotional needs met. These feelings are not difficult to access as they are often both strong and consciously felt. With some skilled exploration on the part of the therapist, such emotions can usually be uncovered in the first few sessions as part of this stage of EFT.
To return to Sophie and Burke, gendered emotional experience was obvious and overtly expressed by both partners. While Sophie was now angrier and occasionally beginning to withdraw, her primary emotions consisted of feeling hurt and alone as a result of Burke’s multiple withdrawals. She felt that he should know what she wanted and how and when to provide it. At the beginning of therapy she was unable to ask for what she wanted in a clear, assertive way. For Burke, the accessing of his emotions took multiple sessions and a lot of work. His ability to express sadness, longing, and positive feelings toward Sophie was greatly impaired by years of gender training that taught him not to experience or express these emotions (Pollack, 1998; Real, 1995). Through the exploration of family-of-origin gender learning (an effective intervention to begin to make gender visible to couple clients), Burke identified that his father rarely even spoke to his children or his wife and certainly never expressed himself emotionally in any way. Sophie noted that her mother was an expressive, affectionate woman, whereas her father, a pilot, was frequently absent from home.
Step 4: Reframing the Problem in Terms of Attachment Needs
The integrated application of this step involves a dual reframing. First, the problems in the relationship are refrained using the newly experienced emotions of each partner and the expression of unmet needs (Greenberg & Johnson, 1986; Johnson, 1996). Second, a gender reframe is employed such that both partners are seen to be struggling against socialized gender learning in the interest of the health of their relationship. This last reframe may be particularly helpful for withdrawn men who find it difficult to access and express emotion. Combined, the dual reframe says, “You want to be close to one another, and you are struggling to overcome a lot of learning that tells you not to interact in this way.” The gender reframe normalizes the powerful emotional experience of each partner and can help to soften entrenched, rigid positions in the cycle.
This reframe was particularly relevant for Sophie and Burke because both partners were identifying that they wanted to do things differently from their parents and Sophie was identifying her desire for a more balanced relationship. The reframe also gives permission to women and men to explore different aspects of their attachment needs and to express these needs in nonnormative gendered ways that fit better for them as individuals and as a couple. Thus, Burke can express his vulnerability, care, and need for Sophie, while Sophie can assert and express her needs in more concrete, healthy ways.
Step 5: Promoting Identification with Disowned Needs and Integration into Relationship Interactions
This EFT step involves a deeper exploration of disowned parts of the self. Partners are asked to tell the other about their need to withdraw or their feelings of vulnerability, thereby promoting a greater understanding and acceptance of these disowned aspects of the self (Greenberg & Johnson, 1986). From the perspective of the integrated model this technique can be applied in a fairly straightforward way, with the result that it helps each partner begin to put a name to her/his emotional experience, creating awareness to varying degrees about their gendered ways of being in the relationship. In therapy, Sophie and Burke were asked at different points to share with each other how it felt not to be able to come together after an argument, to feel the need to withdraw (in Burke’s case) or be angry (for Sophie). Sophie was asked to tell Burke how hard it was to ask him for what she needed, and Burke was directed to tell Sophie how hard it was to tell her positive things about her that he appreciated. In addition, much of the work in this step focused on Burke’s disowned need for intimacy and his resulting inability to connect at a deeper level with his partner.
Steps 6 and 7: Promoting Acceptance of Each Partner’s Experience and New Interaction Patterns and Facilitating the Expression of Needs and Wants
Step 6 involves the disclosure of each partner’s vulnerability and attachment needs to the other, whereas step 7 involves the clarification and expression of needs and wants in the relationship (Greenberg & Johnson, 1986; Johnson, 1996). As part of an integrated model, these two steps may be closely intertwined as a result of the gender differences between partners. For example, for Burke much of his energy in therapy was spent attempting to access and express his emotional experience, whereas Sophie had much less of a problem telling Burke how she felt and opening up with him in an emotionally connected way. Thus, step 6 for this couple was more focused on helping Burke to open up and share with Sophie, whereas step 7 involved more of a focus on Sophie, helping to facilitate her clarification and more healthy, assertive expression of needs and wants in the relationship. It is crucial within the integrated model that both partners uncover and express their attachment needs. It is insufficient for the male (in this case, withdrawn) partner to express his needs more fully. From a feminist perspective, this may simply create more caretaking work for the woman. For second-order change to take place, the woman must also express her needs and wants in the relationship, and her male partner must be coached to respond appropriately to them. The gender aspects of these two steps will vary for different couples. Flexibility and discretion should be used on the part of the therapist.
Steps 8 and 9: The Emergence of New Solutions and the Consolidation of New Positions
These steps involve the creation of new and alternative responses, an awareness of the previous negative cycle, and the initiation of more regular positive interactions and experiences (Greenberg & Johnson, 1986; Johnson, 1996). With respect to the feminist component of the integrated model, the new positions should ideally facilitate an ability to communicate about substantive issues of gender and power in the relationship. Near the end of therapy, Sophie and Burke reported that they had begun to have one of their “old” disagreements but that they had been able to stop the fight, analyze and discuss what had just happened, share their experiences of the conflict, and go on with their day without withdrawing from one another. Burke was able to tell Sophie the aspects of her that he appreciated and why he wanted to be with her. More recently, Sophie and Burke were able to work out a plan to set aside free time to spend with one another and to restructure domestic work in such a way that the labor was more equitably shared.
Summary of the Integrated Model: Achievement of Feminist Goals
Throughout the integrated model, explicit feminist discussions about gender and power are incorporated as additive as well as transformative components of EFT. Feminist interventions are wide ranging and include: (1) questions about where role expectations come from (i.e., cultural norms, religious standards), (2) what the couple wants to be different in their relationship from their parents’ marriages, and what their ideal partnership might look like, (3) reflections on the part of the therapist regarding how couple issues create imbalances of power that negatively affect the relationship, and (4) the challenging of each partner regarding her/his gendered behavior in the relationship.
Feminist family theorists have pointed out the ways in which women clients in family therapy have ended up carrying more responsibility for the therapeutic process than their male partners. This occurs as a result of women’s learned expertise in communication and relationships, their greater investment in and responsibility for the family relative to men, and a resulting increased cooperation on the part of the woman with the therapist (Goldner, 1985b). The feminist/EFT model avoids the pitfall of extra work that women have historically been assigned in family therapy. First, the model provides a language and approach for framing and intervening in men’s systemic patterns of withdrawal and distancing. Next, the approach enables the therapist to bring the male partner into the process, particularly through the emotion-focused interventions, thereby relieving the woman of overresponsibility for the emotional work in the relationship.
The integrated model makes gender visible. Once gender is visible, new options become available whereby men and women can experience new emotions, express them without fear in the newly safe context of the accepting relationship, and reconstruct the practical aspects of their relationship according to their newly discovered, more directly expressed needs. Thus, both men and women are made aware of and responsible for their gender learning and behaviors in the relationship. The integrated approach also accomplishes the important couple therapy task of shifting the couple from blaming each other for relationship problems to working together on the problems that exist, in a sense, outside of themselves.
Finally, the feminist/EFT integrated model enables us to look at power in a more sophisticated, complex way. Building on the feminist knowledge of key issues that support imbalances of power (money, household responsibility, and control over decision making), the integrated model also enables us to examine power issues in the emotional division of labor. Here, power is less clear-cut. Although doing much of the emotional work can make women more responsible for and overinvested in the relationship, it also gives women power relative to men. In the case of the couple above, Burke clearly has more power in the relationship in political terms, yet he experiences his position in the relationship as disempowered because of Sophie’s frequent anger toward him and her advanced emotional and relationship skills. Many men experience confusion and fear caused by their impoverished emotional lives, resulting in an often complete inability to understand what their female partner is saying about the problems in the relationship. This confusion is easily transformed into defense mechanisms and/or power plays. The integrated model effectively circumvents these defense mechanisms through enhancing the emotional connection between therapist and partner and enables men to begin to experience and understand what is happening in the relationship. It provides a framework and language for them to be able to truly be in relationship. At the same time, women are explicitly empowered through the therapeutic process. While their male partners are being taught how to carry their emotional weight in the relationship, women are guided to express their needs and wants, and the relationship is restructured with those needs and wants in mind. Thus, the integrated model simultaneously hand holds and challenges both partners-a potent combination for gender change.
This article has presented an integrated feminist/EFT practice model for use with contemporary heterosexual couples. Given the impact of feminism on family life over the last 30 years, a welldeveloped, critical perspective on gender has become essential to effective family therapy practice. Further, our field faces continued transformations into the new millennium and over the next generation in order to deal with the tremendous social and demographic changes that are already taking place. These changes are occurring within couples who are partnering across culture, religion, and race and are affecting couples from without as a result of challenging political and economic conditions. More than ever before, family therapists need to be attuned to the old and the new in the sociopolitical world from which our clients come. The integration of approaches that include both micro- and macrolevel perspectives constitutes an essential step toward that end.
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University of Toronto
Carole-Anne Vatcher, MSW, RSW, is in private practice, 2161 Yonge Street, Suite 200, Toronto, Ontario, Canada M4S 3A6.
Marion Bogo, MSW, AdvDipSW, is Professor and Sandra Rotman Chair in Social Work, Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Copyright American Association for Marriage and Family Therapy Jan 2001
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