Contemporary Family Therapy

, Volume 35, Issue 3, pp 557–567 | Cite as

Emotionally Focused Couple Therapy with Couples Facing Terminal Illness

  • Sarah Tie
  • Shruti PoulsenEmail author
Original Paper


Research on effective therapeutic interventions for couples dealing with terminal illness is scant. Changes in daily routine, added responsibilities, role changes, and the grief process are all contributors to the enormous stress and emotional strain felt by these couples. Couples where one partner is terminally ill may experience anger, depression, guilt, and anxiety. The authors propose that emotionally focused couple therapy (EFT), originally developed by Greenberg and Johnson (Emotionally focused therapy for couples, Guilford Press, New York, NY, 1988) may be effective in addressing this distress and in facilitating the grieving and support process in couples dealing with terminal illness. EFT is a systemic, experiential form of therapy that builds upon Bowlby’s (Attachment and loss: Volume I: Attachment, Basic Books, New York, NY, 1969) attachment theory. By exploring the emotional experience of both partners it may be possible to re-structure the couple’s emotional partnership and support the grief process for both partners.


Emotionally focused therapy Terminal illness Couple intervention Grief process 


  1. Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A study of the strange situation. Hillsdale, NJ: Erlbaum.Google Scholar
  2. Baider, L., Perez, T., & Kaplan De-Nour, A. (1989). Gender and adjustment to chronic disease: A study of couples with colon cancer. General Hospital Psychiatry, 11, 1–8. doi: 10.1016/0163-8343(89)90018-2.PubMedCrossRefGoogle Scholar
  3. Becvar, D. S., & Becvar, R. J. (2009). Family therapy: A systemic integration (7th ed.). Boston, MA: Pearson Education, Inc.Google Scholar
  4. Bowlby, J. (1969). Attachment and loss: Volume I: Attachment. New York, NY: Basic Books.Google Scholar
  5. Bowlby, J. (1980). Attachment and loss: Volume III: Separation and depression. New York, NY: Basic Books.Google Scholar
  6. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. New York, NY: Basic Books.Google Scholar
  7. Brown, J. E., Brown, R. F., Miller, R. M., Dunn, S. M., King, M. T., Coates, A. S., et al. (2000). Coping with metastatic melanoma: The last year of life. Psycho-Oncology, 9, 284–292. doi: 10.1002/1099-1611(200007/08)9:4<283:AID-PON460>3.0.CO;2-N.CrossRefGoogle Scholar
  8. Carlson, L. E., Bultz, B. D., Speca, M., & St. Pierre, M. (2000). Partners of cancer patients: Part I. Impact, adjustment, and coping across the illness trajectory. Journal of Psychosocial Oncology, 18, 39–63. doi: 10.1300/J077v18n02_03.CrossRefGoogle Scholar
  9. Caruso-Herman, D. (1989). Concerns for the dying patient and family. Seminars in Oncology Nursing, 5, 120–123. doi: 10.1016/0749-2081(89)90071-5.PubMedCrossRefGoogle Scholar
  10. Corbin, J., & Strauss, A. (1985). Managing chronic illness at home: Three lines of work. Qualitative Sociology, 8(3), 224–247. doi: 10.1007/BF00989485.CrossRefGoogle Scholar
  11. Cort, E., Monroe, B., & Oliviere, D. (2004). Couples in palliative care. Sexual and Relationship Therapy, 19, 337–354. doi: 10.1080/14681990410001715454.CrossRefGoogle Scholar
  12. d’Ardenne, P. (2004). The couple sharing long-term illness. Sexual and Relationship Therapy, 19, 291–308. doi: 10.1080/14681990410001715427.CrossRefGoogle Scholar
  13. Duke, S. (1998). An exploration of anticipatory grief: The lived experience of people during their spouses’ terminal illness and in bereavement. Journal of Advanced Nursing, 28, 829–839. doi: 10.1046/j.1365-2648.1998.00742.x.PubMedCrossRefGoogle Scholar
  14. Fitzgerald, J., & Thomas, J. (2012). A report: Couples with medical conditions, attachment theoretical perspectives and evidence for emotionally-focused couples therapy. Contemporary Family Therapy, 34, 277–281. doi: 10.1007/s10591-012-9184-8.CrossRefGoogle Scholar
  15. Gallo, L. C., & Smith, T. W. (2001). Attachment style in marriage: Adjustment and responses to interaction. Journal of Social and Personal Relationships, 18(2), 263–289. doi: 10.1177/0265407501182006.CrossRefGoogle Scholar
  16. Glasdam, S., Jensen, A. B., Madsen, E. L., & Rose, C. (1996). Anxiety and depression in cancer patients’ spouses. Psycho-Oncology, 5, 23–29. doi: 10.1002/(SICI)1099-1611(199603)5:1<23:AID-PON206>3.0.CO;2-H.CrossRefGoogle Scholar
  17. Greenberg, L. S., & Johnson, S. M. (1988). Emotionally focused therapy for couples. New York, NY: Guilford Press.Google Scholar
  18. Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52, 511–524. doi: 10.1037//0022-3514.52.3.511.PubMedCrossRefGoogle Scholar
  19. Hottensen, D. (2010). Anticipatory grief in patients with cancer. Clinical Journal of Oncology Nursing, 14(1), 106–107. doi: 10.1188/10.CJON.106-107.PubMedCrossRefGoogle Scholar
  20. Hudson, P. L., Aranda, S., & Kristjanson, L. J. (2004). Meeting the supportive needs of family caregivers in palliative care: Challenges for health professionals. Journal of Palliative Medicine, 7, 19–25. doi: 10.1089/109662104322737214.PubMedCrossRefGoogle Scholar
  21. Johnson, S. M. (2002). Emotionally focused couple therapy with trauma survivors: Strengthening attachment bonds. New York, NY: The Guilford Press.Google Scholar
  22. Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection (2nd ed.). New York, NY: Brunner-Routledge.Google Scholar
  23. Johnson, S. M., Makinen, J. A., & Millikin, J. W. (2001). Attachment injuries in couple relationships: A new perspective on impasses in couples therapy. Journal of Marital and Family Therapy, 27(2), 145–155. doi: 10.1111/j.1752-0606.2001.tb01152.x.PubMedCrossRefGoogle Scholar
  24. Keller, H. (2007). Cultures of infancy. Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  25. Konigsberg, R. D. (2011). The truth about grief: The myth of its five stages and the new science of loss. New York, NY: Simon & Schuster.Google Scholar
  26. Kübler-Ross, E. (1969). On death and dying: What the dying have to teach doctors, nurses, clergy, and their own families. New York, NY: Touchstone.Google Scholar
  27. Lindemann, E. (1963). Symptomatology and management of acute grief. Pastoral Psychology, 14(6), 8–18. doi: 10.1007/BF01770375.CrossRefGoogle Scholar
  28. McLean, L. M., & Hales, S. (2010). Childhood trauma, attachment style, and a couple’s experience of terminal cancer: Case study. Palliative and Supportive Care, 8, 227–233. doi: 10.1017/S1478951509990976.PubMedCrossRefGoogle Scholar
  29. McLean, L. M., & Nissim, R. (2007). Marital therapy for couples facing advanced cancer: Case review. Palliative and Supportive Care, 5, 303–313. doi: 10.1017/S1478951507000466.PubMedGoogle Scholar
  30. McLean, L. M., Jones, J. M., Rydall, A. C., Walsh, A., Esplen, M. J., Zimmermann, C., et al. (2008). A couples intervention for patients facing advanced cancer and their spouse caregivers: Outcomes of a pilot study. Psycho-Oncology, 17, 1152–1156. doi: 10.1002/pon.1319.PubMedCrossRefGoogle Scholar
  31. Mohr, D. C., Moran, P. J., Kohn, C., Hart, S., Armstrong, K., Dias, R., et al. (2003). Couples therapy at end of life. Psycho-Oncology, 12, 620–627. doi: 10.1002/pon.746.PubMedCrossRefGoogle Scholar
  32. Nijboer, C., Triemstra, M., Tempelaar, R., Sanderman, R., & van den Bos, G. A. (1999). Determinants of caregiving experiences and mental health of partners of cancer patients. Cancer, 86, 577–588. doi: 10.1002/(SICI)1097-0142(19990815)86:4<577:AID-CNCR6>3.0.CO;2-S.PubMedCrossRefGoogle Scholar
  33. Northouse, L. L., & Peters-Golden, H. (1993). Cancer and the family: Strategies to assist spouses. Seminars in Oncology Nursing, 9, 74–82. doi: 10.1016/S0749-2081(05)80102-0.PubMedCrossRefGoogle Scholar
  34. Rolland, J. S. (1994). Families, illness, and disability: An integrative treatment model. New York, NY: BasicBooks.Google Scholar
  35. Servaty-Seib, H. L. (2004). Connections between counseling theories and current theories of grief and mourning. Journal of Mental Health Counseling, 26, 125–145. doi: 10.1080/074811899201046.Google Scholar
  36. Shaver, P. R., & Mikulincer, M. (2002). Attachment-related psychodynamics. Attachment & Human Development, 4, 133–161. doi: 10.1080/14616730210154171.CrossRefGoogle Scholar
  37. Simon, J. L. (2008). Anticipatory grief: Recognition and coping. Journal of Palliative Medicine, 11(9), 1280–1281. doi: 10.1089/jpm.2008.9824.PubMedCrossRefGoogle Scholar
  38. Stroebe, M. S. (2002). Paving the way: From early attachment theory to contemporary bereavement research. Mortality: Promoting the Interdisciplinary Study of Death and Dying, 7(2), 127–138. doi: 10.1080/13576270220136267.Google Scholar
  39. Swensen, C. H., & Fuller, S. R. (1992). Expression of love, marriage problems, commitment, and anticipatory grief in the marriages of cancer patients. Journal of Marriage and Family, 54, 191–196. doi: 10.2307/353286.CrossRefGoogle Scholar
  40. Trudeau-Hern, S., & Daneshpour, M. (2012). Cancer’s impact on spousal caregiver health: A qualitative analysis in grounded theory. Contemporary Family Therapy, 34, 534–554. doi: 10.1007/s10591-012-9211-9.CrossRefGoogle Scholar
  41. van Wormer, K. (1985). Guilt feelings in the spouse of the terminally ill. Home Healthcare Nurse, 3(5), 21–25. doi: 10.1097/00004045-198509000-00006.PubMedCrossRefGoogle Scholar
  42. Willert, M. G., Beckwith, B. E., Holm, J. E., & Beckwith, S. K. (1995). A preliminary study of the impact of terminal illness on spouses: Social support and coping strategies. The Hospice Journal, 10(4), 35–48.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.School of Education and Human DevelopmentUniversity of Colorado DenverDenverUSA

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