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Received: 8 January 2021    Accepted: 28 September 2021

DOI: 10.1111/jmft.12560

ORIGINAL ARTICLE

The relationship between therapist

interventions and couples' emotional injury
resolution in emotion focused couples therapy

Ofra Kula MA1  | Reut Machluf MA1  | Eran Bar-­Kalifa PhD1  |

Ben Shahar PhD2

1
Psychology Department, Ben Gurion
University of the Negev, Beer-­Sheva,
Israel
2
The Paul Baerwald School of Social
Work and Social Welfare, The Hebrew
University of Jerusalem, Jerusalem,
Israel
Correspondence
Ben Shahar, The Paul Baerwald School
of Social Work and Social Welfare, The
Hebrew University of Jerusalem, Mt.
Scopus, Jerusalem 91905, Israel.
Email: ben.shahar@mail.huji.ac.il
Abstract
The primary purported change process in emotion-­
focused couples therapy (EFT-­C) occurs as therapists
assist one partner to access and reveal vulnerable emo-
tions and needs and promotes a subsequent compassion-
ate responding from the other partner. This study aimed
to examine the association between therapists' views
regarding their interventions during a given session
and the degree to which partners reported the session
as helpful in resolving their unfinished business. Data
from 22 couples who took part in the York Emotional
Injury Project and received 10–­12 EFT-­C sessions were
analyzed using multilevel models. The primary findings
revealed that when therapists reported using interven-
tions that promoted acceptance of feelings and needs in
a given session, both partners reported higher resolu-
tion levels in relation to their partner. Our results sug-
gest that interventions that facilitate responsiveness
between partners are particularly important in EFT-­C,
and perhaps in couples therapy in general.

KEYWORDS
emotion-­focused therapy for couples, psychotherapy change
processes, psychotherapy research, responsiveness

© 2021 American Association for Marriage and Family Therapy.

J Marital Fam Ther. 2021;00:1–12.  wileyonlinelibrary.com/journal/jmft   |  1

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I N T RO DU CT ION

Emotion-­focused therapy for couples (EFT-­C; Greenberg & Goldman, 2008; Johnson, 2004;
Johnson & Greenberg, 1988) is an experiential, humanistic, systemic model, empirically sup-
ported as effective for treating couples in distress (Bradbury & Bodenmann, 2020). Despite
the evidence showing that EFT-­C is an effective treatment (Beasley & Ager, 2019; Byrne et al.,
2004; Johnson et al., 1999; Rathgeber et al., 2019), the processes of change leading to successful
outcomes (relationship satisfaction), as well as therapist interventions that produce in-­session
change events are still not entirely clear and in need of further research.
According to EFT-­C, a couple's dynamic is determined by each partner's emotional expe-
rience and how these interact. Conflicts and distress are conceptualized as resulting from the
existence of rigid and repeated maladaptive interactional cycles that arise when partners do not
get their basic emotional needs for closeness and validation met (Woldarsky Meneses, 2017).
When these needs are not met, partners experience emotional pain (loneliness, shame), which
drives them to engage in maladaptive behaviors in an attempt to elicit a response from their
partner. In a common scenario, one partner pursues more closeness and contact, whereas the
other partner withdraws to achieve more distance. The pursuing partner often blames and crit-
icizes the withdrawing partner, who, in turn, continues to detach or withdraw. The pursuing
partner might feel lonely and abandoned and regulate this emotional pain by continuously
trying to elicit a response from the other partner (e.g., by angrily criticizing, complaining, blam-
ing). Such “attempted solutions” are experienced as threatening to the withdrawing partner,
who self-­protects by further withdrawing (their attempted solution). The withdrawing partner
might feel shame for “not doing things right” or for disappointing the other, and regulate these
painful feelings by further retreating. Both partners remain stuck, expressing secondary emo-
tions, and thus access to fundamental attachment and identity-­related needs is blocked. Such
pursue-­distance or demand-­withdraw interactions have been thoroughly researched and found
to be crucial in marital conflict (Baucom et al., 2015; Eldridge & Baucom, 2012; Johnson, 2009;
Vanhee et al., 2018).
In the above example, the pursuer's feelings of loneliness and abandonment are considered
primary emotions, whereas the demanding anger is seen as a reactive secondary emotion. The
withdrawer's shame is considered a primary emotion, and the tendency to withdraw or defend is
a secondary response. Secondary emotions and responses often obscure and hide the more vul-
nerable primary painful emotions and needs that underlie them (Johnson & Greenberg, 1988).
Partners often avoid experiencing and revealing their underlying vulnerable emotions (fear,
shame) and associated needs, and instead express secondary emotions (anger, criticism, frus-
tration, indifference) to each other (Greenberg & Goldman, 2008; Greenman & Johnson, 2013).
The primary theoretical assumption in EFT-­C is that helping both partners to access and re-
veal their underlying primary vulnerable emotions and needs, and to respond to one another's
vulnerable emotions and needs in an empathic, supportive, validating, and compassionate man-
ner, are crucial to relationship repair (Greenberg & Goldman, 2008; Johnson & Greenberg, 1988).
During the therapeutic process, therapists first validate secondary emotions and responses and
then help each partner to access, experience, and reveal underlying vulnerable primary emotions
as well as their associated basic needs for closeness, support, validation, and acceptance. Such
unguarded revealing tends to elicit a compassionate response from the other partner. Thus, re-
vealing vulnerability and subsequent compassionate responding are considered central change
processes, leading to restructuring maladaptive cycles and creating a more secure and regulated
bond (Greenberg & Goldman, 2008; Johnson & Greenman, 2006).
JOURNAL OF MARITAL AND FAMILY THERAPY      |  3

A number of process research studies have corroborated different aspects of this model. In
the first EFT process study, Johnson and Greenberg (1988) found that couples who responded
well to EFT showed deeper emotional experiencing and more affiliative responses in their best
sessions. Next, in a series of three studies, Greenberg et al. (1993) showed that couples devel-
oped more affiliative (empathic, supportive, understanding) responses toward each other during
therapy, had sessions that were rated as productive involved deeper levels of experiencing and
more affiliative statements, and that expression of vulnerable emotions was followed by affilia-
tive responses. Several subsequent studies have largely focused on blamer-­softening events (i.e.,
in-­session events in which pursuing partners access and reveal underlying primary vulnerable
emotions) and showed that such events predicted a variety of favorable treatment outcomes, such
as increased levels of trust and connection between couples, and overall relationship satisfaction
(Bradley & Furrow, 2004, 2007; Dalgleish et al., 2015; Moser et al., 2018). Lee et al. (2017) showed
that helping withdrawing partners re-­engage also involves accessing and expressing deeper vul-
nerable, previously avoided emotions and needs.
A number of EFT-­C studies have focused on helping couples overcome emotional injuries and
facilitate forgiveness and reconciliation. An emotional injury is a significant event in the couples'
relationship which leaves one of the partners feeling deeply abandoned or betrayed. These events
often involve one partner having an affair, deception regarding finances and drug use, or signifi-
cantly breaching trust in other ways. These events often become pivotal in the couple's life, and
a rigid maladaptive interactional cycle evolves around them as the injured partner often blames,
attacks, and demands acknowledgment of the injury whereas the offending partner defends,
minimizes, dismisses, or withdraws (Johnson et al., 2001; Makinen & Johnson, 2006). Makinen
and Johnson (2006) examined the process of change in couples experiencing an emotional (at-
tachment) injury receiving EFT-­C. They found that the couples who were able to resolve the
injury during treatment showed deeper levels of experiencing and more affiliative interactions
as therapy progressed. In a subsequent task-­analytic study using the same sample of couples,
Zuccarini et al. (2013) found that events based on the injured partner softening (expressing vul-
nerable emotions and needs) and the offending partner responding compassionately to these
vulnerability expressions distinguished between resolved and unresolved couples.
Consistent findings also emerged from the work of Greenberg's group on facilitating forgive-
ness in couples experiencing emotional injuries (Greenberg et al., 2010; McKinnon & Greenberg,
2013, 2017; Meneses & Greenberg, 2011; Woldarsky Meneses & Greenberg, 2014). These stud-
ies also reported that vulnerability expressions and subsequent compassionate responding are
crucial steps to forgiveness and reconciliation. For example, McKinnon and Greenberg (2013)
found that sessions that contained expressions of vulnerability were rated more positively by
both partners on a global measure of session outcome. In addition, couples who shared vulnera-
bility during their treatment reported greater improvement in their relationship satisfaction and
trust at the end of treatment. In their later analysis, McKinnon and Greenberg (2017) reported
that expression of emotional vulnerability by one partner, followed by a supportive response by
the other partner, predicted greater improvements in domains of forgiveness, unfinished busi-
ness, and trust.
All studies described thus far have focused on clients' processes leading to positive outcomes,
and only a few studies focused on therapist interventions that facilitate these productive client
processes (Greenman & Johnson, 2013). Clinical and theoretical writings emphasize that to fa-
cilitate the expression of vulnerability and compassionate responsiveness, EFT-­C therapists em-
phasize several therapeutic tasks (Greenberg & Goldman, 2008; Woldarsky Meneses, 2017). First,
they establish a collaborative alliance and a strong emotional bond with each of the partners.
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Second, they help the couple de-­escalate by framing their difficulties in terms of a repeated mal-
adaptive cycle that both partners can unite against. Third, therapists help each partner to deepen
their emotional experience and access and re-­own primary vulnerable emotions and their asso-
ciated needs. Fourth, therapists work to restructure maladaptive interactional cycles by helping
partners, often using enactments, express and reveal primary vulnerable emotions and needs to
each other and respond to these vulnerable emotions with empathy, acceptance, support, and
compassion. The primary hypothesis in this study is that, although all of these therapeutic tasks
are important, promoting vulnerability expression and subsequent compassionate responding
are the most essential therapist activities, because these are the ones that directly shape new
interactions between the partners.

The current study

The primary goal of this study is to examine EFT-­C change processes using therapists' perspec-
tives regarding their interventions in each session in a study examining EFT-­C for emotional
injuries. In most EFT-­C process research, therapist in-­session interventions and partners' be-
haviors and emotional expressions are coded by independent objective raters. Relying on raters'
observations has many advantages. For example, it provides a more objective and intensive ob-
servation of micro-­analytic steps in a “zoom-­in” fashion. However, one disadvantage of such
coding is that it is extremely labor-­intensive, and usually, only limited parts of the therapy can be
coded. Therefore, in most EFT-­C process research, only specific events, such as blamer-­softening
or vulnerable segments, are coded. Another disadvantage is that it leaves out the client and thera-
pist's personal, subjective perceptions of what they experienced in the session. Even though their
perceptions may be biased in some ways, they are still likely to be meaningful and valuable. In
this study, therefore, we were interested in examining the association between therapists' views
regarding their interventions during a given session, and the degree to which each partner felt
that the session was helpful in resolving injury-­related unfinished business. Analyzing data from
each session, using client and therapist reports: (1) enabled an overview of the entire course of
therapy, rather than viewing the therapy through a prism of specific events, and (2) allowed us to
examine associations between three sources of data (each of the partners and the therapist's) and
thus served to limit the amount of shared variance. Our specific hypothesis was that therapists'
ratings of the degree to which they used interventions that promote vulnerability expression and
interventions that promote compassionate responding on a given session, would predict higher
levels of resolution on that session, above and beyond the use of other common interventions
(namely, validation, identifying the cycle and accessing primary emotions).

MET H O D

Participants

The current analysis is based on data from the York Emotional Injury Project (Greenberg et al.,
2010). In this study, couples dealing with a significant emotional injury that remained unresolved
for at least 2 years received 10–­12 sessions of EFT-­C. Examples of events resulting in emotional
injuries included affairs, deception regarding finances and drug use, insisting on an abortion,
and failing to provide support at a critical time. In the original Project, 33 couples completed
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therapy (Woldarsky Meneses & Greenberg, 2014). However, the current analysis is based on an
investigation of only 22 couples for which data regarding both therapist interventions and degree
of post-­session resolution existed. In the original project, all couples were heterosexual, and in all
but two cases the offenders were males. Once the couples without data on therapist interventions
and degree of resolution were excluded, we were left with a sample in which males were the of-
fenders and females were the injured in all cases.
Participants in this project were over 18, had been cohabiting together for at least 2 years, and
included partners who intended to stay together and overcome their unresolved anger and hurt.
The majority of the sample identified themselves as being of White-­European descent (71.9%).
Other reported ethnic backgrounds included Asian, Caribbean, Hispanic, Arabic, and First
Nations. Participants were excluded if they were already in another form of couples' therapy, or
if there were any signs of violence or abuse, substance abuse, severe psychological disturbances,
or severe personality disorders. For more details about the procedure of the original study, see
Greenberg et al. (2010). In the current sample of 22 couples, age ranged from 27 to 73 (M = 45.26,
standard deviation [SD]  =  9.86). The length of their romantic relationships ranged from 5 to
41 years (M = 16.31; SD = 9.39), and on average, they had two children (M = 1.82; SD = 0.94).

Therapists

Eighteen therapists participated in the original study. Each therapist treated between one to four
couples. Ten therapists were advanced doctoral students in clinical psychology, six therapists
were Ph.D. level clinical psychologists, one therapist had a Master's degree in marriage and fam-
ily therapy, and one therapist was a clinical social worker. Sixteen of the therapists were women.
Therapist age ranged from 27 to 55 (mean age = 37.72). Seventeen therapists where White and
one was Asian. The therapists received 30 hours of specialized training in EFT-­C related to re-
solving emotional injuries. To ensure adherence to EFT-­C, weekly supervision with video re-
views was conducted by Leslie Greenberg, one of the two developers of the model.

Measures

Injury resolution

At the end of each session, partners completed an adapted version of the Unfinished Business
Resolution Scale (UFB-­RS; Singh, 1994). The UFB-­RS was developed to assess the resolution of
unfinished business in relation to significant others. In the current study, a short, 4-­item version
was used, comprising four items (“I feel troubled by my persisting unresolved feelings in rela-
tion to my partner,” “I feel unable to let go of my unresolved feelings in relation to my partner,”
“I forgive my partner for what he/she did to me,” “I feel compassionately understanding of my
partner”). The items were rated on a 5-­point Likert scale (1 = not at all, 5 = very much). Scores
of two items were reversed such that higher scores represented a greater resolution of the injury.
The between-­person (RKF) and within-­person reliabilities (RC) were 0.97 and 0.70, respectively.
In a study examining the process of unfinished business resolution with a significant other, this
scale was found to significantly discriminate between clients who were rated as having resolved
their unfinished business and clients who were rated as remaining unresolved at the end of
therapy (Greenberg & Malcolm, 2002).
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Therapist interventions

At the end of each session, therapists completed a self-­report questionnaire assessing the extent
to which they conducted common EFT-­C interventions. Specifically, the following items meas-
uring the five main EFT-­C interventions were used in the current study: (1) validating the cou-
ple's experience (2) identifying the negative cycle (3) accessing underlying feelings (4) facilitating
the expression of affectively based needs and wants, and (5) promoting acceptance of feelings
and needs. Therapists indicated at the end of each session the extent to which they performed
each intervention on a 7-­point Likert scale (1 = not at all, 7 = very much) without identifying to
which of the partners it was related to.

R E S ULT S

Because our data have a multilevel structure (sessions nested within couples), we used multilevel
regression models. Such models have two levels (a within-­individual level and a between-­individual
level), so they take into account the non-­independence of partners in a couple and can accommo-
date non-­balanced data due to missing data. We estimated separate intercepts and slopes for males
(offenders) and females (injured) using two “intercept/slopes” models. This was done by construct-
ing two dummy-­coded variables: Male (which was set to 1 when modeling males' outcome, and
to zero otherwise) and Female [which was set to 1 when modeling females' outcome, and to zero
otherwise; for more information, see Bolger and Laurenceau (2013)]. Level-­1 predictors—­that is,
therapists' interventions—­were person-­mean centered, so effects could be interpreted as associa-
tions between the outcome and within-­therapist change in therapists' interventions on a particular
session. Finally, we controlled for resolution levels reported in the previous session.
The mixed model equation was as follows:

Resolutiontm∕fj = Male + Female ∗ (γ00m∕f + γ10m∕f ∗ Validationtj + γ20m∕f ∗ Cycletj

+ γ30m∕f ∗ Accesstj + γ40m∕f ∗ Expressiontj + γ50m∕f ∗ Acceptancetj
+ γ60m∕f ∗ Resolutiont−1m∕fj + u0m∕fj + etm∕fj )

Resolutiontm/fj is the predicted outcome on session t for the male (m) or female (f) subject
in couple j. The outcome was modeled by the following fixed effects—­males'/females' intercept
(γ00m/f ), therapists' interventions in session t with couple j (γ10m/f, γ20m/f, γ30m/f, γ40m/f, γ50m/f ), and
the subject's resolution reports on session t − 1 (γ60m/f ). In addition, random effects at level 2
(u0m/fj) and level 1 (etm/fj) were included in the equation to model between-­subject and within-­
subject variability, respectively. To account for partners' interdependence, the random effects
were allowed to covariate within couples.
Bi-­variate correlations as well as means and SDs of the study variables are presented in
Table 1. As shown, partners levels of resolution were positively associated. In addition, all thera-
pist interventions were significantly correlated with each other. Finally, only the intervention of
promoting acceptance was correlated with resolution of both partners.
The results of the multi-­level model are presented in Table 2. As can be seen, therapists' pro-
moting acceptance intervention was associated with greater levels of resolution, as reported by
both females (injured partner) and males (offender partner), over and above all other therapist
interventions. Interestingly, for the males, therapists' accessing underlying emotions was associ-
ated with lower levels of resolution.
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T A B L E 1   Bi-­variate correlations, means, and standard deviations of the study variables

1 2 3 4 5 6 7
(1) Female’s partner 3.00 r = .355 r = .082 r = −.019 r = .053 r = .191 r = .285
resolution (0.95) p < .001 p > .999 p > .999 p > .999 p = .106 p = .003
(2) Male’s partner 3.57 (0.89) r = .118 r = .035 r = .054 r = .133 r = .234
resolution p = .66 p > .999 p > .999 p = .544 p = .018
(3) Validation 5.37 r = .255 r = .347 r = .260 r = .381
(1.27) p = .004 p < .001 p = .004 p < .001
(4) Identifying the 4.65 r = .343 r = .249 r = .232
cycle (1.77) p < .001 p = .006 p = .014
(5) Accessing 4.83 r = .588 r = .614
primary (1.68) p < .001 p < .001
emotions
(6) Expressing 4.27 r = .732
emotions (1.87) p < .001
(7) Promoting 4.35
acceptance (1.88)

T A B L E 2   Results of the multi-­level model analysis

Female partner Male partner

Estimates Estimates
(SE) CI p (SE) CI p
Intercept 2.97 (0.16) 2.66 to 3.29 <0.001 3.55 (0.13) 3.30 to 3.81 <0.001
Validation −0.05 (0.06) −0.16 to 0.06 0.394 −0.01 (0.05) −0.11 to 0.09 0.863
Cycle 0.01 (0.05) −0.08 to 0.10 0.794 0.03 (0.04) −0.05 to 0.12 0.401
Accessing −0.01 (0.05) −0.12 to 0.09 0.775 −0.10 (0.05) −0.19 to 0.043
−0.00
Expressing 0.01 (0.05) −0.09 to 0.12 0.785 0.00 (0.05) −0.09 to 0.10 0.976
Accepting 0.20 (0.06) 0.09 to 0.32 0.001 0.23 (0.05) 0.12 to 0.33 <0.001
Lagged outcome 0.21 (0.09) 0.04 to 0.38 0.016 0.14 (0.08) −0.02 to 0.29 0.081
Abbreviations: CI, confidence interval; SE, standard error.
Bold p values represent statistically significant values (below a p value of 0.05).

D I S C US S I O N

This study's primary goal was to examine the theoretical assumption that vulnerability expres-
sion and compassionate responding predict change in EFT-­C. The current analysis relied on the
therapist's perspective regarding change processes during a given session and examined how
these processes predicted partners' experience of resolution following the session. Rather than
focusing on specific events, such as blamer softening or re-­engagement of the withdrawing part-
ner, we focused on therapists' and partners' global assessment of their experiences every ses-
sion during the entire course of therapy. This approach provides a broader (“zoom-­out”) view of
the entire therapeutic process and complements the micro-­analytic (“zoom-­in”) approach used
when researchers focus on specific events and intensively observe and code them.
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The primary findings revealed that when therapists reported using interventions that promote
acceptance of shared vulnerable emotions in a given session, both partners reported higher reso-
lution levels following the session. That is, partners were better able to let go of their unresolved
feelings toward their partner, felt more compassion and understanding toward them, were less
troubled by their unresolved feelings and felt more forgiveness. In other words, our results sug-
gest that interventions that facilitate responsiveness seem to be particularly important in EFT-­C,
and perhaps in couples’ therapy in general.
These findings are consistent with other studies, such as McKinnon and Greenberg (2017),
where the degree of expressed vulnerability by both the offending partner and the injured part-
ner, followed by the other partner's supportiveness, predicted emotional resolution. Similarly,
Moser et al. (2018) found that couples reported a significant increase in relationship satisfac-
tion during sessions where partners engaged with each other with emotional vulnerability and
responsiveness in specific softening events. Specifically, it seems that the expression of vulner-
able primary emotions is an important ingredient in EFT-­C, but that responding to these expres-
sions in an accepting, supportive, and compassionate way is necessary for change to transpire.
Goldman and Greenberg (2013) recently stated that “in restructuring the interaction, it is the
partners’ acceptance of the expressed vulnerable underlying feelings that is paramount and it is
this that sets up a new interaction” (pp. 69).
Our findings are also consistent with basic relationship science research showing that re-
sponsiveness is associated with favorable outcomes. Receiving responsive caregiving from a part-
ner has been consistently predictive of better relational and personal well-­being (Abbey et al.,
1995; Collins & Feeney, 2000; Kaul & Lakey, 2003; Lemay et al., 2007). For example, partners'
responsiveness was found to contribute to higher positive affect and lower negative affect (Otto
et al., 2015) and is a critical component for the development of trust and felt security in relation-
ships (Collins & Feeney, 2000).
A surprising finding of this study was that when therapists reported attempting to deepen
and access primary vulnerable emotions in a given session, it predicted lower resolution lev-
els among male offenders (but not among injured females). These findings were not expected
in light of the results of previous process studies. For example, McKinnon and Greenberg
(2017) reported that the offending partner's level of expressed vulnerability predicted im-
provements on different measures, such as the degree of forgiveness and unfinished busi-
ness felt by the injured partner, and the perception of being forgiven felt by the offending
partner. Woldarsky Meneses and Greenberg (2014) found that expressions of shame by of-
fending partners significantly predicted improvements in forgiveness and marital distress
at the end of treatment. Several possible explanations might clarify the contradicting re-
sults obtained in the current analysis. First, in the current study, we relied on therapists'
reports of their interventions, whereas in other studies, emotions were observed by indepen-
dent raters. Therapists' subjective self-­report describing their experience of working with
partners toward deeper emotions may differ profoundly from how the deepening process is
coded by independent observers or how it is perceived by the partners themselves in their
self-­reports. In addition, in both McKinnon and Greenberg (2017) and Woldarsky Meneses
and Greenberg (2014) studies, offending partners' vulnerability predicted overall treatment
outcomes, whereas in the current study we examined in-­session outcomes. It is possible
that even though accessing vulnerability is important for the overall process and therefore
predicts favorable treatment outcomes, when it is experienced by the offenders in a specific
session it may lead to transient feeling of “being stuck” or having unresolved emotional pain,
which is then reported as less resolution.
JOURNAL OF MARITAL AND FAMILY THERAPY      |  9

Another important finding was that none of the other therapist interventions were associated
with resolution, as reported at the end of the session. Our results suggest that although interven-
tions like validation, cycle identification, accessing primary vulnerable emotions and revealing
them are important ingredients in EFT-­C, they might be better viewed as building blocks leading
to the primary ingredient, which is compassionate responding. In other words, validation, iden-
tifying the cycle, and accessing primary emotions are all part of a sequence leading to enactment
episodes in which partners reveal primary vulnerable emotions and experience subsequent ac-
ceptance and compassion. If the sequence does not culminate in responsiveness, however, it
seems that it is not sufficient to lead to feelings of resolution at the end of the session.

Clinical implications

Overall, our findings underscore the importance of helping partners develop the capacity to lis-
ten empathically and respond compassionately when their partners take the risk of revealing
their vulnerable primary emotions. Clinically, these findings suggest that right after one part-
ner shares identity-­or attachment-­based vulnerable feelings (e.g., shame, loneliness), therapists
should turn to the listening partner and explore his or her “gut-­level” emotional response (“what
do you feel in your stomach as she says this?”). In such enactment episodes, therapists should
help the listening partner to access, unpack, label, heighten, differentiate, and express compas-
sionate feelings toward the sharing partner and then explore with the revealing partner what it
is like to receive compassion.
However, in many instances, partners find it difficult to respond with compassion to their
partners' vulnerability. These instances are particularly challenging for therapists because the
revealing partner had taken a significant risk exposing vulnerability and remains alone and inval-
idated, which often leads to the re-­enactment of the old maladaptive interactional cycle. When
such blocks are activated in a session, therapists can try to address them by (1) validating how
difficult it was for the revealing partner to share vulnerable emotions unguardedly and not get
a supportive response, (2) exploring with the listening partner the difficulties in hearing their
partners’ pain. Compassion blocks often emanate from difficult childhood experiences (Matos
et al., 2017) and these need to be explored and processed in order to develop the capacity for
compassionate responding.

Limitations

Several limitations of this study are worth considering. First, the current analysis relied on a
small number of couples. Second, all the couples included in the study involved a male-­offender
partner and a female-­injured partner, preventing us from teasing apart gender and role differ-
ences. Third, all couples in the study where heterosexual, preventing generalization to non-­
heterosexual couples. Future studies should use larger samples and expand and diversify the
sample of couples to overcome these limitations and improve the generalizability of the find-
ings. Another limitation of the current study is that therapists reported on their interventions at
the level of the couple (e.g., In this session, I promoted acceptance of feelings and needs) rather
than referring specifically to one of the partners (e.g., I helped partner A to accept partner B’s
feelings and needs). In addition, although data were collected from multiple perspectives (both
partners and their therapist), the current study's results were based solely on self-­report data
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and may be susceptible to various biases. Finally, the way therapist intervention items were
worded did not distinguish between the interventions themselves and what actually occurred
in the session. Thus, when therapists responded to the item “In this session, I promoted vulner-
ability expression,” it is not clear whether they merely used interventions that facilitated vul-
nerability expression or if vulnerability expression actually occurred during the session. It could
be, for example, that partners had difficulties expressing vulnerability and therefore therapists
used more interventions to help them with this task. To overcome these limitations, future
studies can ask therapists to provide more detailed reports regarding their interventions (e.g.,
specifying to which partner the intervention was directed and whether or not the intervention
was successful), and also supplement these self-­report data with more objective measures (e.g.,
observers' coding).

Conclusion

The core purported transformation process portrayed by EFT-­C theory involves one partner re-
vealing vulnerable emotions and needs and the other partner responding compassionately. This
process is hypothesized to fundamentally change the emotional climate between couples, in-
terrupt the ongoing maladaptive interactional cycle, and create a more secure relational bond
(Greenberg & Goldman, 2008; Johnson & Greenberg, 1988).
Therefore, examining therapists' interventions that facilitate this process is an important task.
The results reported above suggest that when therapists indicate that they use more interventions
to promote acceptance of emotions and their associated needs in a given session, partners report
greater progress in resolving their difficulties in that session. Future research could extend these
results and investigate specific therapist interventions that effectively help couples reveal their
vulnerability and respond compassionately. In addition, studies could attempt to delineate the
conditions that optimally facilitate vulnerability and responsiveness expressions during EFT-­C.

ORCID
Ben Shahar  https://orcid.org/0000-0003-3913-2863

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How to cite this article: Kula, O., Machluf, R., Bar-­Kalifa, E., & Shahar, B. (2021). The
relationship between therapist interventions and couples' emotional injury resolution in
emotion focused couples therapy. Journal of Marital and Family Therapy, 00, 1–­12.
https://doi.org/10.1111/jmft.12560