Comparing Brief Psychoanalytic Couple Therapy and Emotionally Focused Therapy in Reducing Relationship Distress

Official title

Comparing the Efficacy of Brief Psychoanalytic Couple Therapy and Emotionally Focused Therapy in Reducing Relationship Distress and Psychopathological Symptoms: A Randomized Controlled Trial

Overview

This study compares the effects of two different couple therapy approaches-Brief Psychoanalytic Couple Therapy (BPCT) and Emotionally Focused Therapy (EFT)-on reducing relationship problems and emotional symptoms like depression and anxiety. Many couples struggle with emotional distance, repeated arguments, and dissatisfaction in their relationships. While EFT is a widely used and research-supported therapy that focuses on rebuilding emotional bonds, BPCT is a less-studied method that aims to help couples understand how early relationship experiences and unconscious patterns affect their current interactions. The purpose of this study is to find out whether one of these therapies is more effective than the other in improving relationship satisfaction and reducing emotional distress. The study also looks at changes in how people regulate their emotions and how secure they feel in their relationships after therapy. In this randomized controlled trial, 60 heterosexual couples experiencing relationship distress and symptoms of anxiety or depression will be randomly assigned to one of three groups: BPCT group - couples receive weekly online therapy focusing on deep emotional and psychological patterns in their relationship. EFT group - couples receive weekly online therapy focusing on emotional connection and improving communication. Waitlist control group - couples do not receive therapy during the study but will be offered therapy afterward. Each therapy lasts 12 weeks, and follow-up assessments will be conducted up to 6 months after therapy ends. Data will be collected before, during, and after treatment using questionnaires that measure relationship satisfaction, depression, anxiety, emotional regulation, and attachment style. The results of this study will help determine which type of therapy is more beneficial for couples experiencing emotional and relational difficulties and may provide important insights for mental health professionals working with distressed couples.

Detailed description

This study is a randomized controlled trial (RCT) designed to compare the clinical efficacy of Brief Psychoanalytic Couple Therapy (BPCT) and Emotionally Focused Therapy (EFT) in reducing relationship distress and associated psychopathological symptoms, including depression, anxiety, and emotional dysregulation. The study also explores secondary outcomes such as changes in adult attachment styles and emotion regulation strategies over time.

While EFT has an established empirical base and is commonly used in clinical practice, BPCT remains underexplored despite its longstanding clinical application. BPCT draws on psychoanalytic principles and focuses on unconscious relational dynamics, early attachment schemas, and defense mechanisms such as projection and transference. EFT, in contrast, is rooted in attachment theory and experiential therapy, emphasizing emotional expression and restructuring maladaptive interaction cycles between partners.

A total of 60 heterosexual couples (n = 120 individuals) experiencing moderate to severe relationship distress-as measured by the Dyadic Adjustment Scale (DAS-32)-and reporting clinically relevant levels of depression and/or anxiety symptoms will be enrolled. Participants will be randomly assigned to one of three arms:

BPCT group (n = 20 couples) - 12 weekly online sessions, each lasting 50 minutes, conducted by trained psychodynamic couple therapists. The focus will be on interpretation of unconscious conflict, symbolic meaning of relational behaviors, and insight into early object relations as they manifest in the couple dynamic.

EFT group (n = 20 couples) - 12 weekly online sessions, also 50 minutes each, delivered by certified EFT therapists. Sessions will center on emotional accessibility, bonding conversations, and reshaping negative emotional cycles.

Waitlist Control group (n = 20 couples) - no therapy during the intervention phase; therapy will be offered following the post-study follow-up assessment.

Assessments will occur at four time points:

Baseline (T0): Full clinical and relational assessments including DAS-32, Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and the Difficulties in Emotion Regulation Scale (DERS).

Mid-treatment (T1, Week 6): Relationship distress and psychopathology assessments (DAS-32, BDI-II, BAI).

Post-treatment (T2, Week 12): All primary and secondary outcome measures. Follow-up (T3, 6 months after completion): Long-term treatment effects and maintenance of gains.

Statistical analysis will be conducted using repeated measures ANOVA and mixed-effects regression models to account for within-couple dependence and missing data. The Reliable Change Index (RCI) will be used to assess clinically significant change. Between-group effect sizes will also be calculated.

The trial is powered to detect medium effect sizes (Cohen's d = 0.50) with 80% power, accounting for a 20% dropout rate. Therapists will receive supervision to maintain treatment fidelity, and outcome assessors will be blinded to group allocation.

All interventions will be conducted online via secure video conferencing platforms to ensure accessibility and consistency across participants.

This study is expected to contribute significantly to the literature on couple therapy by being the first direct RCT comparison of BPCT and EFT. The findings may inform clinical decision-making regarding the selection of therapeutic models for relational and emotional problems in couples, and potentially promote the integration of psychodynamic and attachment-based frameworks in couple therapy practice.

Interventions

• Behavioral Brief Psychoanalytic Couple Therapy
  Brief Psychoanalytic Couple Therapy (BPCT) consists of 12 weekly online sessions (50 minutes each) focused on uncovering unconscious relational dynamics, symbolic conflict meanings, and early attachment schemas. Techniques include relational interpretations, exploration of projective identification and transference, and analysis of emotional defenses. Therapists maintain a neutral, reflective stance to promote insight and self-awareness within the couple dynamic.
• Behavioral Emotionally Focused Therapy
  Emotionally Focused Therapy (EFT) involves 12 weekly online sessions (50 minutes each) focusing on repairing emotional bonds and enhancing attachment security. The intervention targets maladaptive emotional interaction cycles and promotes the expression of primary emotions and attachment needs. Therapists actively guide couples through restructuring emotional responses and rebuilding secure, responsive communication patterns.

Primary outcome measures

• Change in Relationship Satisfaction (DAS-32) [Time frame: Baseline, Week 6, Week 12, and 6-month Follow-up]
• Change in Depressive Symptoms (BDI-II) [Time frame: Baseline, Week 6, Week 12, and 6-month Follow-up]
• Change in Anxiety Symptoms (BAI) [Time frame: Baseline, Week 6, Week 12, and 6-month Follow-up]
• Change in Emotion Dysregulation (DERS) [Time frame: Baseline, Week 12, and 6-month Follow-up]

Secondary outcome measures (1)

• Change in Adult Attachment Style (AAS) [Time frame: Baseline, Week 12, and 6-month Follow-up]

Eligibility criteria

Inclusion criteria

• Heterosexual couples (both partners must participate)
• Age between 24 and 65 years
• Minimum 2 years of relationship duration
• At least one partner scoring ≤ 30 on the Dyadic Adjustment Scale (DAS-32), indicating clinically significant relationship distress
• At least one partner scoring in the mild, moderate, or severe range on the Beck Depression Inventory-II (BDI-II) or Beck Anxiety Inventory (BAI)

Exclusion criteria

• Current participation in individual or couple psychotherapy
• Use of psychiatric medication during the past 3 months
• Presence of severe psychiatric disorders (e.g., psychosis, bipolar disorder)
• History or presence of physical or severe psychological partner violence, assessed via Conflict Tactics Scale (CTS-2)
• Active substance use disorder within the past 6 months

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Turkey (Türkiye) · 1 center

• Beykoz University — Istanbul

Identifiers

NCT: NCT07100951 · BPCT_vs_EFT_RCT_2025

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗