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.
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
120
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.
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.
Beykoz University
Istanbul, Turkey (Türkiye)
RECRUITINGChange in Relationship Satisfaction (DAS-32)
The Dyadic Adjustment Scale-32 (DAS-32) is a 32-item self-report measure of relationship adjustment. It assesses four subscales: dyadic consensus, satisfaction, cohesion, and affectional expression. Scores range from 0 to 151, with higher scores indicating better relationship quality. A score below 100 indicates relationship distress. Changes will be assessed across the four time points to evaluate therapeutic impact.
Time frame: Baseline, Week 6, Week 12, and 6-month Follow-up
Change in Depressive Symptoms (BDI-II)
The Beck Depression Inventory-II (BDI-II) is a 21-item self-report questionnaire measuring the severity of depressive symptoms. Scores range from 0 to 63. Scores between 14-19 reflect mild depression, 20-28 moderate, and 29-63 severe. Higher scores indicate greater severity. The change in BDI-II scores will be used to assess symptom improvement.
Time frame: Baseline, Week 6, Week 12, and 6-month Follow-up
Change in Anxiety Symptoms (BAI)
The Beck Anxiety Inventory (BAI) is a 21-item self-report inventory that measures the severity of anxiety symptoms. Scores range from 0 to 63, with scores above 16 indicating clinically significant anxiety. Higher scores indicate more severe anxiety. Changes in BAI scores will track anxiety symptom reduction.
Time frame: Baseline, Week 6, Week 12, and 6-month Follow-up
Change in Emotion Dysregulation (DERS)
The Difficulties in Emotion Regulation Scale (DERS) is a 36-item measure assessing six dimensions of emotion regulation: nonacceptance, goals, impulse, awareness, strategies, and clarity. Total scores range from 36 to 180, with higher scores indicating more difficulties in emotion regulation. Changes in total scores across time points will be evaluated.
Time frame: Baseline, Week 12, and 6-month Follow-up
Change in Adult Attachment Style (AAS)
The Couples Satisfaction Index-4 (CSI-4) is a brief, 4-item scale designed to assess global relationship satisfaction. Responses are based on Likert-type items. Scores range from 0 to 21, with higher scores reflecting greater satisfaction. The CSI-4 has demonstrated strong internal consistency and criterion validity. Changes in CSI-4 scores will be used as a secondary index of intervention effectiveness.
Time frame: Baseline, Week 12, and 6-month Follow-up
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.