The Comparison of the Effectiveness of Emotionally Focused Couple Therapy and Couple Therapy with Reality Therapy Approach on Couple’s Functional Flexibility and Distress Tolerance

Document Type : Original Article


1 Department of Counseling, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran

2 Associate Professor, Department of Counseling, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran

3 . Associate Professor, Department of Psychology, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran

4 Assistant Professor, Department of Counseling, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran


Aim: The present study aimed to compare the effectiveness of emotionally-focused couple therapy and with the reality therapy on couple’s functional flexibility and distress tolerance. Method: This research was a quasi-experimental study with a pre-test and post-test associated with a control group and a 3-month follow-up. The statistical population included couples referring Counseling Center in Tehran 2018. Of them, 60 couples volunteered to participate in the research answered the Connor-Davidson Functional Flexibility Questionnaire (Resilience Scale) (2003) and Simons and Gaher Distress Tolerance Scale (2005). After the screening, 45 couples were selected who were randomly assigned to an experimental group who exposed to an intervention of emotionally-focused, an experimental group who exposed to an intervention of reality therapy, and a control group, 15 couples in each group. Both experimental groups were received eight 90-minutes sessions of intervention. Johnson's Emotion-Focused (2012) and Glaser’s Reality Therapy (2016) were used. The data were analyzed using a mixed ANOVA of repeated measures. Results: The results indicated the effect of emotion-focused intervention on functional flexibility (P= 0.001, F= 29.75) and distress tolerance (P = 0.004, F = 12.14) and the impact of reality therapy on functional flexibility (P=0.004, F=12.14) and distress tolerance (P=0.004, F= 12.14) and the stability of these effects at the follow-up phase. Conclusion: Both interventions led the couples to remove their focus from their spouse's behavior and to focus on their behavior, and while increasing their tolerance, they were able to improve their relationship by learning the right communication program.


Allen, R. C., & Palk, G. (2018). Development of recommendations and guidelines for strengthening resilience in emergency department nurses. Traumatology. Advance online publication [ Link].
Anderson. H. (2012). A Spirituality for Family living. In Walsh. F. Spiritual Resource in Family therapy. New York: Guilford Press
Denton, W.H., Wittenborn, A.K., & Golden, R.N. (2010). Augmenting Antidepressant Medication Treatment of Depressed Women with Emotionally Focused Therapy for Couples: A Randomized Pilot Study. Journal of Marital and Family Therapy, 38(1): 23-38. [Link]
Dutch, M. S., & Ratanasiripong, P. (2017). Marriage family therapist’s attitudes toward evidencebased treatments and readiness for change. Journal of Psychotherapy Integration, 27(4): 540-547. [Link]
Elliott, T. R., Hsiao, Y.-Y., Kimbrel, N. A., DeBeer, B. B., Gulliver, S. B., Kwok, O.-M., Morissette, S. B., & Meyer, E. C. (2019). Resilience facilitates adjustment through greater psychological flexibility among Iraq/Afghanistan war veterans with and without mild traumatic brain injury. Rehabilitation Psychology, 64(4): 383–397. [Link]
Keough, M.E., Riccardi, C.J., Timpano, K.R., Mitchell, M.A., & Schmidt, N.B. (2010). Anxiety Symptomatology: The Association with distress tolerance and anxiety sensitivity. Behavior Therapy, 41: 567-574. [Link]
Johnson, S.M. (2012). The practice of emotionally focused couple therapy. New York: Brunner – Rutledge.
Johnson, S., & Zuccarini, D. (2010). Integrating Sex and Attachment in Emotionally Focused Couple Therapy. Journal of Marital and Family Therapy, 36(4): 431-445. [Link]
MacKillop, J., & De Wit, H. (Eds). (2013). The Wiley-Blackwell Handbook of Addiction Psychopharmacology. John Wiley & Sons.
Tie S, Poulsen Sh (2013). Emotionally focused couple therapy with couple’s marital adjustment. Contemporary Family Therapy; 35(3): 393-402. [Link]
Wiebe, A. S., & Johnson, M. S. (2017). Creating relationship that foster resilience in Emotionally Focused Therapy. Current Opinion in Psychology, 13: 65-69. [Link]
Williams, A. D., Thompson, J., & Andrews, G. (2013). The impact of psychological distress tolerance in the treatment of depression. Behaviour research and therapy, 51(8): 469-475. [Link]
Williamson, H. C., Rogge, R. D., Cobb, R. J., Johnson, M. D., Lawrence, E., & Bradbury, T. N. (2015). Risk moderates the outcome of relationship education: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(3): 617629. [Link]
Yi-Frazier, J. P., Fladeboe, K., Klein, V., Eaton, L., Wharton, C., McCauley, E., & Rosenberg, A. R. (2017). Promoting Resilience in Stress Management for Parents (PRISM-P): An intervention for caregivers of youth with serious illness. Families, Systems, & Health, 35(3): 341–351. [Link]
Zuccarini, D., Johnson, S.M., Dalgeish, T.L., & Makinen, J.A. (2013). Forgiveness and Reconciliation in Emotionally Focused Therapy for Couples: The Client Change Process and Therapist Interventions. Journal of Marital Fam Ther, 39(2): 14862. [Link]