LAPORAN PRAKTIKUM REVIEW ANALISIS CINEMA EDUCATION

“OUTBREAK (1995)”

KEPERAWATAN KELUARGA

Oleh:
Kelompok 1
KELAS E - 2016
Jatmiko Dwi Purnomo NIM 162310101237
Fahmadini Rozana P. NIM 162310101253
Fifi Lanna Fauziah NIM 162310101265
Muhammad Sufyan Asasi NIM 162310101271
Augustha Eridmes Sabru NIM 162310101317

PROGRAM SARJANA ILMU KEPERAWATAN

FAKULTAS KEPERAWATAN
UNIVERSITAS JEMBER
2018
A. KEHADIRAN KELUARGA
1. Gambaran singkat tentang film
Film Outbreak menceritakan tentang wabah dan penyebaran virus
yang sangat cepat melalui udara. Awalnya, virus tersebut menyerang
penduduk yang ada di Motaba river valley,Zaire, Afrika dan sudah
menewaskan banyak orang disana. Virus ini kemudian menyebar ke
kota California, Amerika. Inang dari virus ini yaitu monyet yang hidup
di Afrika, awalnya mereka tidak tau kalau inangnya itu dari seekor
monyet, yang kemudian monyet tersebut diselundupkan dari Afrika
dibawa ke California dan menjadi wabah disana. Virus ini menginfeksi
siapa saja dengan tanda gejala awal yaitu demam tinggi, batuk dan
mata akan menjadi merah dan jika tidak ditangani alam beberapa jam
akan menyebabkan kematian pada orang yang terinveksi virus
tersebut. Virus tersebut menyerang sel-sel dari orang yang terinveksi.
Tenaga medis militer tepatnya di United States Army Medical
Research Institusi of Infectious Diseases (USAMRIID) berusaha untuk
mencari inang atau pembawa virus tersebut guna menemukan
antiserum, sehingga dapat mencegah penyebaran virus ataupun
kematian pada orang yang terinfeksi, tetapi pada awalnya USAMRIID
tidak mengetahui bahwa inang dari virus tersebut adalah dari monyet.
Ketika di California dan menjadi wabah, akhirnya Sam Daniels
menemukan inang tersebut adalah dari seekor monyet.
Pemeran Utama :
Sam Daniels : yang diperankan oleh Dustin Hoffman, yaitu sebagai
Dokter tentara Kolonel di United States Army
Medical Research Institusi of Infectious Diseases
(USAMRIID) yang berperan penting dalam
penemuan inang dari virus serta antiserum untuk
mencegah penyebaran yang lebih luas. Sam Daniels
memiliki karakter yang tegas serta bertanggung jawab
atas keputusan yang diambilnya.
Roberta “Robby” Keough: yang diperankan oleh Rese Russo ysitu
sebagai mantan istri Sam Daniels yang masih
memiliki hubungan baik dengan Sam Daniels. Robby
juga berperan penting dalam mengidentifikasi terkait
virus yang mewabah dan menginfeksi penduduk.
Pemeran Pendukung:
Brigadier General Billy Ford: yang diperankan oleh Morgan
Freeman sebagai Jenderal tentara USAMRIID sahabat
Sam Daniels dan juga atasannya yang bertugas
memberikan perintah bagi Sam Daniels dalam
menjalankan tugas-tugasnya.
Casey Schuler: yang diperankan oleh Kevin Spacey sebagai rekan
kerja Sam Daniels dan Robby yang juga meneliti
terkait kasus yang berhubungan dengan virus. Ia juga
merupakan seorang Dokter di USAMRIID.
Donald “Donnie” McClintock: yang diperankan oleh Donald
Shuterland yaitu jenderal di USAMRIID yang juga
memegang kekuasaan dalam memerintahkan
bawahannya bertindak sesuai dengan yang ia
perintahkan.
Salt : yang diprankan oleh Cuba Gooding Jr merupakan
Mayor di yang juga rekan kerja Sam Daniels dalam
menemukan inang dan antiserum serta melakukan
penelitian terkait virus yang menjadi wabah di
California, Amerika tersebut.
Benjamin Iwabi : seorang penduduk Zaire, Afrika yang
menceritakan terkait penyebaran virus yang tengah
melanda desanya
2. Gambaran Ecomap Keluarga Tersebut

3. Analisis Ecomap Secara Spesifik Terkait Hubungan Keluarga Dan

Lingkungan Sekitar
Sam Daniels memiliki perceraian dengan istrinya, namun masih
memiliki hubungan yang baik. Sam Daniels tinggal berpisan dengan
mantan istrinya dan tinggal dengan kedua anjing peliharaannya. Sam
Daniels memiliki rasa tanggung jawab yang tinggi untuk pekerjaan
yang dijalaninya. Sam Daniels juga memiliki Hubungan yang kuat
dengan rekan-rekan kerjanya, meski Sam Daniels memiliki pangkat
yang lebih tinggi namun ia selalu mengayomi bawahannya dan
memperlakukan mereka selayaknya teman. Bekerja sebagai tenaga
medis di bidang militer Sam Daniels selalu berikatan kuat dengan
rumah sakit ataupun pusat penelitian virus dan bakteri. Selain
pekerjaannya, Sam Daniels juga memiliki hewan peliharaan yang
tinggal dengannya dan diperlakukan dengan baik oleh Sam Daniels
sebagaimana orang lain menyayangi hewan peliharaannya. Namun
Sam Daniels memiliki hubungan yang kurang baik dengan atasannya,
 terutama ketika menjalankan perintah. Sam Daniels lebih sering
membangkang terhadap perintah yang diberikan atasan dan lebih
memilih menjalani perkerjaannya sesuai dengan kehendak hatinya.

B. PENILAIAN KELUARGA DAN KEBUTUHAN KELUARGA

1. Kondisi Fisik dan Psikososial
Kondisi fisik: Sam Daniels merupakan tenaga medis yang bergerak
dibidang militer sehingga dituntut untuk memiliki fisik
yang baik dan optimal. Tubuhnya yang kekar serta
memiliki stamina yang baik menjadi salah satu kondisi
fisik yang dimiliki Sam Daniels sebagaimana sesuai
dengan pekerjaannya dibindang militer. Sedangkan
untuk kondisi fisik mantan awalnya juga memiliki
kondisi fisik yang baik, namun setelah terinfeksi virus
kondisi visiknya mulai melemah, mata dan area mata
yang mulai memerah, dan wajah yang pucat.
Psikososial: Sam Daniels memiliki hubungan yang baik dengan rekan
kerjanya ataupun dengan mantan istrinya. Meski
memiliki jabatan yang cukup tinggi ia tidak pernah
memperlakukan bahwahannya dengan semena-mena
namun menganggap mereka sebagai temannya. Sam
Daniels memiliki rasa tanggung jawab yang tinggi dan
segera bergerak cepat ketika menyelesaikan suatu
masalah, ia memiliki kekhawatiran yang tinggi ketika
rekan-rekannya berada dalam kondisi yang mungkin
membahayakan, Sam Daniels juga memiliki hewan
peliharaan dan memeperlakukannya dengan baik.
Berdasarkan hal tersebut dapat dikatakan bahwa Sam
Daniels memiliki rasa empati yang cukup tinggi untuk
longkungan sekitarnya.
2. Faktor Lingkungan dan Sosiokultural; Nilai, Keyakinan dan
Ritual
Lingkungan: Sam Daniels dikelilingi oleh orang-orang baik yang
bersedia untuk terus mendukungnya dalam mengambil
suatu bentuk keputusan, namun tidak semua orang sekitar
Sam Daniels sepermikiran dengannya, adapula beberapa
pihak yang menentang keputusan Sam Daniels bahkan
berniat menggagalkan rencana Sam Daniels dalam proses
pencaria sumber wabah yang menyerang suatu kota di
California, Amerika. Sam Daniels lebih banyak berada di
wilayah kerja yaitu militer dibanding dirumah, sehingga
menuntut Sam Daniels untuk dapat berlaku tegas serta
cepat dalam mengambil suatu keputusan. Tekanan yang
keras serta dilema antara hati nurani dengan perintah
atasan menjadi masalah yang sering dihadapi Sam Daniels
dalam memutuskan suatu permasalahan.
Nilai: sebagai seseorang yang bergelut dibidang militer utamanya
dalam kesehatan, Sam Daniels memiliki rasa kemanusiaan
yang tinggi. Terbukti ketika Sam Daniels mengetahui
adanya penyebaran wabah aneh disuatu daerah, ia
bersungguh-sungguh menekuni terkait dengan penyebaran
hingga bagaimana cara menemukan pengobatan untuk
wabah tersebut tanpa mengunggu intrusi dari atasannya,
Sam Daniels lebih memilih untuk mengikuti hati
nuraninya untuk segera menemukan antiserum untuk
mencegah penyebaran wabah yang lebih parah lagi.
Keyakinan: ketika menghadi suatu masalah Sam Daniels meyakini
bahwa ada inang atau pembawa virus hingga
menyebabkan suatu wabah. Sam Daniels juga meyakini
bahwa inang tersebut merupakan kunci untuk
menyembuhkan penyakit yang disebabkan oleh virusnya.
Sehingga dapat disimpulkan bahwa Sam Daniels
 berkeyakinan bahwa suatu masalah memiliki penyebab
dan masalah tersebut dapat diatasi dengan mencari
penyebabnya.
Spiritual: Dalam film tidak begitu digambarkan terkait dengan spiritual
Sam Daniels ataupun keluarga.
3. Status Gizi dan Obat-obatan
Status gizi : Dalam film tidak disebutkan bagaimana status gizi Sam
Daniels, tetapi Sam Daniels sehat dan mempunyai tubuh
proporsional yang bekerjanya di militer.
Obat-obatan : Sam Daniels tidak mengkonsumsi obat-obatan tertentu.
Hanya saja sebagai orang yang bertanggung jawab dalam
bidang kesehatan utamanya militer, Sam Daniels memiliki
ambisi untuk menemukan obat atau antiserum yang
kemudian diberikan kepada orang-orang yang terinfeksi
virus termasuk mantan istrinya.
4. Penggunaan Sumber Perawatan Kesehatan atau Pengobatan
Alternatif
Sam Daniels merupakan seseorang yang bergerak dibidang militer
khususnya di bidang medisnya, ketika menagani suatu masalah terkait
kesehatan yaitu penyebaran wabah, Sam Daniels lebih sering berada di
rumah sakit untuk penelitian terkait virus ataupun penangannya.
Ketika mantan istrinya terserang virus, Sam Daniels juga
mempercayakan tenaga medis untuk merawat mantan istrinya tersebut.
5. Diagnosa Medis
Motaba Virus
6. Bagaimana Kondisi Klien Mempengaruhi Keluarga dan Reaksi
Mereka
Ketika Sam Daniels mengetahui mantan istrinya berisiko terinfeksi
virus, ia sangat khawatir yang kemudian segera mencari sumber dari
wabah untuk menemukan antiserum yang dapat menolong istrinya
tersbut hingga menentang perintah atasannya dan membahayakan
keselamatannya. Karena meskipun Sam Daniels telah bercerai dengan
 istrinya, namun ia masih sangat peduli dengan istrinya tersebut.
Begitupula dengan mantan istri Sam Daniels setelah mendengar kabar
bahwa Sam Daniels akan meninggalkannya untuk mencari antiserum,
ia mendukung keputusan Sam Daniels. Walaupun Sam Daniels atau
pun mantan istri beranggapan bahwa sulit untuk kondisinya
diselamatkan, namun mereka masih berusaha mencari solusi dari
permasalahan tersebut
7. Persepsi Keluarga Tentang Kesehatan
Sam Daniels dan mantan istrinya sangat menjaga terkait dengan
kesehatan dirinya ataupun lingkungan sekitar. Hal ini terlihat ketika
mereka berhadapan dengan suatu masalah terkait penyebaran virus
yang cepat, mereka selalu mencaga tubuhnya untuk tidak
terkontaminasi sedikitpun dengan udara sekitar karena khawatir akan
terinfeksi, begitupun ketika mereka mengetahui kesalahan mereka
yang dapat berisiko memungkinkan terinfeksinya virus, mereka
dengan segera membersihkan diri diruangan khusus untuk
mensterilkan tubuh mereka ataupun memberikan cairan.
8. Kekuatan Keluarga
Meski Sam Daniels sudah bercerai dengan istrinya, namun Sam
Daniels masih memiliki hubungan yang baik. Hal ini terlihat ketika
mereka masih saling berhubungan dan saling mendukung terkait
dengan masalah yang tengah dihadapi. Istri Sam Daniels juga sering
memperlihatkan perhatiannya terkait dengan kesehatan dan kondisi
Sam Daniels. ketika mantan istri Sam Daniels terinfeksi virus, Sam
Daniels juga memberikan perhatian yang penuh untuknya bahkan rela
membahayakan dirinya untuk mencari obat untuk mematikan virus
yang ada dalam tubuh mantan istrinya tersebut. Sam Daniels dan
mantan istri juga memiliki koping yang baik dalam menghadapi
masalah mereka, mereka lebih sering berdiskusi ketika ada masalah
muncul ataupun ketika mantan istri Sam Daniels terinfeksi virus,
mereka dengan sabar menantikan penemuan antiserum untuk
menyembuhkan penyakit dan mengatasi mewabahnya virus.
 Laporan analisis film tersebut menggunakan teori Betty Neuman
yang membahas tentang teori sistem model yang merupakan gabungan
dari konsep holistik dan pendekatan sistem terbuka yang dapat
berinteraksi, beradaptasi, dengan dan disesuaikan oleh lingkungan
yang digambarkan sebagai stressor yang diperlihatkan dalam film
bahwa garis resistennya sudah tertembus shingga banyak orang yang
mengalami virus tersebut.
C. IDENTIFIKASI MASALAH
Data Maladaptif Diagnosa Keperawatan Rencana Keperawatan Tindakan Keperawatan Jurnal Rujukan
a. Ketika sam a. Ketidakefektifan Mediasi Konflik (5020) a. Menyediakan tempat Vazhappilly,
Daniel akan pergi hubungan keluarga a. Sediakan tempat yang nyaman, netral dan J.J. dan Marc,
ke Zaire dan b.d ketidakefektifan yang nyaman, terjaga kerahasiaannya E.S.R. 2017.
menitipkan keterampilan netral dan terjaga untuk proses Efficacy of
anjingnya ke pemecahan d.d kerahasiaannya dilaksanakannya diskusi Emotional-
Robby dan Ketika sam Daniel untuk proses b. Menawarkan panduan Focused
mereka berdepat dilaksanakannya selama proses (mediasi) Couples
akan pergi ke Zaire
karena anjingnya diskusi c. Menggunakan berbagai Communicatio
dan menitipkan
akan dibawa b. Tawarkan panduan teknik komunikasi yang n Program for
Robby ke Atlanta anjingnya ke Robby selama proses efektif Enhacing
b. Robby dan mereka berdepat (mediasi) d. Membantu untuk Couples’
mengatakan agar karena anjingnya c. Gunakan berbagai menenmukan akar Communicatio
Sam Daniel akan dibawa Robby teknik komunikasi permasalahannya n and Marital
membawa ke Atlanta, Robby yang efektif e. Memfasilitasi pencarian Satisfication
barang- mengatakan agar d. Bantu untuk jalan keluar yang dapat Among
barangnya untuk Sam Daniel menenmukan akar diterima oleh kedua Distressed
dibawa pulang, membawa barang- permasalahannya belah pihak Partners.
barang-barang barangnya untuk e. Fasilitasi pencarian f. Mendukung upaya Journal of
tersebut termasuk dibawa pulang, jalan keluar yang resolusi semua pihak Contempory
foto-foto masa dapat diterima oleh g. Memonitor jalannya Psychotherapy.
barang-barang
lalu antara Sam kedua belah pihak proses resolusi 48 : 79-88
tersebut termasuk
Daniel dengan f. Dukung upaya
Robby foto-foto masa lalu resolusi semua
c. Sam dan Robby antara Sam Daniel pihak
berdebat dengan Robby, Sam g. Monitor jalannya
dan Robby berdebat
 mengeni mengeni proses resolusi
ketidakpastian ketidakpastian
kepulangan Sam kepulangan Sam dari
dari Zaire yang Zaire yang
berdampak pada berdampak pada
kapan anjing kapan anjing
peliharaan Sam
peliharaan Sam akan
akan diambil dari
diambil dari Robby,
Robby
d. Sam dan Robby Sam dan Robby
berdebat ketika berdebat ketika
Robby membawa Robby membawa
anjingnya Sam anjingnya Sam waktu
waktu naik taksi, naik taksi, dan Sam
dan Sam tidak tidak bisa
bisa mengungkapkan apa
mengungkapkan yang ingin dikatakan
apa yang ingin kepada Robby
dikatakan kepada
Robby
a. Ketika Sam Kesiapan meningkatkan Peningkatan Integritas Peningkatan Integritas Vazhappilly,
berkata kepada hubungan d.d Ketika Sam Keluarga (7100) Keluarga (7100) J.J. dan Marc,
Robby saat berkata kepada Robby saat a. Bina hubungan a. Membina hubungan E.S.R. 2017.
Robby sudah Robby sudah melewati masa saling percaya saling percaya dengan Efficacy of
melewati masa kritisnya. dengan anggota anggota keluarga Emotional-
kritisnya. - Sam : ingin memulai keluarga b. Mempertimbangkan Focused
- Sam : ingin hidup baru denganku b. Pertimbangkan pemahaman keluarga Couples
memulai lagi?” pemahaman terhadap kondisi yang Communicatio
 hidup baru - Robby : mungkin. keluarga terhadap ada n Program for
denganku Karena sekarang aku kondisi yang ada c. Mempertimbangkan Enhacing
lagi?” sudah punya antibodi” c. Pertimbangkan perasaan keluarga Couples’
- Robby : perasaan keluarga terhadap situasi yang Communicatio
mungkin. terhadap situasi mereka hadapi n and Marital
Karena yang mereka d. Mengindentifikasikan Satisfication
sekarang aku hadapi prioritas konflik yang Among
sudah punya d. Indentifikasikan ada diantara anggota Distressed
antibodi” prioritas konflik keluarga Partners.
yang ada diantara e. Membantu keluarga Journal of
anggota keluarga dalam mengatasi konflik Contempory
e. Bantu keluarga f. Memfasilitasi Psychotherapy.
dalam mengatasi komunikasi yang terbuka 48 : 79-88
konflik antar anggota keluarga
f. Fasilitasi
komunikasi yang
terbuka antar
anggota keluarga
D. TERAPI KELUARGA
Judul Film
Masalah Keluarga
Terapi Keluarga
Pengertian Terapi keluarga
Indikasi terapi keluarga
Kontraindikasi terapi keluarga
Persiapan terapi keluarga
Prosedur Terapi Keluarga :
1. Prainteraksi
Outbreak (1995)
Masalah dalam keluarga ini adalah penyakit
virus motaba yang diderita oleh seorang
peneliti, yang kemudian seorang peneliti ini
takut jika dirinya harus mati terlebih dahulu
dan tidak dapat disembuhkan.
Terapi integrasi non komunikasi yang hebat
dengan emosional terfokus
Terapi keluarga yang dilakukan adalah terapi
keluarga yang menupayakan dapat
menciptakan suasana kondusif interaksi yang
sehat dan untuk meniadakan gaya yang tidak
diinginkan dan berbahaya serta meningkatkan
gaya komunikasi dan keterampilan dari para
mitra; ini pada gilirannya akan mengarah
pada peningkatan kepuasan pernikahan
sebagai dua variabel ini berkorelasi kuat
Kelurga dengan pasien yang mengalami
ketidakpuasan dalam suatu pernikahan
-
a. Menentukan waktu kapan untuk datang
ke pasien
b. Perawat mencari data tentang pasien
melalui rekam medis maupun dari
keluarga
c. Pra-Edukasi dengan membina hubungan
saling percaya antara perawat, keluarga
dan pasien.
a. Lakukan pengkajian data dan catatan
 perawatan klien
b. Cek ulang identitas dan data klien
c. Nilai kesiapan diri perawat
d. Susun rencana pertemuan dengan klien
e. Siapkan peralatan yang dibutuhkan
f. Cuci tangan
2. Orientasi a. Melakukan salam dan senyum kepada
klien
b. Memvalidasi identitas klien
c. Memperkenalkan nama perawat
d. Menanyakan identitas pasien (nama
lengkap dan tanggal lahir) kepada
keluarga klien
e. Melakukan validasi (kognitif, afektif,
psikomotor) pada keluarga klien
f. Menjelaskan maksud dan tujuan program
terapi
g. Kontrak waktu, tempat dan kesediaan
klien serta keluarga klien
3. Kerja a. Mengumpulkan anggota keluarga (suami
dan istri)
b. Mengumpulkan tindakan dengan cara
yang baik untuk menciotakan rasa
percaya dan nyaman
c. Pasangan suami istri diminta untuk
mengisi form yang telah disediakan
perawat
d. Pasangan suami istri diminta untuk
mengisi tes yang telah disediakan
perawat
e. Perawat menghitung total skor tes yang
telah dilakukan oleh pasangan suami istri
 (klien)
f. Perawat memberikan kegiatan kelompok,
presentasi audio visual, memberikan
buku pegangan, tugas rumah, dan
sebagainya sesuai dengan jadwal yang
telah ditentukan oleh perawat.
g. Terminasi a. Melakukan evaluasi subjektif
b. Melakukan evaluasi objektif
c. Beri reinforcement positif
d. Lakukan kontrak untuk tindakan pada
pertemuan selanjutnya
e. Akhiri pertemuan dengan cara yang baik
Evaluasi terapi keluarga a. Mendokumentasikan hasil dari tindakan
b. Menilai keefektifan tindakan yang telah
dilakukan
c. Mengambil keputusan untuk
menghentikan atau melanjutkan terapi
Sumber Referensi: Vazhappilly, J.J. dan Marc, E.S.R. 2017.
Efficacy of Emotional-Focused Couples
Communication Program for Enhacing
Couples’ Communication and Marital
Satisfication Among Distressed Partners.
Journal of Contempory Psychotherapy. 48 :
79-88
E. CRITICAL APRAISAL
Penulis Jurnal
Judul Jurnal
Nama Jurnal,Edisi dan Tahun
Tujuan Penelitian
Metode Penelitian
Hasil dan Pembahasan
Implikasi Keperawatan
Joshy Jacob Vazhappily, Marc Eric S. Reyes
Efficacy of Emotion-Focused Couples Communication
Program for Enhancing Couples’ Communication
and Marital Satisfaction Among Distressed Partners
Journal Of Contemporary Psikoterapi, 48:79-88. 2018
Untuk mengetahui peningkatan komunikasi perkawinan
dan kepuasan antara pasangan tertekan.
Studi saat ini membuat penggunaan metode penelitian
eksperimental yang benar, khususnya antara subjek,
untuk menentukan kemanjuran dari program intervensi
peneliti-dikembangkan. Penelitian ini melibatkan dua
kelompok dan desain terdiri dari desain pretest-posttest
kelompok dalam menentukan keampuhan effi- Emosi-
Focused Pasangan Komunikasi Program. Kelompok-
kelompok yang dibentuk oleh seleksi acak dan kedua
kelompok mengambil pretest dan posttest, sedangkan
kelompok eksperimen menerima pengobatan, peserta
dari kelompok kontrol tidak menerima pengobatan
apapun. standar etika dan prinsip-prinsip yang dianut
dalam melakukan penelitian dan persetujuan diperoleh
dari Komite Ulasan etis dari University sebelum
melakukan percobaan.
Hasil penelitian menunjukkan Inventarisasi Primer
Komunikasi (PCI) dan DAS menunjukkan bahwa
Emotion-Focused pasangan program komunikasi
memiliki dampak yang besar dalam meningkatkan
komunikasi pasangan dan meningkatkan kepuasan di
antara peserta penelitian.
Program komunikasi emosi-focused pasangan ini
berkhasiat dalam menigkatkan kualitas hubungan
pasangan menikah. Program komunikasi menimbulkan
perubahan signifikan secara statistik pada tingkat
komunkasi pasangan dan kepuasan pernikahan antara
para peserta. Intervensi dari program ini juga
membuktikan keandalan dan validitas program emosi
komunikasi-focused pasangan sebagai alat psikoterapi
yang manjur dalam memperbaiki hubungan mereka dan
meningkatkan kualitas perkawinan mereka.
Komunikasi yang efektif dan keterbukaan terhadap
emosi pasangan akan memperkuat ikatan saling
pengertian dan penerimaan dan akan menjalin
persahabatan yang lebih dan keintimam antara pasangan.
Dalam melakukan terapi ini perawat harus melakukan
komunikasi terapeutik yang baik dengan keluarga
sehingga terapi yang diterapkan bisa terlaksanakan
dengan baik dan mendapatkan hasil yang efektif.
Journal of Contemporary Psychotherapy (2018) 48:79–88
https://doi.org/10.1007/s10879-017-9375-6

ORIGINAL PAPER

Efficacy of Emotion-Focused Couples Communication Program

for Enhancing Couples’ Communication and Marital Satisfaction
Among Distressed Partners
Joshy Jacob Vazhappilly1   · Marc Eric S. Reyes1,2

Published online: 25 November 2017

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Abstract
This study investigated the efficacy of ‘Emotion-Focused Couples’ Communication Program’ for enhancing marital com-
munication and satisfaction among distressed couples. It used a ‘two-group randomized control trial’ with 32 couples who
belonged to the urban, middle class society of Maharashtra, India. ‘Primary Communication Inventory’ and ‘Dyadic Adjust-
ment Scale’ were used to measure the level of communication and marital satisfaction. The program lasted five weeks and
the results showed significant effects elicited by the program. Two-way ANOVA was used for data analysis and Cohen’s d
test measured effect’s extent. This suggested ‘Emotion-Focused Couples’ Communication Program’ to be an effective tool
for enhancing communication and marriage quality, thus positing that a healthy communication between the partners ensures
greater marital satisfaction in a spousal relationship.

One of the basic human needs is to establish relationship
with someone; belonging to and being attached with a loving
and caring partner provide a sense of security and enhance
well-being (Bumeister and Leary 1995). According to the
adult attachment theory, individuals look for and feel secure
and confident in the presence of an attachment figure that
one is emotionally close to (Bowlby 1973; Raeisipoor et al.
2012). As posited by Azeez (2013), marriage is a unique
institution that responds to this need, helping humans find
fulfillment and meaning in life, and acting as a source of
individual happiness. A satisfying marriage therefore
becomes one of the most important goals of human per-
sons, and facilitates the attainment of the full actualization
of human potentialities (Whisman et al. 2009).
Notwithstanding the studies and researches attesting the
benefits of marriage, there is an alarmingly growing num-
ber of instances where marriage itself becomes a source of
* Joshy Jacob Vazhappilly
jojvazha@gmail.com
Marc Eric S. Reyes
msreyes@ust.edu.ph
1
The Graduate School, University of Santo Tomas, Manila,
Philippines
2
Department of Psychology, College of Science, University
of Santo Tomas, Manila, Philippines
great distress and dissatisfaction among the partners causing
discomfort and negative set-backs that push the partners into
physical and psychological ill-health (Roberts et al. 2007).
In recent times many studies have come up with the find-
ings that relationship hazards and marital disharmony have
substantially contributed towards dysfunction and distress
among couples and families (Sandhya 2009). Poor marital
adjustment has an adverse effect on the mental and physi-
cal health of the couples, preventing them from experienc-
ing physiological and psychological well-being which is
one of the original intents of marriage (Finchem and Beach
2010). The emergence of a vast variety of mental sicknesses
(Goldfarb et al. 2007), as well as physiological discomfort
and illness (Pihet et al. 2007) is largely attributed to marital
distress. Deprivation of emotional security and absence of
an attachment figure often push the persons into neurobio-
logical imbalances and causes a dip in the so-called cuddle
hormone ‘Oxytocin’ which plays a vital role in the immune
system (Taylor et al. 2000).
There can be a number of reasons for a couple to experi-
ence distress and discord in their marital relationship. In
fact, scholars cite a variety of factors like education, physi-
cal health, finance, order of marriage, cultural milieu, age
of the partners, and number of children and so on as fac-
tors determining the quality of a marital relationship. One
that stands out and demands considerate attention among
all these factors is the effective communication or the lack

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of it between the couples. While a healthy communication
nurtures human relationship, a faulty and unhealthy com-
munication pattern leads the couples to disconnect from one
another and causes a dip in the level of marital satisfaction
(Rosenberg 2003). An effective communication between the
partners is imperative for a satisfactory and healthy mar-
ried relationship (Theiss and Solomon 2006), because com-
munication helps the couple enhance and strengthen their
love relationship. This leads to better understanding of and
respect and regard for the partner and helps to know each
other more deeply (Bodenmann et al. 2009).
It is worth noting that most couples who have problems
in their communication styles do also have problems in their
relationship (Askari et al. 2012; Ledermann et al. 2010).
For, the characteristics and styles of interpersonal interac-
tions play a very decisive role in marital satisfaction (Abbasi
and Afsharinia 2015; Smith et al. 2008). Several scientific
studies affirm that intimacy, which is an essential factor of
marital satisfaction, can be attained only when there is an
effective communication and willingness for mutual disclo-
sure (Yalcin and Karahan 2007). Research has proven that
it is easy to distinguish between the distressed couples from
the non-distressed or happy ones just by looking at their
communication patterns marked by the behaviors like con-
stant nagging, avoidance, fault findings and so on (Birchler
and Fals-Stewart 2006). Both longitudinal (Olson and Miller
2007) as well as cross sectional researches have proven
beyond doubt that an effective couples’ communication
pattern definitively and consistently predict higher levels of
marital satisfaction and an absence of such an effective style
of mutual interaction not only makes the relationship cold,
but in fact pushes it in to deeper levels of distress (Litzinger
and Gordon 2005; Troy 2000).
Considering the significance of an effective communica-
tion in ensuring satisfactory conjugal relationship, and tak-
ing it as a starting point, the present study was envisioned to
address the marital distress experienced by urban and upper
middle class families of India, by helping them improve their
communication skills through an intervention program. In
the Indian ethos, marriage is considered a sacred institution
and a pious duty and an essential pre-requisite for the attain-
ment of MOKSHA-liberation or salvation of human soul.
It is also deeply related to the emotions of the individuals,
especially females, who start dreaming about marriage as
they enter into adolescence and early adulthood and look
up to married life and bearing children as a fulfillment of
their womanhood (Sonawat 2001). However, this picture is
undergoing changes in a fast pace as instances of marital
distress and divorce cases are becoming increasingly high
(Faye et al. 2013).
Studies conducted at different parts of India among dif-
ferent sections of the society indicate a steady growth in the
cases of marital disharmony and distress leading, sometimes,
13
Journal of Contemporary Psychotherapy (2018) 48:79–88
to the extreme point of divorce and family break-up (Anna
2003). Though compared to many western and developed
countries, divorce rate in India is still very low at 1.1% as
found in the decinnial census conducted by the Governement
of India, there appears to be a rise in the number of peo-
ple approaching family courts seeking annulment of their
marital bond. According to the results of a social survey
conducted in India by a leading English Daily ‘Hindustan
Times’ there is an unprecedented rise in the divorce rate in
the country in recent times and divorce applications in the
family courts in the metropolitan cities of Mumbai, Kol-
kata, Bangaluru, Lucknow, Nagpur, Hyderabad, Delhi and
Chennai have doubled or even tripled over the last 5 years
(Times 2015). According to a recent survey conducted by
Rediff News, Maharashtra topped the nation in divorce cases
in the year 2011 with over 20,000 cases filed in the cities
of Mumbai, Nashik, Pune and Nagpur (RediffNews 2012).
Studies posit that along with various factors contributing
towards marital distress, a rigid, unhealthy and inadequate
communication between the partners plays a vital role in
cuasing greater reluctance to let go and give in (Times
2015). Moreover, the traditional and conservative nature of
the Indian society and its rigid social norms put limits to
couples’ expression of affection, mutual availability and inti-
macy. The presence of the parents/ in-laws and the important
others in the family, and their responsibilities and obligation
towards family seldom allow the couples to spend quality
time with one another and freely share their needs and aspi-
rations without inhibitions (Sonawat 2001). This augments
the level of distress among the couples.
In comparison to the vast population of the country, a
whopping 1.21 billion, and the growing number of families
and couples facing marital problem, studies and curative
interventions to stem the marital distress are so very few.
Seldom does one find studies in the direction of addressing
the problem of poor communication skills of the couples,
and even if there are a few, they are scanty and scattered
(Askari et al. 2012; Sonawat 2001). The researcher sought to
fill this research gap by developing an intervention program
that would be significant in addressing the menacingly grow-
ing problem of marital distress in India.
In this study, the researcher integrated Non-Violent Com-
munication (NVC) and Emotionally-Focused Therapy (EFT)
in developing a psychotherapeutic intervention for enrich-
ing couples’ communication and marital satisfaction of dis-
tressed couples. The intervention aimed at improving the
communication style and skill of the partners; this would in
turn lead to the enhancement of marital satisfaction as these
two variables are strongly correlated (Vazhappilly and Reyes
2016). The purpose of the intervention was to enable the par-
ticipants to avoid a language that disconnects and to acquire
a language which is nonviolent and compassionate—a lan-
guage of life as Rosenberg calls it- a language that facilitates
Journal of Contemporary Psychotherapy (2018) 48:79–88 81
better connection (Rosenberg 2003). The integration of Non-
Violent Communication with Emotionally Focused Therapy
provided the intervention program the extra edge in creating
conducive atmosphere of healthy interaction and to negate
the unwanted and harmful styles.
Non-Violent Communication speaks of tools and strate-
gies that are nonviolent; enhancing empathy; and promot-
ing compassionate communication. Rosenberg speaks of
connecting to oneself and to others with empathy, restrain-
ing from judgmental and diagnostic language and ensuring
better connectedness. Non-Violent Communication offers
an alternative to the culture that implicitly and explicitly
employs violence and destructive strategies for meeting
one’s needs. It promotes a peaceful give and take culture,
which draws inspiration from the concept of AHIMSA of
Mahatma Gandhi (Rosenberg 2003).
For Mahatma Gandhi, Ahimsa is not a deterrent value,
something that prevents people from doing harm to others,
but a highly positive aptitude for doing good (Ramchiary
2013). In its positive form and as exposited by Gandhi,
Ahimsa means the largest love, the greatest charity. It is a
positive and conscious act of wishing the best for the other
and not merely abstaining from inflicting pain. This comes
from the great Indian spiritual traditions which hold ‘doing
good’ to others is the greatest virtue’.
Emotionally-Focused Therapy calls our attention to the
hidden and often unattended world of emotions, which is
in fact the vanguard of human behavior. Propounded in the
early 80 s by Dr. Sue Johnson and her companion Dr. Les
Greenberg, Emotionally-Focused Therapy upholds the phi-
losophy that the core of human existence and experience
is human relationship. It posits that emotionally fulfilling
relationships are integral components and essential aspects
of mental and physical well-being of the individual (John-
son 2004). The emotionally focused interventions seek to
establish and re-create powerful emotional bond between the
partners (Dalgleish et al. 2015). The emphasis is on emo-
tions as powerful determinants of human behavior; if these
are not properly nurtured and taken care of, harmful and
maladjusted behavioral patterns are certain to surface.
The rationale behind the integration of these two theoreti-
cal models was that Non-Violent Communication as a theory
promoting communication is very much grounded conceptu-
ally in the Gandhian concept of Ahimsa-Nonviolence which
is very familiar to the people of India and they can eas-
ily relate to it. Furthermore, a good amount of rigidity in
terms of expression of feelings and emotions still exists in
the caste-ridden, conservative Indian society. Often emo-
tions, especially of the female partner, are neglected; they
are bottled up, finding no way for a release. The constructs
of Emotionally Focused Therapy could be greatly helpful in
recognizing and resolving these bottled up emotions in an
effective manner. The focus on the inner world of emotions
and dealing with them in a compassionate way would pro-
vide a greater chance of the intervention program reaping
the desired rewards.
The development of the program underwent a series of
steps. After having studied the existing related literature and
having gained a better grasp of the relationship issues of the
couples through interviews and discussions, we went on to
integrate the constructs of communication and emotion from
the theoretical foundations of Non-Violent Communication
and Emotionally Focused Therapy. Thus, the group interven-
tion program ‘Emotion-Focused Couples’ Communication
Program’ was developed and was termed as ‘BETWEEN
US’ (an acronym of the modules of the program). The logi-
cal flow of the program was to begin with cognition, emotion
and behavioral modification, and then move on to healing of
the past hurts and growing in greater appreciation of oneself
and the other.
The ‘Emotion-Focused Couples’ Communication Pro-
gram was evaluated by a team of experts among whom
were two clinical psychologists, two marriage counselors,
one educationist and a medical consultant. The experts
were given a format, which was an adapted form of the tool
developed and used by USAID, for the evaluation and cer-
tification of Emotion-Focused Couples’ Communication
Program. The comments and observations from the experts
on technical and conceptual aspects of the program were
incorporated and it was pilot- tested for its feasibility with a
group of six couples.
Outline of Emotion-Focused Couples’ Communication
Program: Table 1 Presents the outline of the program mod-
ules in a tabular format.
The researcher-developed intervention program is both
therapeutic and educative as it has modules that deal with
past hurts (Module No: 5) and those that teach the partici-
pants how to overcome judgmental attitudes and other nega-
tive patterns of behavior which jeopardize smooth and effec-
tive communication and healthy relationships.
Method
Participants
Participants were 32married couples (N = 64 individuals)
who belonged to the urban and upper middle-class soci-
ety of the city of Chandrapur, Maharashtra in the Cen-
tral India. Their age ranged between 30 years to 54 years
(mean = 40.78; SD = 5.03). Barring a minority (N = 3), all
were first-time marriages (N = 29). As regards to educational
attainment, majority of the participants were college gradu-
ates (64%); there were couples who were high school gradu-
ates (21%) as well as those who had a master’s degree (15%).
We selected 32 couples who met the criteria for inclusion
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Table 1  EFCCP program modules

Module Objective Activities

13
1 Beginning of the Journey Introducing EFCCP Starting with a prayer/song
Creating awareness on compassion, connectedness and com- Ice-breaking group activities
munication; building rapport; exploring expectations Brain-storming
Setting ground rules Lecture by the facilitator
Understanding the basic four steps of Observation, Feelings, Yogic breathing and relaxation
Needs & Requests as against the cognitive blocks to effec- Showing a movie clip on marriage
tive communication expressed in Diagnosis and Demands Lecture on the four factors
Class-room exercises
Home-work assignments
Ending with a mindful breathing session to internalize the day’s
learning
2 Entering the inner horizon Starting with oneself, to establish self empathy, self accept- Pranayama-breathing and body scan
ance, to identify and accept one’s own deep-seated feelings Story of the wood cutter
and needs; -to overcome self criticism, self pity, self denial Lecture on the foundations of the self-empathy
and avoidance; -to create healthy understanding of the self In-session empathy exercise
Home-work- empathy journal
3 Toward Listening with empathy-With Giraffe’s ears To enable active and compassionate listening, devoid of judg- Group activity where couples engage in conversation, facilitator
ments; -to take criticism jovially; -to be able to recognize later asking for their feedback to see their listening styles
the feelings and needs of the other and to respond to them Lecture on active, compassionate hearing
positively; -to be able to understand others’ behaviors as Talk on empathy
Expressions of their needs; -to understand and acquire empa- In-session exercises on listening and empathy
thy towards oneself and the other Home-work journal writing
4 With genuineness and Honesty To enable partners to be genuine, truthful in expressing their Group activity for spontaneity of expressions
needs; -to come out of pretexes and compromises, perso- Lecture on honesty and genuineness in interpersonal relation-
nas, masks & inhibitions; -to be genuinely what one is; -to ships
express one’s feelings and needs openly and without fear or Exercise for distinguishing feelings from interpretations
shame Exercise for honest expressions
5 Erasing the scars- healing the attachment injuries of the past To sooth and heal past painful memories; -to beat the hazards Yogic meditation for internalizing and healing
of interpersonal relationships, i.e. anger, guilt, shame Group activity to enable acceptance and create space
depression; -to reconnect oneself with the partner; -to avoid In-session exercise
‘Should-talks’ Home-work journal
Ending with a song, “Itni shaktee hame dena data”
6 Energy Tonic: Appreciation & Gratitude to familiarize the concept of Ahimsa as the supreme char- ...Vedic hymn of LOKAH SAMASTA…
ity expressed in appreciating and thanking the other; -to Lecture on Ahimsa, positive and constructive effects of appreci-
show positive affects of mutual appreciation & gratitude as ating and thanking the partner
constructs of healthy relationship Visualizing and mind scanning (how much do I appreciate and
thank my partner?)
In-session exercises and home-works
Journal of Contemporary Psychotherapy (2018) 48:79–88
 Table 1  (continued)
Module
7 Nurturing greater Intimacy and Connectedness
8 Ushering in of new Music & Dance
9 Stabilizing the Change Savoring the Gain
13
Objective Activities
To nurture comraidery, belongingness, openness and honesty; Lecture on intimacy and conjugal friendship
In-session discussion among the couples to invent new and
to lead to connection, honor, respect & esteem; -to facilitate
greater acceptance; -to enhance empathy; -creating & expe- endearing ways and gestures of expressing love
riencing greater intimacy- through sharing, love, active and Learning afresh the art of observation, active listening, empa-
satisfying sex life; -to learn to give from the heart thy, honesty, making requests
Exercise of ‘touch and word’
Home-assignment- preparing a surprise gift to the partner
To launch on to a new horizon of affectionate and romantic Mantra recitation of positive affects of love, appreciation and
relationship; -to use a new language of loving relationship gratitude
of understanding and accepting instead of judging and blam- Yogic breathing to internalize the new found joy, the experience
ing; to be able to experience greater attachment fulfillment of reconnecting with the partner
and emotional security so that distress and discomfort give Couples entering into an romantic ball (social dancing in pair at
way to joy and freedom parties and gatherings) to celebrate the joy
To enable couples to maintain and sustain the growth and Pranayama
Journal of Contemporary Psychotherapy (2018) 48:79–88
change they experienced during the workshop; -to savor the Group discussions
new-found freedom and joy in relationship; -to review and Ritual contract writing
evaluate the entire program Resolutions for spending more time, engaging in more fun-
activities…
Planning for the future
Reviews ,observations and, benefits
Winding up with thanksgiving gestures and ending with a
prayer
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84
and randomly assigned them to the experimental group (16
couples; 32 individuals) and the control group (16 couples;
32 individuals). They were selected after a process of screen-
ing. As the first step in identifying the participants for the
research, we conducted one-day seminars and talks to the
teachers and parents of the schools and colleges of the city
of Chandrapur and contacted as many as 237 couples who
expressed their willingness to participate in a study about
couples’ communication and marital satisfaction. This was
pruned down to 198 basing on the completeness of their
responses. The198 couples (396 individuals) were adminis-
tered the two research tools, namely Primary Communica-
tion Inventory and Dyadic Adjustment Scale and became the
pool of participants from whom the present study selected
the participants for the intervention program depending on
their scores on the research tools.
The couples were asked to sign an informed consent form
prior to participation in the program and the principles of
confidentiality and the ethical norms were adhered to in
conducting the study. The inclusion criteria followed in the
selection of the participants are the following:
i. Couples who are married either civilly or according
to the particular laws of the religious community they
belong to,
ii. The couples who live together in the same house at
least for the past 1 year continuously,
iii. Those married for not less than 3 and not more than
25 years,
iv. Those who have a minimum of high-school education
and a working knowledge of English language, and
v. Those whose scores are alarmingly low, and warrant-
ing immediate attention with regard to their mutual
communication and marital satisfaction to be meas-
ured by Primary Communication Inventory Dyadic
Adjustment Scale respectively.
Design
The current study made use of a true experimental research
method, particularly the between subjects, to determine the
efficacy of the researcher-developed intervention program.
The research involved two groups and the design consisted
of a Pretest- Posttest Group design in determining the effi-
cacy of Emotion-Focused Couples’ Communication Pro-
gram. The groups were formed by random selection and both
groups took the pretest and posttest, while the experimental
group received the treatment, the participants of the control
group did not receive any treatment. Ethical standards and
principles were adhered to in conducting the research and
approval was obtained from the Ethical Review Committee
of the University before conducting the experiment.
13
Journal of Contemporary Psychotherapy (2018) 48:79–88
Measures
Primary Communication Inventory (PCI)
The Primary Communication Inventory (PCI) assessed the
communication between the couples with a 25-item inven-
tory scored on a 5-point Likert-type scale (5= “very fre-
quently” and 1=“never”). It tested both verbal (e.g., Item
no: 1: “How often do you and your spouse talk over pleas-
ant things that happen during the day?”) and non-verbal
(e.g., Item no: 7: “Do you know the feelings of your spouse
from his/her facial and bodily gestures?”) communications
between the partners. The scale had a number of transposed
questions, items where the respondent had to give his/her
perception about the partner’s communication ability than
stating something about him/herself (5, 6, 7, 9, 11, 13, 15, 21
and 24), and therefore it was necessary for both the partners
to fill out the test to obtain the accurate score. Likewise,
there were items to be reverse-scored (8, 15 and 17), those
considered as negative questions. In using the PCI, a high
overall score would be a good indicator of the soundness of
communication between two people. Its highest potential
score is 125 and the lowest is 25. PCI did not have a cut-
off score; a higher score meant a better communication and
close scores between the couple meant stronger communica-
tion between the two. In the present study, the PCI showed
excellent reliability with a Cronbach’s alpha of 0.94.
Dyadic Adjustment Scale (DAS)
The Dyadic Adjustment Scale (DAS) developed by Gra-
ham Spanier (1976), a 32-item inventory scored on a Likert
scale, measured marital adjustment and satisfaction among
the couples. Having four subscales of dyadic consensus,
dyadic cohesion, affection expression and marital satisfac-
tion, and a global scale of dyadic adjustment, it was known
for its high validity and reliability, giving a total score for
the overall adjustment level and four sub-scores for marital
satisfaction (e.g., Item No: 16: “How often do you discuss
or have considered divorce, separation, or termination of
your relationship?”), cohesion (e.g., Item no: 25: “How
often do you and your mate have a stimulating exchange of
ideas?”), consensus (e.g., Item Nos: 1and2: “Indicate the
approximate extent of agreement or disagreement between
you and your partner for handling family finances, matters of
recreation, and so on”), and affectional expression (e.g., Item
No: 23: “How often do you kiss your partner?”). The DAS
was widely used by researchers and clinicians alike over a
few decades in the field of couples and marriage studies,
and has been found effective. A global quality measure for
each member in dyadic adjustment had a cut-off score of 107
(T-score < 40) as an indication of serious distress in married
couples, as was proposed by Crane, Middleton and Bean
Journal of Contemporary Psychotherapy (2018) 48:79–88 85
(2000). In the present study, the DAS showed a Cronbach’s
alpha of 0.97 indicating excellent reliability.
Procedure
The data gathering procedure was phased out into three:
pre-experimental, experimental and post-experimental. The
pre-experimental phase consisted of contacting the partici-
pants, finding and finalizing the venue and fixture of the
intervention. For selecting the participants, the present study
conducted surveys and interviews in the English Medium
Schools of the city of Chandrapur among the teachers and
parents of the students. We selected those who met the inclu-
sion criteria for the intervention program. We requested the
participants to sign the informed consent form and assured
them regarding the confidentiality of the proceedings. The
first phase of the intervention began with assigning the par-
ticipants into the experimental and control groups and giving
the overview of the program ‘Emotion-Focused Couples’
Communication Program’, followed by the actual execution
of the intervention program to the experimental group.
The intervention lasted 5 weeks with two sessions a week
each. While the experimental group received the therapy
according to the modules of the intervention program which
included lectures on key topics, various group activities,
audio-visual presentations, hand-outs, home-assignments
and so on, the control group did not receive any treatment.
The participants of the control group continued their daily
routine of work and activities related to their job and family
obligations. At the completion of the intervention program,
complying with the ethical requirements of research, as
well as seeing the active response of the participants in the
experimental group and the benefits they gained, we gave a
summary of the program to the control group after the post-
test. In the post-experimental phase, the pre-intervention and
post-intervention scores were evaluated by subjecting it to
statistical analysis.
Table 2  Two-way Analysis of
Variance for efficacy of EFCCP
Primary communication inventory
 Pretest Mean (SD)
 Posttest Mean (SD)
 Dyadic Adjustment Scale
 Pretest Mean (SD)
 Posttest Mean (SD)
The significant change resulting from the intervention program are highlighted in bold
*** p < 0.001
Results
A two-factor (2 × 2) Analysis of Variance was conducted
to evaluate the effect of ‘Emotion-Focused Couples’ Com-
munication Program’ on the dependant variables of ‘level
of couples’ communication and the degree of the marital
satisfaction’ of the participants. The two variables in this
study are time (pre/posttests) and group (Experimental/con-
trol). The dependent variables are the scores on the research
measures Primary Communication Inventory and Dyadic
Adjustment Scale, with higher scores indicating higher lev-
els of couples’ communication and marital satisfaction. The
means and standard deviations for the dependent variables
are presented in Table 2.
As seen in Table 2, the study showed an obviously notable
efficacy as the participants of the experimental group exhib-
ited higher level of communication and experienced bet-
ter degree of marital satisfaction. While mean and standard
deviation values of the pretest scores of both experimental
and control groups as measured by Primary Communication
Inventory (Exp: 77.75 (6.52); Ctrl: 77.53 (6.46)) and Dyadic
Adjustment Scale (Exp: 98.50 (3.16); Ctrl: 98.37 (3.24))
remained similar, the posttest results showed an increase in
the mean and standard deviation values of the experimental
group (PCI—103.65(4.27); DAS—125.12(3.04), even as it
remained more or less the same in the case of the control
group (PCI—77.53(6.36); DAS—98.28 (3.40).
An alpha level of 0.05 was used for the initial analyses.
The results for the two-way ANOVA showed a significant
interaction between time and group, F (1, 62) = 150.11for
Primary Communication Inventory (PCI) and 551.77 for
Dyadic Adjustment Scale (DAS) at a p value of less than
0.001, indicating that any differences between the groups of
the study depend upon the intervention of the program over
a period of time.
By comparing pre-test post-test scores of the experi-
mental group, a Cohen’s d test was accomplished to inter-
pret the extent of the efficacy of the researcher-developed
Experimental group Control group F value of
group × time
interaction
150.11***
77.75 (6.52) 77.53 (6.43)
103. 64 (4.27) 77.53 (6.36)
551.77***
98.50 (3.16) 98.37 (3.24)
125.12 (3.04) 98.28 (3.40)
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86
‘Emotion-Focused Couples’ Communication Program’.
The results showed a Cohen’s d value as 09.49 for Primary
Communication Inventory (PCI) and 19.87 for Dyadic
Adjustment Scale (DAS) indicating that Emotion-Focused
Couples’ Communication Program had a large effect in
improving the couples’ communication and enhancing mari-
tal satisfaction among the participants of the research study.
Discussion
The result of this study brings out strong implications that
the Emotion- Focused Couples’ Communication Program
we developed is instrumental in enhancing couples’ com-
munication and marital satisfaction among the participants
of the experimental group. Emotion-Focused Couples’ Com-
munication Program is efficacious in enhancing relationship
quality of the married couples; as Gottman, Carrere, Swan-
son, and Coan, (2000) posit, a healthy interaction pattern in
married relationship works like a tonic, ever rejuvenating
the marital relationship, for the very relationship itself is
dialogical. The results show that the nine-modular Emo-
tion-Focused Couples’ Communication Program elicited
statistically significant change in the level of couples’ com-
munication and marital satisfaction among the participants.
The result of the intervention program proves the reliability
and validity of Emotion-Focused Couples’ Communication
Program as an efficacious psychotherapeutic tool in help-
ing distressed couples mend their relationships and improve
their marriage quality.
Emotion-Focused Couples’ Communication Programis a
structured and short-term approach in Couples Therapy that
functions based on clear concepts of mutual communication
and interaction taking into consideration various road-blocks
to healthy communication and hindering fuller relationship
satisfaction. In Emotion-Focused Couples’ Communica-
tion Program, attempt is made to recognize the emotions
and transfer them into comprehensible messages and con-
structive behaviour, which is positively responded with by
the other partner, thus promoting constructive and healthy
communication.
The findings of the present study effectively substanti-
ate the findings and results of many a previous study that
an enriching and effective communication leads to greater
levels of marital satisfaction (Emmer-Sommer 2004; Litz-
ingerand; Gordon 2005), because communication is a basic
skill essential for the relationship to function (Birchlerand
False-Stewart 2006). As a consequence of the improved
communication, there is a growth in the social, cognitive
and interactional skills in the couples contributing towards
an enhanced personal and dyadic well-being of the couples
(Finchamand Beach 2010). People with greater measure of
mutual appreciation, affective attachment and with emotions
13
Journal of Contemporary Psychotherapy (2018) 48:79–88
of gratitude and forgiveness are able to cope with trying
situations in marriage and grow in greater intimacy in their
relationship. The results of our study convincingly sug-
gest that there has been an increase in the level of couples’
communication and marital satisfaction among the partici-
pants of the experimental group. This is in line with the
findings of Najafi et al. (2015) which posit that effective
communication and openness to the emotions of the partner
would strengthen the bonds of mutual understanding and
acceptance and would foster greater friendship and intimacy
among couples. Similarly, Campbell, Butzer, and Wong
(2008) found in their study that spouses with more positive
patterns of communication experienced greater satisfaction
and possessed higher quality of marital relationship.
Limitations and Future Directions
This intervention program was designed as a group activity.
During the discussions and in their feedbacks, some of the
participants had expressed their uneasiness on certain topics
to be discussed in public. This is typically so considering
the not-so-open nature of the Indian society with regard to
topics like sex-life and familial matters. This situation could
hamper the full involvement of all the participants given
the uneasiness attached to the subject. Thus, the program’s
design as a group activity could prove to be a limitation.
Therefore, sufficient avenues are to be provided in the pro-
gram for occasional individual sharing and processing with
the facilitator(s). Furthermore, while healthy communication
is undoubtedly one of the major determinants of a healthy
marital relationship, it is necessary to take into consideration
other related factors like the career or job satisfaction and
financial well-being, an area which the present study has not
ventured into, nor was it in the scope of the present research.
Nonetheless, this is an area that needs to be explored further,
either as an extended part of the same program in the future
or as a separate and independent research in itself, so that the
couples in distress can be helped comprehensively.
Emotion-Focused Couples’ Communication Program
trains couples to gain better styles and skills of commu-
nication and dyadic interaction correcting, in the process,
unhealthy styles of judging and diagnosing. This research
showed significant difference in the level of couples’ com-
munication and marital satisfaction among the participants
of the experimental group after having participated in the
intervention program. The remarkable growth in the level of
the dependent variables in the experimental group partici-
pants could rightly be attributed to the researcher-developed
Emotion-Focused Couples’ Communication Program. The
findings of the study thus have opened avenues for family
therapists and marriage counselors to conduct more practi-
cal and clear strategies of helping their clients to achieve
fuller satisfaction and well-being in their married life. If the
Journal of Contemporary Psychotherapy (2018) 48:79–88 87
results of the study are to be taken as an indication, Emotion-
Focused Couples’ Communication Program has significant
clinical implications as it could be tried in the field of mar-
riage and family therapy and counseling effectively and
with a certain degree of assurance of success. It could be an
effective tool in enhancing couples’ communication between
estranged spouses from varied backgrounds if apt and proper
cultural adaptations are made in the program to meet the
needs of diverse populations. However, in the absence of a
follow-up program, the result of this intervention cannot be
generalized. For testing its efficacy, the program has to be
repeatedly administered to different groups over a period
of time.
Compliance with Ethical Standards  Finchem, F. D., & Beach, S. R. H. (2010). Of memes and marriage:
Conflict of interest  Vazhappilly Joshy declares that he has no conflict
of interests. So too, Dr. Reyes, Marc declares that he has no conflict of
interests. Furthermore, they together declare that this research has not
received any funding from any agencies and that they do not belong
to any institutions or organizations except for their affiliation to the
University for their Educational Pursuit.
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https://doi.org/10.1007/s10879-017-9375-6

ORIGINAL PAPER

Efficacy of Emotion-Focused Couples Communication Program

for Enhancing Couples’ Communication and Marital Satisfaction
Among Distressed Partners
Joshy Jacob Vazhappilly1   · Marc Eric S. Reyes1,2

Published online: 25 November 2017

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Abstract
This study investigated the efficacy of ‘Emotion-Focused Couples’ Communication Program’ for enhancing marital com-
munication and satisfaction among distressed couples. It used a ‘two-group randomized control trial’ with 32 couples who
belonged to the urban, middle class society of Maharashtra, India. ‘Primary Communication Inventory’ and ‘Dyadic Adjust-
ment Scale’ were used to measure the level of communication and marital satisfaction. The program lasted five weeks and
the results showed significant effects elicited by the program. Two-way ANOVA was used for data analysis and Cohen’s d
test measured effect’s extent. This suggested ‘Emotion-Focused Couples’ Communication Program’ to be an effective tool
for enhancing communication and marriage quality, thus positing that a healthy communication between the partners ensures
greater marital satisfaction in a spousal relationship.

One of the basic human needs is to establish relationship
with someone; belonging to and being attached with a loving
and caring partner provide a sense of security and enhance
well-being (Bumeister and Leary 1995). According to the
adult attachment theory, individuals look for and feel secure
and confident in the presence of an attachment figure that
one is emotionally close to (Bowlby 1973; Raeisipoor et al.
2012). As posited by Azeez (2013), marriage is a unique
institution that responds to this need, helping humans find
fulfillment and meaning in life, and acting as a source of
individual happiness. A satisfying marriage therefore
becomes one of the most important goals of human per-
sons, and facilitates the attainment of the full actualization
of human potentialities (Whisman et al. 2009).
Notwithstanding the studies and researches attesting the
benefits of marriage, there is an alarmingly growing num-
ber of instances where marriage itself becomes a source of
* Joshy Jacob Vazhappilly
jojvazha@gmail.com
Marc Eric S. Reyes
msreyes@ust.edu.ph
1
The Graduate School, University of Santo Tomas, Manila,
Philippines
2
Department of Psychology, College of Science, University
of Santo Tomas, Manila, Philippines
great distress and dissatisfaction among the partners causing
discomfort and negative set-backs that push the partners into
physical and psychological ill-health (Roberts et al. 2007).
In recent times many studies have come up with the find-
ings that relationship hazards and marital disharmony have
substantially contributed towards dysfunction and distress
among couples and families (Sandhya 2009). Poor marital
adjustment has an adverse effect on the mental and physi-
cal health of the couples, preventing them from experienc-
ing physiological and psychological well-being which is
one of the original intents of marriage (Finchem and Beach
2010). The emergence of a vast variety of mental sicknesses
(Goldfarb et al. 2007), as well as physiological discomfort
and illness (Pihet et al. 2007) is largely attributed to marital
distress. Deprivation of emotional security and absence of
an attachment figure often push the persons into neurobio-
logical imbalances and causes a dip in the so-called cuddle
hormone ‘Oxytocin’ which plays a vital role in the immune
system (Taylor et al. 2000).
There can be a number of reasons for a couple to experi-
ence distress and discord in their marital relationship. In
fact, scholars cite a variety of factors like education, physi-
cal health, finance, order of marriage, cultural milieu, age
of the partners, and number of children and so on as fac-
tors determining the quality of a marital relationship. One
that stands out and demands considerate attention among
all these factors is the effective communication or the lack

13
Vol.:(0123456789)

80
of it between the couples. While a healthy communication
nurtures human relationship, a faulty and unhealthy com-
munication pattern leads the couples to disconnect from one
another and causes a dip in the level of marital satisfaction
(Rosenberg 2003). An effective communication between the
partners is imperative for a satisfactory and healthy mar-
ried relationship (Theiss and Solomon 2006), because com-
munication helps the couple enhance and strengthen their
love relationship. This leads to better understanding of and
respect and regard for the partner and helps to know each
other more deeply (Bodenmann et al. 2009).
It is worth noting that most couples who have problems
in their communication styles do also have problems in their
relationship (Askari et al. 2012; Ledermann et al. 2010).
For, the characteristics and styles of interpersonal interac-
tions play a very decisive role in marital satisfaction (Abbasi
and Afsharinia 2015; Smith et al. 2008). Several scientific
studies affirm that intimacy, which is an essential factor of
marital satisfaction, can be attained only when there is an
effective communication and willingness for mutual disclo-
sure (Yalcin and Karahan 2007). Research has proven that
it is easy to distinguish between the distressed couples from
the non-distressed or happy ones just by looking at their
communication patterns marked by the behaviors like con-
stant nagging, avoidance, fault findings and so on (Birchler
and Fals-Stewart 2006). Both longitudinal (Olson and Miller
2007) as well as cross sectional researches have proven
beyond doubt that an effective couples’ communication
pattern definitively and consistently predict higher levels of
marital satisfaction and an absence of such an effective style
of mutual interaction not only makes the relationship cold,
but in fact pushes it in to deeper levels of distress (Litzinger
and Gordon 2005; Troy 2000).
Considering the significance of an effective communica-
tion in ensuring satisfactory conjugal relationship, and tak-
ing it as a starting point, the present study was envisioned to
address the marital distress experienced by urban and upper
middle class families of India, by helping them improve their
communication skills through an intervention program. In
the Indian ethos, marriage is considered a sacred institution
and a pious duty and an essential pre-requisite for the attain-
ment of MOKSHA-liberation or salvation of human soul.
It is also deeply related to the emotions of the individuals,
especially females, who start dreaming about marriage as
they enter into adolescence and early adulthood and look
up to married life and bearing children as a fulfillment of
their womanhood (Sonawat 2001). However, this picture is
undergoing changes in a fast pace as instances of marital
distress and divorce cases are becoming increasingly high
(Faye et al. 2013).
Studies conducted at different parts of India among dif-
ferent sections of the society indicate a steady growth in the
cases of marital disharmony and distress leading, sometimes,
13
Journal of Contemporary Psychotherapy (2018) 48:79–88
to the extreme point of divorce and family break-up (Anna
2003). Though compared to many western and developed
countries, divorce rate in India is still very low at 1.1% as
found in the decinnial census conducted by the Governement
of India, there appears to be a rise in the number of peo-
ple approaching family courts seeking annulment of their
marital bond. According to the results of a social survey
conducted in India by a leading English Daily ‘Hindustan
Times’ there is an unprecedented rise in the divorce rate in
the country in recent times and divorce applications in the
family courts in the metropolitan cities of Mumbai, Kol-
kata, Bangaluru, Lucknow, Nagpur, Hyderabad, Delhi and
Chennai have doubled or even tripled over the last 5 years
(Times 2015). According to a recent survey conducted by
Rediff News, Maharashtra topped the nation in divorce cases
in the year 2011 with over 20,000 cases filed in the cities
of Mumbai, Nashik, Pune and Nagpur (RediffNews 2012).
Studies posit that along with various factors contributing
towards marital distress, a rigid, unhealthy and inadequate
communication between the partners plays a vital role in
cuasing greater reluctance to let go and give in (Times
2015). Moreover, the traditional and conservative nature of
the Indian society and its rigid social norms put limits to
couples’ expression of affection, mutual availability and inti-
macy. The presence of the parents/ in-laws and the important
others in the family, and their responsibilities and obligation
towards family seldom allow the couples to spend quality
time with one another and freely share their needs and aspi-
rations without inhibitions (Sonawat 2001). This augments
the level of distress among the couples.
In comparison to the vast population of the country, a
whopping 1.21 billion, and the growing number of families
and couples facing marital problem, studies and curative
interventions to stem the marital distress are so very few.
Seldom does one find studies in the direction of addressing
the problem of poor communication skills of the couples,
and even if there are a few, they are scanty and scattered
(Askari et al. 2012; Sonawat 2001). The researcher sought to
fill this research gap by developing an intervention program
that would be significant in addressing the menacingly grow-
ing problem of marital distress in India.
In this study, the researcher integrated Non-Violent Com-
munication (NVC) and Emotionally-Focused Therapy (EFT)
in developing a psychotherapeutic intervention for enrich-
ing couples’ communication and marital satisfaction of dis-
tressed couples. The intervention aimed at improving the
communication style and skill of the partners; this would in
turn lead to the enhancement of marital satisfaction as these
two variables are strongly correlated (Vazhappilly and Reyes
2016). The purpose of the intervention was to enable the par-
ticipants to avoid a language that disconnects and to acquire
a language which is nonviolent and compassionate—a lan-
guage of life as Rosenberg calls it- a language that facilitates
Journal of Contemporary Psychotherapy (2018) 48:79–88 81
better connection (Rosenberg 2003). The integration of Non-
Violent Communication with Emotionally Focused Therapy
provided the intervention program the extra edge in creating
conducive atmosphere of healthy interaction and to negate
the unwanted and harmful styles.
Non-Violent Communication speaks of tools and strate-
gies that are nonviolent; enhancing empathy; and promot-
ing compassionate communication. Rosenberg speaks of
connecting to oneself and to others with empathy, restrain-
ing from judgmental and diagnostic language and ensuring
better connectedness. Non-Violent Communication offers
an alternative to the culture that implicitly and explicitly
employs violence and destructive strategies for meeting
one’s needs. It promotes a peaceful give and take culture,
which draws inspiration from the concept of AHIMSA of
Mahatma Gandhi (Rosenberg 2003).
For Mahatma Gandhi, Ahimsa is not a deterrent value,
something that prevents people from doing harm to others,
but a highly positive aptitude for doing good (Ramchiary
2013). In its positive form and as exposited by Gandhi,
Ahimsa means the largest love, the greatest charity. It is a
positive and conscious act of wishing the best for the other
and not merely abstaining from inflicting pain. This comes
from the great Indian spiritual traditions which hold ‘doing
good’ to others is the greatest virtue’.
Emotionally-Focused Therapy calls our attention to the
hidden and often unattended world of emotions, which is
in fact the vanguard of human behavior. Propounded in the
early 80 s by Dr. Sue Johnson and her companion Dr. Les
Greenberg, Emotionally-Focused Therapy upholds the phi-
losophy that the core of human existence and experience
is human relationship. It posits that emotionally fulfilling
relationships are integral components and essential aspects
of mental and physical well-being of the individual (John-
son 2004). The emotionally focused interventions seek to
establish and re-create powerful emotional bond between the
partners (Dalgleish et al. 2015). The emphasis is on emo-
tions as powerful determinants of human behavior; if these
are not properly nurtured and taken care of, harmful and
maladjusted behavioral patterns are certain to surface.
The rationale behind the integration of these two theoreti-
cal models was that Non-Violent Communication as a theory
promoting communication is very much grounded conceptu-
ally in the Gandhian concept of Ahimsa-Nonviolence which
is very familiar to the people of India and they can eas-
ily relate to it. Furthermore, a good amount of rigidity in
terms of expression of feelings and emotions still exists in
the caste-ridden, conservative Indian society. Often emo-
tions, especially of the female partner, are neglected; they
are bottled up, finding no way for a release. The constructs
of Emotionally Focused Therapy could be greatly helpful in
recognizing and resolving these bottled up emotions in an
effective manner. The focus on the inner world of emotions
and dealing with them in a compassionate way would pro-
vide a greater chance of the intervention program reaping
the desired rewards.
The development of the program underwent a series of
steps. After having studied the existing related literature and
having gained a better grasp of the relationship issues of the
couples through interviews and discussions, we went on to
integrate the constructs of communication and emotion from
the theoretical foundations of Non-Violent Communication
and Emotionally Focused Therapy. Thus, the group interven-
tion program ‘Emotion-Focused Couples’ Communication
Program’ was developed and was termed as ‘BETWEEN
US’ (an acronym of the modules of the program). The logi-
cal flow of the program was to begin with cognition, emotion
and behavioral modification, and then move on to healing of
the past hurts and growing in greater appreciation of oneself
and the other.
The ‘Emotion-Focused Couples’ Communication Pro-
gram was evaluated by a team of experts among whom
were two clinical psychologists, two marriage counselors,
one educationist and a medical consultant. The experts
were given a format, which was an adapted form of the tool
developed and used by USAID, for the evaluation and cer-
tification of Emotion-Focused Couples’ Communication
Program. The comments and observations from the experts
on technical and conceptual aspects of the program were
incorporated and it was pilot- tested for its feasibility with a
group of six couples.
Outline of Emotion-Focused Couples’ Communication
Program: Table 1 Presents the outline of the program mod-
ules in a tabular format.
The researcher-developed intervention program is both
therapeutic and educative as it has modules that deal with
past hurts (Module No: 5) and those that teach the partici-
pants how to overcome judgmental attitudes and other nega-
tive patterns of behavior which jeopardize smooth and effec-
tive communication and healthy relationships.
Method
Participants
Participants were 32married couples (N = 64 individuals)
who belonged to the urban and upper middle-class soci-
ety of the city of Chandrapur, Maharashtra in the Cen-
tral India. Their age ranged between 30 years to 54 years
(mean = 40.78; SD = 5.03). Barring a minority (N = 3), all
were first-time marriages (N = 29). As regards to educational
attainment, majority of the participants were college gradu-
ates (64%); there were couples who were high school gradu-
ates (21%) as well as those who had a master’s degree (15%).
We selected 32 couples who met the criteria for inclusion
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82

Table 1  EFCCP program modules

Module Objective Activities

13
1 Beginning of the Journey Introducing EFCCP Starting with a prayer/song
Creating awareness on compassion, connectedness and com- Ice-breaking group activities
munication; building rapport; exploring expectations Brain-storming
Setting ground rules Lecture by the facilitator
Understanding the basic four steps of Observation, Feelings, Yogic breathing and relaxation
Needs & Requests as against the cognitive blocks to effec- Showing a movie clip on marriage
tive communication expressed in Diagnosis and Demands Lecture on the four factors
Class-room exercises
Home-work assignments
Ending with a mindful breathing session to internalize the day’s
learning
2 Entering the inner horizon Starting with oneself, to establish self empathy, self accept- Pranayama-breathing and body scan
ance, to identify and accept one’s own deep-seated feelings Story of the wood cutter
and needs; -to overcome self criticism, self pity, self denial Lecture on the foundations of the self-empathy
and avoidance; -to create healthy understanding of the self In-session empathy exercise
Home-work- empathy journal
3 Toward Listening with empathy-With Giraffe’s ears To enable active and compassionate listening, devoid of judg- Group activity where couples engage in conversation, facilitator
ments; -to take criticism jovially; -to be able to recognize later asking for their feedback to see their listening styles
the feelings and needs of the other and to respond to them Lecture on active, compassionate hearing
positively; -to be able to understand others’ behaviors as Talk on empathy
Expressions of their needs; -to understand and acquire empa- In-session exercises on listening and empathy
thy towards oneself and the other Home-work journal writing
4 With genuineness and Honesty To enable partners to be genuine, truthful in expressing their Group activity for spontaneity of expressions
needs; -to come out of pretexes and compromises, perso- Lecture on honesty and genuineness in interpersonal relation-
nas, masks & inhibitions; -to be genuinely what one is; -to ships
express one’s feelings and needs openly and without fear or Exercise for distinguishing feelings from interpretations
shame Exercise for honest expressions
5 Erasing the scars- healing the attachment injuries of the past To sooth and heal past painful memories; -to beat the hazards Yogic meditation for internalizing and healing
of interpersonal relationships, i.e. anger, guilt, shame Group activity to enable acceptance and create space
depression; -to reconnect oneself with the partner; -to avoid In-session exercise
‘Should-talks’ Home-work journal
Ending with a song, “Itni shaktee hame dena data”
6 Energy Tonic: Appreciation & Gratitude to familiarize the concept of Ahimsa as the supreme char- ...Vedic hymn of LOKAH SAMASTA…
ity expressed in appreciating and thanking the other; -to Lecture on Ahimsa, positive and constructive effects of appreci-
show positive affects of mutual appreciation & gratitude as ating and thanking the partner
constructs of healthy relationship Visualizing and mind scanning (how much do I appreciate and
thank my partner?)
In-session exercises and home-works
Journal of Contemporary Psychotherapy (2018) 48:79–88
 Table 1  (continued)
Module
7 Nurturing greater Intimacy and Connectedness
8 Ushering in of new Music & Dance
9 Stabilizing the Change Savoring the Gain
13
Objective Activities
To nurture comraidery, belongingness, openness and honesty; Lecture on intimacy and conjugal friendship
In-session discussion among the couples to invent new and
to lead to connection, honor, respect & esteem; -to facilitate
greater acceptance; -to enhance empathy; -creating & expe- endearing ways and gestures of expressing love
riencing greater intimacy- through sharing, love, active and Learning afresh the art of observation, active listening, empa-
satisfying sex life; -to learn to give from the heart thy, honesty, making requests
Exercise of ‘touch and word’
Home-assignment- preparing a surprise gift to the partner
To launch on to a new horizon of affectionate and romantic Mantra recitation of positive affects of love, appreciation and
relationship; -to use a new language of loving relationship gratitude
of understanding and accepting instead of judging and blam- Yogic breathing to internalize the new found joy, the experience
ing; to be able to experience greater attachment fulfillment of reconnecting with the partner
and emotional security so that distress and discomfort give Couples entering into an romantic ball (social dancing in pair at
way to joy and freedom parties and gatherings) to celebrate the joy
To enable couples to maintain and sustain the growth and Pranayama
Journal of Contemporary Psychotherapy (2018) 48:79–88
change they experienced during the workshop; -to savor the Group discussions
new-found freedom and joy in relationship; -to review and Ritual contract writing
evaluate the entire program Resolutions for spending more time, engaging in more fun-
activities…
Planning for the future
Reviews ,observations and, benefits
Winding up with thanksgiving gestures and ending with a
prayer
83

84
and randomly assigned them to the experimental group (16
couples; 32 individuals) and the control group (16 couples;
32 individuals). They were selected after a process of screen-
ing. As the first step in identifying the participants for the
research, we conducted one-day seminars and talks to the
teachers and parents of the schools and colleges of the city
of Chandrapur and contacted as many as 237 couples who
expressed their willingness to participate in a study about
couples’ communication and marital satisfaction. This was
pruned down to 198 basing on the completeness of their
responses. The198 couples (396 individuals) were adminis-
tered the two research tools, namely Primary Communica-
tion Inventory and Dyadic Adjustment Scale and became the
pool of participants from whom the present study selected
the participants for the intervention program depending on
their scores on the research tools.
The couples were asked to sign an informed consent form
prior to participation in the program and the principles of
confidentiality and the ethical norms were adhered to in
conducting the study. The inclusion criteria followed in the
selection of the participants are the following:
i. Couples who are married either civilly or according
to the particular laws of the religious community they
belong to,
ii. The couples who live together in the same house at
least for the past 1 year continuously,
iii. Those married for not less than 3 and not more than
25 years,
iv. Those who have a minimum of high-school education
and a working knowledge of English language, and
v. Those whose scores are alarmingly low, and warrant-
ing immediate attention with regard to their mutual
communication and marital satisfaction to be meas-
ured by Primary Communication Inventory Dyadic
Adjustment Scale respectively.
Design
The current study made use of a true experimental research
method, particularly the between subjects, to determine the
efficacy of the researcher-developed intervention program.
The research involved two groups and the design consisted
of a Pretest- Posttest Group design in determining the effi-
cacy of Emotion-Focused Couples’ Communication Pro-
gram. The groups were formed by random selection and both
groups took the pretest and posttest, while the experimental
group received the treatment, the participants of the control
group did not receive any treatment. Ethical standards and
principles were adhered to in conducting the research and
approval was obtained from the Ethical Review Committee
of the University before conducting the experiment.
13
Journal of Contemporary Psychotherapy (2018) 48:79–88
Measures
Primary Communication Inventory (PCI)
The Primary Communication Inventory (PCI) assessed the
communication between the couples with a 25-item inven-
tory scored on a 5-point Likert-type scale (5= “very fre-
quently” and 1=“never”). It tested both verbal (e.g., Item
no: 1: “How often do you and your spouse talk over pleas-
ant things that happen during the day?”) and non-verbal
(e.g., Item no: 7: “Do you know the feelings of your spouse
from his/her facial and bodily gestures?”) communications
between the partners. The scale had a number of transposed
questions, items where the respondent had to give his/her
perception about the partner’s communication ability than
stating something about him/herself (5, 6, 7, 9, 11, 13, 15, 21
and 24), and therefore it was necessary for both the partners
to fill out the test to obtain the accurate score. Likewise,
there were items to be reverse-scored (8, 15 and 17), those
considered as negative questions. In using the PCI, a high
overall score would be a good indicator of the soundness of
communication between two people. Its highest potential
score is 125 and the lowest is 25. PCI did not have a cut-
off score; a higher score meant a better communication and
close scores between the couple meant stronger communica-
tion between the two. In the present study, the PCI showed
excellent reliability with a Cronbach’s alpha of 0.94.
Dyadic Adjustment Scale (DAS)
The Dyadic Adjustment Scale (DAS) developed by Gra-
ham Spanier (1976), a 32-item inventory scored on a Likert
scale, measured marital adjustment and satisfaction among
the couples. Having four subscales of dyadic consensus,
dyadic cohesion, affection expression and marital satisfac-
tion, and a global scale of dyadic adjustment, it was known
for its high validity and reliability, giving a total score for
the overall adjustment level and four sub-scores for marital
satisfaction (e.g., Item No: 16: “How often do you discuss
or have considered divorce, separation, or termination of
your relationship?”), cohesion (e.g., Item no: 25: “How
often do you and your mate have a stimulating exchange of
ideas?”), consensus (e.g., Item Nos: 1and2: “Indicate the
approximate extent of agreement or disagreement between
you and your partner for handling family finances, matters of
recreation, and so on”), and affectional expression (e.g., Item
No: 23: “How often do you kiss your partner?”). The DAS
was widely used by researchers and clinicians alike over a
few decades in the field of couples and marriage studies,
and has been found effective. A global quality measure for
each member in dyadic adjustment had a cut-off score of 107
(T-score < 40) as an indication of serious distress in married
couples, as was proposed by Crane, Middleton and Bean
Journal of Contemporary Psychotherapy (2018) 48:79–88 85
(2000). In the present study, the DAS showed a Cronbach’s
alpha of 0.97 indicating excellent reliability.
Procedure
The data gathering procedure was phased out into three:
pre-experimental, experimental and post-experimental. The
pre-experimental phase consisted of contacting the partici-
pants, finding and finalizing the venue and fixture of the
intervention. For selecting the participants, the present study
conducted surveys and interviews in the English Medium
Schools of the city of Chandrapur among the teachers and
parents of the students. We selected those who met the inclu-
sion criteria for the intervention program. We requested the
participants to sign the informed consent form and assured
them regarding the confidentiality of the proceedings. The
first phase of the intervention began with assigning the par-
ticipants into the experimental and control groups and giving
the overview of the program ‘Emotion-Focused Couples’
Communication Program’, followed by the actual execution
of the intervention program to the experimental group.
The intervention lasted 5 weeks with two sessions a week
each. While the experimental group received the therapy
according to the modules of the intervention program which
included lectures on key topics, various group activities,
audio-visual presentations, hand-outs, home-assignments
and so on, the control group did not receive any treatment.
The participants of the control group continued their daily
routine of work and activities related to their job and family
obligations. At the completion of the intervention program,
complying with the ethical requirements of research, as
well as seeing the active response of the participants in the
experimental group and the benefits they gained, we gave a
summary of the program to the control group after the post-
test. In the post-experimental phase, the pre-intervention and
post-intervention scores were evaluated by subjecting it to
statistical analysis.
Table 2  Two-way Analysis of
Variance for efficacy of EFCCP
Primary communication inventory
 Pretest Mean (SD)
 Posttest Mean (SD)
 Dyadic Adjustment Scale
 Pretest Mean (SD)
 Posttest Mean (SD)
The significant change resulting from the intervention program are highlighted in bold
*** p < 0.001
Results
A two-factor (2 × 2) Analysis of Variance was conducted
to evaluate the effect of ‘Emotion-Focused Couples’ Com-
munication Program’ on the dependant variables of ‘level
of couples’ communication and the degree of the marital
satisfaction’ of the participants. The two variables in this
study are time (pre/posttests) and group (Experimental/con-
trol). The dependent variables are the scores on the research
measures Primary Communication Inventory and Dyadic
Adjustment Scale, with higher scores indicating higher lev-
els of couples’ communication and marital satisfaction. The
means and standard deviations for the dependent variables
are presented in Table 2.
As seen in Table 2, the study showed an obviously notable
efficacy as the participants of the experimental group exhib-
ited higher level of communication and experienced bet-
ter degree of marital satisfaction. While mean and standard
deviation values of the pretest scores of both experimental
and control groups as measured by Primary Communication
Inventory (Exp: 77.75 (6.52); Ctrl: 77.53 (6.46)) and Dyadic
Adjustment Scale (Exp: 98.50 (3.16); Ctrl: 98.37 (3.24))
remained similar, the posttest results showed an increase in
the mean and standard deviation values of the experimental
group (PCI—103.65(4.27); DAS—125.12(3.04), even as it
remained more or less the same in the case of the control
group (PCI—77.53(6.36); DAS—98.28 (3.40).
An alpha level of 0.05 was used for the initial analyses.
The results for the two-way ANOVA showed a significant
interaction between time and group, F (1, 62) = 150.11for
Primary Communication Inventory (PCI) and 551.77 for
Dyadic Adjustment Scale (DAS) at a p value of less than
0.001, indicating that any differences between the groups of
the study depend upon the intervention of the program over
a period of time.
By comparing pre-test post-test scores of the experi-
mental group, a Cohen’s d test was accomplished to inter-
pret the extent of the efficacy of the researcher-developed
Experimental group Control group F value of
group × time
interaction
150.11***
77.75 (6.52) 77.53 (6.43)
103. 64 (4.27) 77.53 (6.36)
551.77***
98.50 (3.16) 98.37 (3.24)
125.12 (3.04) 98.28 (3.40)
13

86
‘Emotion-Focused Couples’ Communication Program’.
The results showed a Cohen’s d value as 09.49 for Primary
Communication Inventory (PCI) and 19.87 for Dyadic
Adjustment Scale (DAS) indicating that Emotion-Focused
Couples’ Communication Program had a large effect in
improving the couples’ communication and enhancing mari-
tal satisfaction among the participants of the research study.
Discussion
The result of this study brings out strong implications that
the Emotion- Focused Couples’ Communication Program
we developed is instrumental in enhancing couples’ com-
munication and marital satisfaction among the participants
of the experimental group. Emotion-Focused Couples’ Com-
munication Program is efficacious in enhancing relationship
quality of the married couples; as Gottman, Carrere, Swan-
son, and Coan, (2000) posit, a healthy interaction pattern in
married relationship works like a tonic, ever rejuvenating
the marital relationship, for the very relationship itself is
dialogical. The results show that the nine-modular Emo-
tion-Focused Couples’ Communication Program elicited
statistically significant change in the level of couples’ com-
munication and marital satisfaction among the participants.
The result of the intervention program proves the reliability
and validity of Emotion-Focused Couples’ Communication
Program as an efficacious psychotherapeutic tool in help-
ing distressed couples mend their relationships and improve
their marriage quality.
Emotion-Focused Couples’ Communication Programis a
structured and short-term approach in Couples Therapy that
functions based on clear concepts of mutual communication
and interaction taking into consideration various road-blocks
to healthy communication and hindering fuller relationship
satisfaction. In Emotion-Focused Couples’ Communica-
tion Program, attempt is made to recognize the emotions
and transfer them into comprehensible messages and con-
structive behaviour, which is positively responded with by
the other partner, thus promoting constructive and healthy
communication.
The findings of the present study effectively substanti-
ate the findings and results of many a previous study that
an enriching and effective communication leads to greater
levels of marital satisfaction (Emmer-Sommer 2004; Litz-
ingerand; Gordon 2005), because communication is a basic
skill essential for the relationship to function (Birchlerand
False-Stewart 2006). As a consequence of the improved
communication, there is a growth in the social, cognitive
and interactional skills in the couples contributing towards
an enhanced personal and dyadic well-being of the couples
(Finchamand Beach 2010). People with greater measure of
mutual appreciation, affective attachment and with emotions
13
Journal of Contemporary Psychotherapy (2018) 48:79–88
of gratitude and forgiveness are able to cope with trying
situations in marriage and grow in greater intimacy in their
relationship. The results of our study convincingly sug-
gest that there has been an increase in the level of couples’
communication and marital satisfaction among the partici-
pants of the experimental group. This is in line with the
findings of Najafi et al. (2015) which posit that effective
communication and openness to the emotions of the partner
would strengthen the bonds of mutual understanding and
acceptance and would foster greater friendship and intimacy
among couples. Similarly, Campbell, Butzer, and Wong
(2008) found in their study that spouses with more positive
patterns of communication experienced greater satisfaction
and possessed higher quality of marital relationship.
Limitations and Future Directions
This intervention program was designed as a group activity.
During the discussions and in their feedbacks, some of the
participants had expressed their uneasiness on certain topics
to be discussed in public. This is typically so considering
the not-so-open nature of the Indian society with regard to
topics like sex-life and familial matters. This situation could
hamper the full involvement of all the participants given
the uneasiness attached to the subject. Thus, the program’s
design as a group activity could prove to be a limitation.
Therefore, sufficient avenues are to be provided in the pro-
gram for occasional individual sharing and processing with
the facilitator(s). Furthermore, while healthy communication
is undoubtedly one of the major determinants of a healthy
marital relationship, it is necessary to take into consideration
other related factors like the career or job satisfaction and
financial well-being, an area which the present study has not
ventured into, nor was it in the scope of the present research.
Nonetheless, this is an area that needs to be explored further,
either as an extended part of the same program in the future
or as a separate and independent research in itself, so that the
couples in distress can be helped comprehensively.
Emotion-Focused Couples’ Communication Program
trains couples to gain better styles and skills of commu-
nication and dyadic interaction correcting, in the process,
unhealthy styles of judging and diagnosing. This research
showed significant difference in the level of couples’ com-
munication and marital satisfaction among the participants
of the experimental group after having participated in the
intervention program. The remarkable growth in the level of
the dependent variables in the experimental group partici-
pants could rightly be attributed to the researcher-developed
Emotion-Focused Couples’ Communication Program. The
findings of the study thus have opened avenues for family
therapists and marriage counselors to conduct more practi-
cal and clear strategies of helping their clients to achieve
fuller satisfaction and well-being in their married life. If the
Journal of Contemporary Psychotherapy (2018) 48:79–88 87
results of the study are to be taken as an indication, Emotion-
Focused Couples’ Communication Program has significant
clinical implications as it could be tried in the field of mar-
riage and family therapy and counseling effectively and
with a certain degree of assurance of success. It could be an
effective tool in enhancing couples’ communication between
estranged spouses from varied backgrounds if apt and proper
cultural adaptations are made in the program to meet the
needs of diverse populations. However, in the absence of a
follow-up program, the result of this intervention cannot be
generalized. For testing its efficacy, the program has to be
repeatedly administered to different groups over a period
of time.
Compliance with Ethical Standards  Finchem, F. D., & Beach, S. R. H. (2010). Of memes and marriage:
Conflict of interest  Vazhappilly Joshy declares that he has no conflict
of interests. So too, Dr. Reyes, Marc declares that he has no conflict of
interests. Furthermore, they together declare that this research has not
received any funding from any agencies and that they do not belong
to any institutions or organizations except for their affiliation to the
University for their Educational Pursuit.
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