Abstract
<p>Objective: Emotionally Focused Couple Therapy (EFCT) is an evidence-based approach to treating couple relationship distress (Spengler et al., 2024), however the evidence comes primarily from English-speaking samples drawn from the U.S. and Canada. This randomized controlled trial (pre-registered at ClinicalTrials.gov, ID: blinded for review) aimed to investigate the efficacy of EFCT delivered in Spanish compared to waitlist controls in Argentina, Costa Rica, Guatemala, Mexico, and Spain. Method: 140 individuals in 70 heterosexual couples were randomized to EFCT or wait-list control conditions. Treatment consisted of 18-20 sessions of EFCT provided by 17 community-based therapists with advanced training in EFCT. Primary outcomes were dyadic adjustment, relationship satisfaction, attachment anxiety, and attachment avoidance. Measures were administered at pretest, posttest, and at several points throughout the intervention period. Linear mixed models were used to examine whether the trajectory of outcome differed across treatment and control conditions. Results: Consistent with hypotheses, individuals in the treatment condition experienced significantly greater improvement in dyadic adjustment (dGMA=1.09), relationship satisfaction (dGMA = .72), and greater decreases in attachment avoidance (dGMA= -.31). No significant differences were evident for attachment anxiety. Conclusion: Our findings suggest that EFCT provided by community-based therapists in Spanish-speaking countries is effective in improving dyadic adjustment and relationship satisfaction, with small decreases in attachment avoidance. Public Health significance statement: This article presents the primary outcomes of the first randomized controlled trial of Emotionally Focused Couple Therapy (EFCT) in Spanish. This 5-nation study demonstrates that couples who engaged in EFCT reported increased dyadic adjustment and relationship satisfaction and reduced attachment avoidance, with gains in the treatment groups enhanced over the control. This study is the first wide-scale, international, translational study of an empirically supported model of couple therapy with front-line therapists in a community setting. The study also provides support for the plausibility and efficacy of training therapists, in a wide variety of natural settings, to be effective in EFCT. Because decades of research have shown that couple level distress is related to a wide variety of mental and physical health problems, as well as work satisfaction and productivity, translational research highlighting effective and accessible therapy models for reducing couple distress is of practical value.</p>