Comparing Brief Psychoanalytic Couple Therapy and Emotionally Focused Therapy in Reducing Relationship Distress (BPCT-EFT-RCT)

Beykoz University

Status: Enrolling

Conditions: Attachment; Relationship Distress; Emotion Regulation; Anxiety Disorders; Depressive Disorder

Treatments: Behavioral: Brief Psychoanalytic Couple Therapy; Behavioral: Emotionally Focused Therapy

Study type: Interventional

Funder types: Other

Identifiers

NCT07100951

BPCT_vs_EFT_RCT_2025

Details and patient eligibility

About

This study compares the effects of two different couple therapy approaches-Brief Psychoanalytic Couple Therapy (BPCT) and Emotionally Focused Therapy (EFT)-on reducing relationship problems and emotional symptoms like depression and anxiety.

Many couples struggle with emotional distance, repeated arguments, and dissatisfaction in their relationships. While EFT is a widely used and research-supported therapy that focuses on rebuilding emotional bonds, BPCT is a less-studied method that aims to help couples understand how early relationship experiences and unconscious patterns affect their current interactions.

The purpose of this study is to find out whether one of these therapies is more effective than the other in improving relationship satisfaction and reducing emotional distress. The study also looks at changes in how people regulate their emotions and how secure they feel in their relationships after therapy.

In this randomized controlled trial, 60 heterosexual couples experiencing relationship distress and symptoms of anxiety or depression will be randomly assigned to one of three groups:

BPCT group - couples receive weekly online therapy focusing on deep emotional and psychological patterns in their relationship.

EFT group - couples receive weekly online therapy focusing on emotional connection and improving communication.

Waitlist control group - couples do not receive therapy during the study but will be offered therapy afterward.

Each therapy lasts 12 weeks, and follow-up assessments will be conducted up to 6 months after therapy ends. Data will be collected before, during, and after treatment using questionnaires that measure relationship satisfaction, depression, anxiety, emotional regulation, and attachment style.

The results of this study will help determine which type of therapy is more beneficial for couples experiencing emotional and relational difficulties and may provide important insights for mental health professionals working with distressed couples.

Full description

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

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

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

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

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

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

Assessments will occur at four time points:

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

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

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

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

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

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

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

Enrollment: 120 estimated patients

Sex: All

Ages: 24 to 65 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

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

Exclusion criteria

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

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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120 participants in 3 patient groups

Brief Psychoanalytic Couple Therapy (BPCT)

Experimental group

Description:

Couples in this arm will receive 12 weekly online sessions (50 minutes each) of Brief Psychoanalytic Couple Therapy (BPCT). Therapy focuses on unconscious relational dynamics, early attachment schemas, and projective identification. The therapist facilitates insight through interpretation of symbolic meaning in conflict and reenactments of early object relations. The stance is neutral and exploratory.

Treatment:

Behavioral: Brief Psychoanalytic Couple Therapy

Emotionally Focused Therapy (EFT)

Active Comparator group

Description:

Couples in this arm will receive 12 weekly online sessions (50 minutes each) of Emotionally Focused Therapy (EFT). EFT targets negative emotional interaction cycles, encourages expression of primary emotions, and fosters attachment security. The therapist plays an active and emotionally attuned role to restructure relational bonds and increase responsiveness between partners.

Treatment:

Behavioral: Emotionally Focused Therapy

Waitlist Control

No Intervention group

Description:

Couples in the waitlist control group will not receive active intervention during the 12-week study period but will complete the same assessments at all time points. After the 6-month follow-up assessment, they will be offered a choice of therapy (BPCT or EFT) outside the study protocol.