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In the Netherlands, 40% of all marriages end in divorce. Although effective relationship therapies are available, few couples use it. The international bestselling self-help book Hold Me Tight (Johnson, 2008) teaches couples how to strengthen their relationship by making their mutual attachment safer. Clinical psychologist Henk Jan Conradi from the University of Amsterdam (UvA), in association with Stichting Emotionally Focused Therapy Nederland, studied the effectiveness of the course based on the book for the first time. The course shows promise, with medium to large effects in relationship satisfaction, partner attachment and psychological complaints.

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Relationship problems and divorce have considerable negative consequences for partners and ex-partners, including depression and anxiety as well as physical problems. Moreover, every year some 50,000 children in the Netherlands are confronted with parental divorce, resulting in psychological complaints and problems at school. Conradi: ‘Although effective relationship therapies are available, few couples seek help from a relationship therapist, presumably because in part there is no reimbursement for relationship therapy. And even if they do seek help, they often do this too late, which exacerbates destructive relationship patterns and makes them more difficult to eliminate. To reach couples with relationship problems at an earlier stage, Johnson developed the Hold Me Tight relationship course, a low-threshold and cheaper alternative for relationship therapy’.

Strengthening the attachment bond

The concept behind the course is that the tenacity of relationship problems is fuelled by an underlying emotional problem, namely a weakened attachment bond between partners. Partners do not openly express emotional needs for approval and support to each other anymore. Instead, partners start blaming or avoiding each other when they don’t feel valued. The course, based on Emotionally Focused Therapy, teaches partners to express their feelings towards each other, thereby making the attachment bond more secure. The group course, in which on average five couples take part, consists of eight, two-hour sessions. The couples receive information on destructive interaction patterns, underlying emotional needs and safe attachment, and take part in roleplaying to practise the material.

The research team monitored 129 Dutch heterosexual couples for six months. This group consisted of (a) 79 self-referred couples with mild attachment problems (for whom the course was originally intended), and (b) 50 vulnerable, clinician-referred couples with severe attachment problems of whom one of the partners had recently been treated in a mental healthcare institution. The course generated good results among the couples with mild attachment problems. After the course, these couples reported markedly higher relationship satisfaction, secure partner attachment, forgiveness, relationship maintenance behaviour (being nice to each other, sharing the household chores, etc.). In addition, they also improved on complaints that had not been the focus of the course, such as depressive and anxious symptoms. The clinician-referred couples characterized by severe attachment insecurity also showed progress, but over time largely reverted to their old level of functioning. Conradi: ‘A preventive course such as Hold Me Tight is particularly promising for couples with mild problems, whereas relationship therapy would be preferable for vulnerable couples’.

Publication details

Conradi, H.J., Dingemanse, P., Noordhof, A., Finkenauer, C., & Kamphuis, J.H. (2017). Effectiveness of the ‘Hold me Tight’ Relationship Enhancement Program in a Self-referred and a Clinician-referred Sample: An Emotionally Focused Couples Therapy-based approach. Family Process. DOI: 10.1111/famp.12305