Emotionally Focused Couple Therapy Within Contexts of Homelessness and Structural Instability: A Clinical Case Conceptualization

Emotionally Focused Couple Therapy (EFCT) is an attachment-based, empirically supported model widely used in the treatment of relational distress. Systematic reviews and outcome studies have demonstrated the effectiveness of EFCT in improving relationship satisfaction, attachment security, and relational functioning across diverse couple populations. However, there is limited information in the extant literature regarding the application of EFCT with couples experiencing chronic structural adversity, including homelessness, housing instability, financial precarity, and ongoing environmental stressors. This article presents a theory-driven clinical case study of an African American couple experiencing homelessness while participating in supportive services through a community mental health program in a western coastal city in the United States. The couple presented with recurring relational conflict, emotional disconnection, trauma-related mistrust, and heightened stress associated with housing instability, parenting demands, and financial pressure. Using an EFCT framework, the article conceptualizes the couple's distress through pursue–withdraw interactional cycle shaped by attachment insecurity, trauma histories, and chronic socioeconomic strain. The article further examines how structural stressors intensified attachment-related fears and emotional reactivity within the relationship. This case highlights the importance of integrating culturally responsive and systemically informed perspectives into attachment-based work with underserved populations. Implications for EFCT practice, community mental health settings, and future research involving couples experiencing chronic structural adversity are discussed.