Document Type


Degree Name

Doctor of Philosophy (PhD)


Social Work


Lyle S. Hallman Faculty of Social Work

First Advisor

Dr. Carol Stalker

Advisor Role

Dissertation Advisor

Second Advisor

Dr. Kristine Lund

Advisor Role

Dissertation Committee Member

Third Advisor

Dr. Tat-Ying Wong, MD

Advisor Role

Dissertation Committee Member



Attachment theory has made substantial contributions to the understanding of close relationships. The purpose of this study was to inquire whether an attachment-informed psychoeducational program is a feasible and effective intervention for couples expecting their first child. The overarching question was: Is an attachment-informed relationship enhancement program, such as Hold Me Tight® (HMT), helpful to couples in strengthening their relationship and increasing their confidence in becoming first-time parents? The research question was addressed using a mixed-methods approach.

In the first phase, the Hold Me Tight® program developed by Dr. Sue Johnson was modified for use with couples becoming parents for the first time. The second phase involved implementation of the modified program and the assessment of its helpfulness. Twelve couples (N=24) participated in the Hold Me Tight® program for Couples Becoming Parents study with zero attrition. The program, intended to help couples better understand their relationship with each other and create the best possible emotional foundation for their child, was well received.

Findings indicate the participants gained a better understanding of their own attachment behaviour towards their partners as well as their partners’ behaviour towards them in times of need; such increased awareness is expected to strengthen their emotional connection. Many of the couples requested a “booster workshop” after the birth of the baby. While the changes over time on scores derived from the quantitative measures were not statistically significant, the qualitative data suggested that the HMT program may have had more effect on the men than the women. Many of the men said the program helped them feel more connected with their partners, and following the program, it was observed that many men were more able to share their vulnerable feelings (e.g. fear and inadequacy) about parenting in the presence of their partners. These behaviours suggested that the men experienced an increase in feelings of security in the relationship with their partners. This finding was supported by marginally significant improvement (p= .052) between pre- and post–program assessment in the males’ scores on The Brief Accessibility, Responsiveness, and Engagement (BARE) Scale, which assessed their perception of their partners’ attachment behaviours. Contrary to what was expected, proportionally more men than women scored above the thresholds for concern on the scale designed to screen for depression and anxiety (Edinburgh Postnatal Depression Scale, EPDS).

Evaluations and feedback provided by both facilitators and participants will facilitate future program improvement. The in-class conversation exercises were found by most participants to be the most valuable of all the activities; this reaffirmed that the greatest strength of the HMT program is the emotionally-focused conversations.

The results of this study inform practice by recognizing the need for more attention to the parental relationship and the mental health of both parents, the wisdom of utilizing attachment core concepts to support healthy relationships, and the need for early interventions that may strengthen the couple relationship and foster psychological well-being for the entire family. The insights from this pilot study will inform a future study of the effectiveness of this intervention using larger samples and more diverse participants.

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