Objective: The purpose of this article is to provide a brief review of the empirical literature regarding the impact of advanced cancer on the marital relationship. The link between attachment, caregiving, and care-receiving behaviors are defined. Both are activated and challenged in this population because the continuity of the marital bond is threatened, as well as the balance of reciprocal caregiving, often resulting in heightened marital distress.

Methods: Emotionally focused therapy (EFT), based in a synthesis of systemic, experiential, and attachment theory, is introduced as a marital protocol to both conceptualize and potentially mitigate the level of increased marital distress, and to achieve reciprocal caregiving.

Results: Two case studies are presented and support the benefit of EFT for those couples facing end of life.

Significance of results: The findings from these case reviews advance the literature and offer an empirically validated marital therapy for this population. Such a protocol that emphasizes attachment theory and the inherent link to caregiving and care receiving may serve as a powerful tool to both explain and alleviate marital distress for couples facing end of life. Working models of attachment can contribute significantly to our understanding of why individuals' distress and their experience of emotional support from spouse caregivers vary in the context of end-stage cancer.