Helping Couples Overcome Bumps in the Road Through Emotionally Focused Therapy (EFT)

What is Emotionally Focused Couple Therapy?

”Emotionally Focused Therapy for Couples (EFT) is a brief attachment-based couple therapy that draws on humanistic and systemic principles to help couples improve their relationship functioning by creating a more secure attachment bond in their relationship” (Johnson, 2004). The model was developed when Sue Johnson, as a graduate student, systematically observed couples in distress and focused on the processes that worked to repair the relationships. EFT is empirically-based, beginning with a meta-analysis of four outcome studies prior to 2000 that draw on attachment theory and the patterns observed in distressed relationships (Johnson et al., 2006). In the 1970s the discipline of couples’ therapy was young and just two treatment modalities in use had a basis in research data: behavioral marital therapy and EFT (Johnson et al., 1999). EFT was a modality that was developed “in the field” by therapists at a time when behavioral therapy was the only researched option, and therefore, behavioral therapies dominated couples’ therapy. Theories of adult love and relationships had not been developed in the literature, and other options had not been explored in a systematic way (Johnson et al., 1999).With Attachment Theory providing a basis for how healthy adult relationships are developed, EFT has developed to help couples to move from separation distress and insecure bonding to a secure relationship attachment (Johnson et al., 1999).

Four Key Assumptions of EFT

There are four key Assumptions of EFT that evolved from the research base (Johnson et al., 1999):

• “First, emotional responses and interactional patterns are reciprocally determining and both must be addressed in therapy.
• Second, partners are stuck in negative patterns that preclude the responsiveness necessary for secure bonding. They are not viewed as immature or unskilled but, rather, as needing support to formulate their attachment needs and fears in a manner that promotes secure bonding.
• Third, emotion is seen as a key element in the definition and the redefinition of close relationships. New emotional experience and new interactions are necessary for change to occur.
• Fourth, adult intimacy is best viewed as an attachment process. This process gives couples interventions a specific focus, target, and set of goals.”

How Does EFT Work?

The EFT process occurs in three stages with nine steps:

Stage one, cycle de-escalation: During the first four steps (stage one), the therapist assesses and de-escalates the problematic cycles of interaction between the couples, with couples coming to realize how their interactions sustain insecurity and emotional distress .

Stage two, restructuring interactions: The three steps of stage two involve creating change events where positions of interaction shift and new bonding experiences are created. Couple learn to be more emotionally responsive and supportive and examine the underlying causes for past responses.

Stage three, consolidation: The two steps of therapy in stage three consolidate the changes made and integrate the changes into the daily lives of the couple to develop a more secure attachment bond and better functioning in their relationship (Johnson et al., 1999; Weib & Johnson, 2016).  

Does It Work?

Early EFT research was focused on comparing the process of building emotional bonding of EFT the  to the behavioral approaches that predominated at that time to see if the outcomes might be improved. A study comparing couple receiving an EFT intervention, an intervention with EFT that included communication training, and a control group found that couples in both groups receiving the EFT intervention had better relationship adjustment and the target problem improved over the control group, and the group with communications training in addition to EFT did not have better outcomes than EFT alone (James, 1991). A randomized clinical trial found couples receiving EFT had higher empathy and self-disclosure, higher observed intimacy, and better relationship stability at follow-up than couples receiving a cognitive therapy treatment (Dandeneau & Johnson, 1994). EFT has also been found to work for partners with depression, partners with post-traumatic stress, and couples coping with illness (Weib & Johnson, 2016). Studies have also documented higher levels of forgiveness, improved sexual satisfaction, and greater levels of attachment security in EFT couples (Weib & Johnson, 2016).

How to Find an Emotionally Focused Therapist

EFT therapists are licensed mental health professionals with additional training and experience in EFT. “The International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) works with affiliated EFT communities around the world to provide certification. In addition to checking credentials, it is important to find an EFT therapist with whom you feel comfortable working.” ICEEFT is a rich source of information about EFT and a reliable site to find a qualified EFT therapist in addition to being an excellent source of information. One way to learn more about EFT, its strengths and goals, and find additional literature is to read What Is EFT?

Another way is to attend a CASAT Training to be held Friday, November 8, 2019 from 9:00 AM – 4:30 PM PST at the University of Nevada – Redfield Campus, 18600 Wedge Parkway Reno, NV 89511. The presenter for the workshop will be Cornelius (Con) Sheehan, Jr., LCSW, ICEEFT Certified Emotionally Focused Therapist and Supervisor. The workshop description and learning objectives are as follows:

“Psychotherapy with couples/family members is challenging for even the most skilled of therapists.  Attentive, responsive and emotionally engaged connecting are increasingly challenged by all sorts of factors.  These range from work schedule demands to electronic device distractions, and of course substance abuse.  Substance abuse is particularly challenging in couple therapy because it is an alternate relationship engaged in by the substance abusing partner.  Appreciating this from an attachment theory perspective offers the therapist an opportunity to bring a humanistic, non-pathologizing, systemic stance to helping partners break through denial, and access and express the most meaningful aspects of their experience in the relationship on their way to becoming more connected.  Emotionally Focused Therapy (EFT), developed by one of the presenter’s mentors, Dr. Sue Johnson, is an extremely effective method of operationalizing attachment theory in work with couples, families and individuals.  EFT places substance abuse behavior in the cycle of reactive behaviors that drive partner distress.  Helping couples see these cycles and how they get caught in them allows a means of de-escalation and regrouping so they can slow down and send clear, emotionally meaningful messages to another:  the stuff of understanding and re-connection.  In this one-day workshop focused on couple therapy, the fundamentals of applying EFT when substance abuse behavior is present will be introduced via description, demonstration and experiential exercise.  A familiarity with EFT is helpful but not a pre-requisite.   Much of the fundamentals discussed will have direct application to work with individuals and families as well as couples.

Learning Objectives:

• Understanding addiction through an attachment lens
• Treatment alliance factors in this type of work
• Understanding how addiction impacts the relational system
• Understanding how the security of the relational system impacts addiction
• Understanding the fundamentals of EFT as a method of bringing attachment theory alive in dyadic therapeutic intervention”

Additional information, including registration details, can be found at CASAT Training or by checking the CASAT OnDemand Calendar. Be sure to check out the Resources and Uploads section of our website.

Add to the discussion in our comment section:

What is your experience with the EFT treatment modality? Would you recommend it to fellow behavioral health providers? 

References

Dandeneau, M. L., & Johnson, S. M. (1994). Facilitating intimacy: Interventions and effects. Journal of Marital and Family Therapy, 20(1), 17–33.

James, P. S. (1991). Effects of a communication-training component added to an Emotionally Focused Couples Therapy. Journal of Marital and Family Therapy, 17(3), 263–275.

Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. New York: Brunner-Routledge.

Johnson, S. M., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally focused couples’ therapy: Status and challenges. Clinical Psychology: Science and Practice, 6(1), 67-79. doi:10.1093/clipsy.6.1.67

Jones, L. K., 2009, Emotionally Focused Therapy With Couples — The Social Work Connection DSW  Social Work Today May/June Issue Vol. 9 No. 3 P. 18

Wiebe, S. A., & Johnson, S. M. (2016). A review of the research in emotionally focused therapy for couples. Family Process, 55(3), 390-407. doi:10.1111/famp.12229

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