Emotionally Focused Couple Therapy (EFT)

Emotionally Focused Couple Therapy is a treatment modality developed by Susan Johnson and Leslie Greenberg in the 1980’s. Since then it has gained popularity by therapists and couples alike. The EFT approach is based on the idea that secure emotional bonds are the basis for adult intimacy and successful romantic relationships. EFT is a synthesis of experiential and systemic perspectives and interventions. The goals of therapy is to create a more secure and satisfying bond between two individuals by expressing and reprocessing each partner’s emotional responses that cause negative interactional positions, and shifting these positions towards accessibility and responsiveness.

EFT is an experiential process in that it views partners as actively perceiving and constructing meaning of their experience based on their current emotional state. Therefore, the central focus in EFT is the client’s present experience and how the client processes that experience. One of the key elements of this therapy is accepting and validating the each partner’s experience/world by the therapist and the other partner. When new elements of experience come into awareness, they get processed and integrated into the client’s sense of self. It is important to note that it is not the client’s needs or feelings that are problematic, but the disowning or disallowing of these feelings and needs. The assumption of EFT is that if partners are allowed to own and integrate their experiences into the self and the relationship, new adaptive responses can occur. For instance, when a previously blaming partner accesses her need for comfort and reassurance, she can learn to express this experience in a way that would evoke a positive response from her partner. This then allows for greater closeness, a stronger emotional bond, and more positive interactions in the relationship.

From a systemic point of view, there is constant focus on the process of interaction between partners. EFT assumes that each partner takes a specific position that needs to be brought into light and linked to an underlying emotion. Certain emotional responses tend to be associated with particular positions such as those who blame tend to feel isolated, unloved and deprived; those who withdraw tend to feel helpless, inadequate, unaccepted or intruded upon. The therapist then reframes these interactions according to the underlying emotion while also encouraging couples to enact problematic cycles in session and explore emotional responses as they occur. For example, a withdrawn husband may be instructed to explicitly state to his wife that he is intimidated and afraid to show who he really is in the relationship.

There are 5 primary assumptions that EFT is based on:

1. It is necessary to target both the individual’s internal as well as interpersonal aspects in couple therapy as the repetitive, negative, and rigid interactions distressed couples experience are the result of each partner’s emotional experience as well as their complimentary responses.

2. The problematic responses distressed couples present are their best attempts to protect themselves from pain while struggling to create a more secure bond. Therefore, emotional responses need to be validated and attended to in therapy.

3. Present, not past, experience is the best material for therapy and emotion is the main target of change. EFT distinguishes between primary and secondary emotions. Secondary emotions are usually easily accessible and often take the form of defensive coping strategies. Primary emotions are often hidden, not attended to, but need to be experienced and processed as they can create new perceptions, responses, and interactional patterns. A good example is aggression (secondary emotion) that is expressed in lieu of a sense of threat (primary emotion).

4. The process of change in EFT does not involve learning new skills or attaining insight. Instead, change in communication arises from new experiences of the self and the other. When the partners perceive each other as responsive and accessible, they are motivated to communicate more openly and freely.

5. As mentioned earlier, the key issue in marital conflict is the security of the interpersonal bond, which is built upon responsiveness and accessibility (Ainsworth, 1973). Strategies that focus on affect and each person’s ability to respond to the other person’s emotional needs are most effective (Johnson, 1986).

EFT is designed to be a short-term therapeutic modality. Treatment usually involves 8-15 sessions. The first two sessions are assessment sessions, while the last two are generally spread out over 4-5 weeks. EFT consists of the following sequence of steps:

• Identifying conflict issues in the core struggle

• Identifying the negative interaction cycle

• Accessing unacknowledged feelings

• Reframing the problem in terms of the underlying feelings

• Identifying with disallowed needs and aspects of self

• Promoting acceptance of the partner’s experience

• Facilitating expression of needs and wants

• Facilitating the emergence of new solutions

• Consolidating new positions

In EFT the client’s experience is the main focus of the therapy process. This is achieved by the therapist focusing on, reflecting, and validating the client’s emotional responses to help the client reprocess experience in the present (Rice, 1974). Typical questions by the therapist might sound like, “What is happening for you as you say this?” and “What is it about the tone of her voice that makes you feel uncomfortable?”. The therapist often expands the client’s emotional experience by repeating key sentences and using metaphors. Moreover, the client’s experience may need to be reframed in terms of the underlying emotions and vulnerabilities.  Reframing the client’s experience also helps to undermine rigid positions and facilitate contact and acceptance. Partners also learn to interact in new ways. For example, a withdrawn spouse might be encouraged to reach out and comfort his vulnerable partner. The therapist can then help to emphasize the significance of this new response and facilitate a positive response from the partner.

Couples who present with problems such as marital dissatisfaction, alienation, lack of intimacy, power struggles, and interactional patterns of blame and withdrawal are the most suitable candidates for EFT. Couples with a violent relationship or one where a partner is leaving the relationship are not appropriate for EFT. It seems that the existence of some level of basic trust and a desire to respect each other’s vulnerabilities are prerequisites for a successful therapeutic outcome.

Emotionally-Focused Couple Therapy References

JOHNSON, S.M. & GREENBERG, L.S. (1987). Emotionally Focused Marital Therapy: An overview. Psychotherapy, 24, 552-561.

JOHNSON, S. M. (1986). Bonds or bargains: Relationship paradigms and their significance for marital therapy. Journal of Marriage and Family Therapy, 12, 259-267.

RICE, L. (1974). The evocative function of the therapist. In D. Wexler and L. Rice (Eds.), Innovations in Client Centered Therapy. New York: Wiley-Interscience.