Emotionally focused therapy

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Emotionally focused therapy (EFT), also known as emotion focused therapy and process-experiential therapy, is a usually short-term (8–20 sessions) structured psychotherapy approach to working with individuals, couples, or families. It includes elements of Gestalt therapy, person-centered therapy, constructivist therapy, systemic therapy, and attachment theory.[1]

Emotionally focused therapy proposes that human emotions have an innately adaptive potential that, if activated, can help clients change problematic emotional states or unwanted self-experiences. Emotions themselves do not inhibit the therapeutic process, but people's incapability to manage emotions and use them well is seen as the problem. Emotions are connected to our most essential needs.[2]


Emotionally focused therapy (EFT) is an empirically supported humanistic treatment[3] that arose out of emotion theory and attachment theory. It views emotions as centrally important in the experience of self and others, in both adaptive and maladaptive functioning, and in therapeutic change. From the EFT perspective, change occurs by means of emotional awareness and arousal, regulation of emotion, reflection on emotion, and transformation of emotion taking place within the context of an empathetically attuned relationship. EFT works on the basic principle that people must first arrive at a place before they can leave it. Therefore, in EFT an important goal is to arrive at the live experience of a maladaptive emotion (e.g., fear and shame) in order to transform it. The transformation comes from the client accessing a new primary adaptive emotional state in the therapy session.[4] Using the notion of transforming emotion with emotion, the EFT therapist guides clients to express emotions that pull for compassion and connection.

Emotionally focused therapy for couples (EFT-C) was originally developed in the 1980s by Sue Johnson and Les Greenberg.[5] Johnson found that couples in distress were caught in a dreadful dance of negative interactions that kept them stuck and unable to resolve their conflicts. Using attachment theory, she developed a treatment to help these couples in distress. Today, EFT-C is one of the most empirically validated types of couples therapy.[6] It has been found that 70–75% of couples move from distress to recovery, and that 90% show significant improvements.[7] These results appear to be less susceptible to relapse than those from other approaches.[citation needed]

Emotion regulation is involved in three major motivational systems central to couples therapy: styles of attachment, identity or working models of self and other, and attraction or liking.[8]

More recently, emotionally focused therapy has also been used with families. Emotionally focused family therapy (EFFT) uses the emotionally focused approach with families, specifically children and parents. EFFT sessions are conducted either weekly or biweekly for approximately 10–15 sessions. Because of its emotional intensity, EFFT is not recommended for all families.[9]

Strengths of EFT[edit]

  1. EFT is collaborative and respectful of clients, combining experiential person-centered therapy techniques with systemic therapy interventions.
  2. Change strategies and interventions are specified through intensive analysis of psychotherapy process.[10]
  3. EFT has been validated by over 20 years of empirical research. There is also research on the change processes and predictors of success.[11]
  4. EFT has been applied to different kinds of problems and populations, although more research on different populations and cultural adaptations is needed.[11]
  5. EFT for couples is based on conceptualizations of marital distress and adult love that are supported by empirical research on the nature of adult attachment.[12]

Stages and steps in the EFT process for couples (Johnson 2008)[edit]

1. Stabilization (assessment and de-escalation phase)[edit]

  • Step 1: Identify the relational conflict issues between the partners
  • Step 2: Identify the negative interaction cycle where these issues are expressed
  • Step 3: Access attachment emotions underlying the position each partner takes in this cycle
  • Step 4: Reframe the problem in terms of the cycle, unacknowledged emotions, and attachment needs

During this stage the therapist creates a comfortable and stable environment for the couple to have an open discussion about any hesitations the couples may have about the therapy, including the trustworthiness of the therapist. The therapist also gets a sense of the couple's positive and negative interactions from past and present and is able to summarize and present the negative patterns for them. Partners soon no longer view themselves as victims of their negative interaction cycle; they are now allies against it.

2. Restructuring the bond (changing interactional positions phase)[edit]

  • Step 5: Access disowned or implicit needs (e.g., need for reassurance), emotions (e.g., shame), and models of self
  • Step 6: Promote each partner's acceptance of the other's experience
  • Step 7: Facilitate each partner's expression of needs and wants to restructure the interaction based on new understandings and create bonding events

This stage involves restructuring and widening the emotional experiences of the couple. This is done through couples recognizing their attachment needs, and then changing their interactions based on those needs. At first their new way of interacting may be strange and hard to accept, but as they become more aware and in control of their interactions they are able to stop old patterns of behavior from reemerging.

3. Integration and consolidation[edit]

  • Step 8: Facilitate the formulation of new stories and new solutions to old problems
  • Step 9: Consolidate new cycles of behavior

This stage focuses on reflection of new emotional experiences and self-concepts. It integrates the couple's new ways of dealing with problems within themselves and in the relationship.[13]

Styles of attachment[edit]

Johnson & Sims (2000) describe four attachment styles:

  1. People who are secure and trusting perceive themselves as lovable, able to trust others and themselves within a relationship. They give clear emotional signals, and are engaged, resourceful and flexible in unclear relationships. Secure partners express feelings, articulate needs, and allow their own vulnerability to show.
  2. People who have a diminished ability to articulate feelings, tend not to acknowledge their need for attachment, and struggle to name their needs in a relationship. They tend to adopt a safe position and solve problems dispassionately without understanding the effect that their safe distance has on their partners.
  3. People who are psychologically reactive and who exhibit anxious attachment. They tend to demand reassurance in an aggressive way, demand their partner's attachment and tend to use blame strategies (including emotional blackmail) in order to engage their partner.
  4. People who have been traumatized and have experienced little to no recovery from it vacillate between attachment and hostility.

Emotion focused couples therapy for trauma survivors[edit]

See also[edit]



EFT for couples[edit]

EFT for families[edit]

Further reading[edit]


External links[edit]