Emotionally focused therapy

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Emotionally focused therapy (EFT) is a short-term (8-20 sessions) structured psychotherapy approach to working with individuals, couples and families. It includes elements of experiential, person-centered, constructivist, and systems theory, but is firmly established in attachment theory.[1]

Emotionally focused therapy proposes that emotions themselves 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.[2] Emotions are connected to our most essential needs. They rapidly alert us to situations important to our advancement. They also prepare and guide us in these important situations to take action towards meeting our needs. Clients undergoing EFT are helped to better identify, experience, explore, make sense of, transform and flexibly manage their emotional experiences.

Overview[edit]

Sue Johnson states in her book 'EFT with Trauma Survivors'[3] that:

[A]ttachment theory...predicts that when attachment security is uncertain, a partner will pursue, fight, and even bully a spouse into responding to attachment cues, even if this has a negative general impact on the relationship (p. 179).

Emotionally Focused therapy (EFT), also known as Emotionally Focused Couples Therapy (EFCT) is an empirically supported humanistic treatment that arose out of emotion theory and attachment theory. It views emotions as centrally important in the experience of self, in both adaptive and maladaptive functioning, and in therapeutic change. From the EFT perspective, change occurs by means of awareness, regulation, reflection, 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 session.

Core emotions of attachment and fears of loss of attachment arise deep in the brain. The deeper into the brain one goes the less it is available to the fast pace of everyday awareness. Emotions are physiological neuroendocrine responses to which we react, when they come into awareness, with thoughts and feelings about those feelings. In EFT the aim is to create a new relationship event to act as a kind of transformer and thereby change reactive emotion with positive emotions of attachment.

Emotionally Focused Therapy for Couples was originally developed in the 1980s by Sue Johnson and Les Greenberg. As a doctoral student, Sue Johnson, now a professor at the University of Ottawa, found that couples in distress were caught in a dreadful dance that kept them stuck and unable to resolve their conflicts. Using John Bowlby attachment theory, she developed a treatment to help these couples in distress. She believed that basic attachment issues were underneath these negative cycle of interactions.[4] Today, EFT is one of the most empirically validated types of couple’s therapy.[5] There is significant research on this approach and it has been found that 70-75% of couples move from distress to recovery, and that 90% show significant improvements. These results appear to be less susceptible to relapse than those from other approaches.[6] As such, EFT-C is an evidence-based treatment protocol.

More recently, Emotionally Focused Therapy has also been used with families. Emotionally Focused Family Therapy (EFFT) has developed from EFT and utilizes the EFT approach with families, specifically children and parents. EFFT sessions are conducted either weekly or biweekly for approximately 10-15 sessions. The aim of EFFT is to repair, instigate, and restore attachment bonds between the family members. It is important that because of its emotional intensity, EFFT is not recommended for all families.[7]

Basic Principles[edit]

1. Relationships are attachment bonds. Effective therapy should address the security of the bond, accessibility and responsiveness of each partner.
2. Change involves a new experience of the self, new experience of the other and new relationship events
3. Rigid interaction patterns create and reflect absorbing emotional states. It's systemic.
4. Emotion is the target and agent of change
5. The therapist is a process consultant
6. Partners are viewed as coping as optimally as they can given their current circumstances i.e. non-pathologizing. Partners are not sick/unskilled, they are only stuck in habitual ways of dealing with emotions

One premise of EFT is that emotions bring the past alive. The past validates present day fears, blocks and styles of relating, which then fuels conflict. If there is to be long-lasting change, emotions are engaged and activated in the creation of new relationship events.

Another premise is that attachment is maintained by perceived responsiveness and accessibility and by emotional engagement and contact. When those are uncertain, attachment becomes insecure and then follows protest, clinging, depression or despair and detachment. These become stuck in rigid patterns or negative interaction cycles until the underlying need for secure attachment is addressed.

The interactions of distressed couples are characterized by negative cycles where, for example, one partner pursues while the other withdraws. The therapist helps the couples go to the underlying emotions that keep them stuck in those rigid positions and negative interaction cycles.

Using the notion of transforming emotion with emotion, the EFT therapist guides each partner to expressing emotions that pull for compassion and connection. EFT promotes soothing and helps clients deal with unstated and therefore unmet attachment needs.

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. These are elaborated below.

Strengths of EFT[edit]

1. EFT is based on clear, explicit conceptualizations of marital distress and adult love. These conceptualizations are supported by empirical research on the nature of marital distress and adult attachment.
2. EFT is collaborative and respectful of clients combining experiential Rogerian techniques with structural systemic interventions.
3. Change strategies and interventions are specified.
4. Key moves and moments in the change process have been mapped into nine steps and three change events.
5. EFT has been validated by over 20 years of empirical research. There is also research on the change processes and predictors of success.
6. EFT has been applied to many different kinds of problems and populations.

Stages and Steps in the EFT process[edit]

1. Stabilization (Assessment and De-escalation Phase)

  • Step 1: Assessment
  • Step 2: Identify negative cycle and attachment issues
  • Step 3: Access underlying attachment emotions
  • Step 4: Reframe the problem into cycle, attachment need and fears. Partners soon no longer view themselves as victims of the cycle; they are now allies against it.
  • 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.

2. Restructuring the bond (the change phase)

  • Step 5: Access implicit needs, fears, models of self
  • Step 6: Promote acceptance by other - expand the dance
  • Step 7: Structure emotional engagement - express attachment needs and wants
  • 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/Consolidation

  • Step 8: New positions in the cycle/enact new stories
  • Step 9: New solutions to pragmatic issues
  • 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. It is the attachment bond that is formed through EFT therapy, which is the newfound strength of the couple.[8][9]

Styles of attachment[edit]

Johnson & Sims [10] describe four attachment styles.

1. People who are secure and trusting perceive themselves as loveable, able to trust others and themselves in 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 to not 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]

References[edit]

  1. ^ Palmer-Olsen, L., Gold, L.L., & Woolley, S.R. (2011). “Supervising emotionally focused therapists: A systematic research-based model”. Journal of Marital and Family Therapy 37 (4): 411-426.
  2. ^ Palmer-Olsen, Gold, & Woolley p. 414
  3. ^ Johnson, S.M. (2002). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds. Guilford Press.
  4. ^ Jones, L. K. (2009). Emotionally Focused Therapy With Couples — The Social Work Connection, Social Work Today, 9(3), 18.
  5. ^ Johnson et al. (2005). Becoming an emotionally focused therapist: The workbook. New York: Routledge.
  6. ^ Gurman, A., & Jacobson, N. (2002). Clinical Handbook of Couples Therapy. Emotionally Focused Couples Therapy: Creating Secure Connections. Guilford Press, p. 226.
  7. ^ Palmer, G., & Efron, D. (2007). “Emotionally focused family therapy: Developing the model”. Journal of Systemic Therapies 26 (4): 17-24.
  8. ^ Jordan, K. (2011). “Counselors helping service veterans re-enter their couple relationship after combat and military services: A comprehensive overview”. The Family Journal 19 (3): 263-273.
  9. ^ Jonhson, S. (September 2010). Emotionnaly Focused Therapy for Couple, Externship in Emotionnally Focused Therapy.
  10. ^ S Johnson, A Sims 'Attachment theory: A map for couples therapy Handbook of attachment interventions' 2000

Greenberg, L.S. and Johnson, S. M. (1988). Emotionally Focused Therapy for Couples. Guilford Press: New York.

Further reading[edit]

  • Greenberg, L. S., & Goldman, R. (2008). "Emotion-Focused Couples Therapy: The Dynamics of Emotion, Love and Power." Washington, DC: American Psychological Association.
  • Johnson, S.M. (2004). The practice of emotionally focused marital therapy: Creating Connection. New York: Bruner / Routledge. - Second Edition of 1996 book.
  • S.M. Johnson, Brent Bradley, J Furrow, A Lee, G Palmer (2005) Becoming an Emotionally Focused Couples Therapist : A Work Book. N.Y. Brunner Routledge.
  • Greenberg, LS and Watson, JC (2005) Emotion-Focused Therapy for Depression. Washington, DC: American Psychological Association Press.
  • Johnson, S.M. and Valerie Whiffen(2003)(Eds). Attachment Processes in Couples and Families. Guilford Press.
  • Johnson, S.M. (2002). Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds. Guilford Press.
  • Johnson, S.M., & Greenberg, L.S. (1994)(Eds). The heart of the matter: Perspectives on emotion in marital therapy. New York: Brunner Mazel.
  • Greenberg, L.S., & Johnson, S.M. (1988). Emotionally Focused Therapy for Couples. New York: Guilford Press.
  • Gurman, A., & Jacobson, N. (2002). Clinical Handbook of Couples Therapy. Emotionally Focused Couples Therapy: Creating Secure Connections, p. 221-250.
  • Rice, L. & Greenberg, L. (Eds.) (1984). Patterns of change: An intensive analysis of psychotherapeutic process. New York: Guilford Press.

External links[edit]