Emotionally focused therapy
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.
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.
- 1 Overview
- 2 Strengths of EFT
- 3 Stages and steps in the EFT process for couples (Johnson 2008)
- 4 Styles of attachment
- 5 Emotion focused couples therapy for trauma survivors
- 6 See also
- 7 Notes
- 8 References
- 9 Further reading
- 10 External links
Emotionally focused therapy (EFT) 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 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. 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. 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. 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.
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.
Strengths of EFT
- EFT is collaborative and respectful of clients, combining experiential person-centered therapy techniques with systemic therapy interventions.
- Change strategies and interventions are specified through intensive analysis of psychotherapy process.
- EFT has been validated by over 20 years of empirical research. There is also research on the change processes and predictors of success.
- EFT has been applied to different kinds of problems and populations, although more research on different populations and cultural adaptations is needed.
- 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.
Stages and steps in the EFT process for couples (Johnson 2008)
1. Stabilization (assessment and de-escalation phase)
- 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)
- 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
- 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.
Styles of attachment
Johnson & Sims (2000) describe four attachment styles:
- 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.
- 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.
- 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.
- 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
- Texts on individual EFT include: Greenberg 2002a; Elliott et al. 2004; Greenberg 2011; Texts on couples EFT (or EFT-C) include: Greenberg & Johnson 1988; Johnson 2004; Greenberg & Goldman 2008; Johnson 2008; Ruzgyte & Spinks 2011; Texts on family EFT (or EFFT) include: Heatherington, Friedlander & Greenberg 2005; Sexton & Schuster 2008; Stavrianopoulos, Faller & Furrow 2014
- Greenberg & Safran 1987; Safran & Greenberg 1991; Greenberg, Rice & Elliott 1993; Greenberg & Paivio 1997; Greenberg 2002b; Johnson 2004; Flanagan 2010
- APA 2013; Lebow 2008, p. 87; Greenberg 2011
- Greenberg 2011; Greenberg 2012
- Greenberg & Johnson 1988
- Ruzgyte & Spinks 2011
- Ruzgyte & Spinks 2011, p. 347
- Goldman & Greenberg 2013
- Palmer & Efron 2007, p. 21
- Rice & Greenberg 1984; Pascual-Leone, Greenberg & Pascual-Leone 2009; Elliott 2010
- Greenberg 2011
- Johnson 2008; Ruzgyte & Spinks 2011
- Johnson 2008; Jordan 2011
- "Website on research-supported psychological treatments". American Psychological Association, Division 12. 2013. Retrieved 30 October 2014.
- Elliott, Robert (March 2010). "Psychotherapy change process research: realizing the promise". Psychotherapy Research 20 (2): 123–135. doi:10.1080/10503300903470743.
- Elliott, Robert; Watson, Jeanne C; Goldman, Rhonda N; Greenberg, Leslie S (2004). Learning emotion-focused therapy: the process-experiential approach to change. Washington, DC: American Psychological Association. ISBN 9781591470809. OCLC 52554018.
- Flanagan, Catherine M (March 2010). "The case for needs in psychotherapy". Journal of Psychotherapy Integration 20 (1): 1–36. doi:10.1037/a0018815.
- Greenberg, Leslie S (2002a). Emotion-focused therapy: coaching clients to work through their feelings. Washington, DC: American Psychological Association. ISBN 9781557988812. OCLC 47289456.
- Greenberg, Leslie S (2002b). "Evolutionary perspectives on emotion: making sense of what we feel". Journal of Cognitive Psychotherapy 16 (3): 331–347. doi:10.1891/jcop.16.3.331.52517.
- Greenberg, Leslie S (2011). Emotion-focused therapy. Theories of psychotherapy series. Washington, DC: American Psychological Association. ISBN 9781433808579. OCLC 655301581.
- Greenberg, Leslie S (November 2012). "Emotions, the great captains of our lives: their role in the process of change in psychotherapy". American Psychologist 67 (8): 697–707. doi:10.1037/a0029858.
- Greenberg, Leslie S; Paivio, Sandra C (1997). Working with emotions in psychotherapy. The practicing professional. New York: Guilford Press. ISBN 9781572309418. OCLC 36705776.
- Greenberg, Leslie S; Rice, Laura North; Elliott, Robert (1993). Facilitating emotional change: the moment-by-moment process. New York: Guilford Press. ISBN 9780898629941. OCLC 27897484.
- Greenberg, Leslie S; Safran, Jeremy D (1987). Emotion in psychotherapy: affect, cognition, and the process of change. The Guilford clinical psychology and psychotherapy series. New York: Guilford Press. ISBN 9780898620108. OCLC 14214819.
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- Rice, Laura North; Greenberg, Leslie S, eds. (1984). Patterns of change: intensive analysis of psychotherapy process. New York: Guilford Press. ISBN 9780898626247. OCLC 8762790.
- Safran, Jeremy D; Greenberg, Leslie S, eds. (1991). Emotion, psychotherapy, and change. New York: Guilford Press. ISBN 9780898625561. OCLC 22665279.
EFT for couples
- Goldman, Rhonda N; Greenberg, Leslie S (March 2013). "Working with identity and self-soothing in emotion-focused therapy for couples". Family Process 52 (1): 62–82. doi:10.1111/famp.12021.
- Greenberg, Leslie S; Goldman, Rhonda N (2008). Emotion-focused couples therapy: the dynamics of emotion, love, and power. Washington, DC: American Psychological Association. ISBN 9781433803161. OCLC 163614069.
- Greenberg, Leslie S; Johnson, Susan M (1988). Emotionally focused therapy for couples. New York: Guilford Press. ISBN 9780898627305. OCLC 17413289.
- Johnson, Susan M (2004) . The practice of emotionally focused couple therapy: creating connection. Basic principles into practice series (2nd ed.). New York: Brunner-Routledge. ISBN 9780415945684. OCLC 54408228.
- Johnson, Susan M (2008). "Emotionally focused couple therapy". In Gurman, Alan S. Clinical handbook of couple therapy (4th ed.). New York: Guilford Press. pp. 107–137. ISBN 9781593858216. OCLC 213008213.
- Johnson, Susan M; Sims, Ann (2000). "Attachment theory: a map for couples therapy". In Levy, Terry M. Handbook of attachment interventions. San Diego: Academic Press. pp. 169–191. ISBN 9780124458604. OCLC 42622207.
- Jordan, Karin (July 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. doi:10.1177/1066480711406689.
- Ruzgyte, Edita; Spinks, Donald (2011). "Emotionally focused therapy". In Metcalf, Linda. Marriage and family therapy: a practice-oriented approach. New York: Springer Pub. Co. pp. 341–364. ISBN 9780826106810. OCLC 663951666.
EFT for families
- Heatherington, Laurie; Friedlander, Myrna L; Greenberg, Leslie S (March 2005). "Change process research in couple and family therapy: methodological challenges and opportunities". Journal of Family Psychology 19 (1): 18–27. doi:10.1037/0893-322.214.171.124.
- Palmer, Gail; Efron, Don (2007). "Emotionally focused family therapy: developing the model". Journal of Systemic Therapies 26 (4): 17–24. doi:10.1521/jsyt.2007.26.4.17.
- Sexton, Thomas L; Schuster, Rachael A (June 2008). "The role of positive emotion in the therapeutic process of family therapy". Journal of Psychotherapy Integration 18 (2): 233–247. doi:10.1037/1053-04126.96.36.199.
- Stavrianopoulos, Katherine; Faller, George; Furrow, James L (January 2014). "Emotionally focused family therapy: facilitating change within a family system". Journal of Couple & Relationship Therapy: Innovations in Clinical and Educational Interventions 13 (1): 25–43. doi:10.1080/15332691.2014.865976.
- Angus, Lynne E; Greenberg, Leslie S (2011). Working with narrative in emotion-focused therapy: changing stories, healing lives. Washington, DC: American Psychological Association. ISBN 9781433809699. OCLC 698451460.
- Boswell, James F; Sharpless, Brian A; Greenberg, Leslie S; Heatherington, Laurie; Huppert, Jonathan D; Barber, Jacques P; Goldfried, Marvin R; Castonguay, Louis G (2014) . "Schools of psychotherapy and the beginnings of a scientific approach". In Barlow, David H. The Oxford handbook of clinical psychology. Oxford library of psychology (Updated ed.). New York: Oxford University Press. pp. 98–127. ISBN 9780199328710. OCLC 874118501.
- Bradley, Brent A (2013). "Emotionally focused couple therapy". In Rambo, Anne Hearon. Family therapy review: contrasting contemporary models. New York: Routledge. pp. 213–217. ISBN 9780415806633. OCLC 754732614.
- Fosha, Diana (January 2004). "'Nothing that feels bad is ever the last step': the role of positive emotions in experiential work with difficult emotional experiences". Clinical Psychology & Psychotherapy 11 (1): 30–43. doi:10.1002/cpp.390.
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- Johnson, Susan M (2002). Emotionally focused couple therapy with trauma survivors: strengthening attachment bonds. The Guilford family therapy series. New York: Guilford Press. ISBN 9781572307353. OCLC 48435185.
- Johnson, Susan M; Bradley, Brent A; Furrow, James L; Lee, Alison; Palmer, Gail; Tilley, Doug; Woolley, Scott (2005). Becoming an emotionally focused couple therapist: the workbook. New York; London: Routledge. ISBN 9780415947473. OCLC 65645168.
- Johnson, Susan M; Greenberg, Leslie S, eds. (1994). The heart of the matter: perspectives on emotion in marital therapy. New York: Brunner/Mazel. ISBN 9780876307410. OCLC 30318897.
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- Emotion-Focused Therapy Clinic, York University, Toronto, Canada
- International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) in Ottawa, Canada