Older couple on bench smiling with heads togetherEmotionally focused therapy, an intervention based on scientific study of adult love and bonding processes in couples, is designed to address distress in the intimate relationships of adults. Strategies from emotionally focused therapy can also be used in family therapy to help family members connect and improve emotional attachment. Couples seeking counseling to improve their relationships may find this method a beneficial approach, as it can help people better understand both their own emotional responses and those of significant people in their lives. 

Therapists who provide emotionally focused couples therapy (as the approach is also known) typically work with couples and families to help facilitate the creation of secure, lasting bonds between intimate partners and family members and reinforce any preexisting positive bonds, with the goal of helping those in treatment increase security, closeness, and connection in intimate relationships. 

Development of Emotionally Focused Therapy 

Canadian psychologist Sue Johnson was the primary originator of emotionally focused therapy, which was developed in the 1980s and is currently used in private practices, hospital clinics, and training centers throughout the world. She and her colleagues founded The International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) in 1998. The Centre provides therapist training, which includes workshops, DVDs, audiotapes, and externships, as well as emotionally focused therapy certification for trainers, therapists, and supervisors. The Centre also facilitates clinical research studies. According to Johnson, the approach focuses on emotions because emotions are often left out of interventions, especially systemic interventions focusing on relationships. 

Emotion-focused therapy, an approach developed by Drs. Leslie Greenberg and Robert Elliot, also focuses on emotions, but this type of therapy is typically an individual therapy. In one-on-one sessions, the therapist works to help the person in therapy examine personal emotions and emotional responses in order to better understand them. This is a marked difference from emotionally focused therapy, which is most often participated in by couples working to develop understanding of their partners’ emotions as well as their own.

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Theory of Emotionally Focused Therapy 

Attachment theory, the concept that people are made healthier by emotional contact and need to feel safe in their connections to others, helped guide the development of this approach. Emotionally focused therapy is based on the concept that distress in intimate relationships is often related to deeply rooted fears of abandonment, as an individual’s emotional response to these fears may be harmful to relationship partners and put strain on a relationship. When intimate partners are not able to meet each other’s emotional needs, they may become stuck in negative patterns of interaction driven by ineffective attempts to get each other to understand their emotions and related needs. 

It may be difficult for outsiders, therapists, and sometimes even for those in a relationship to understand why the emotional arguments and confrontations causing difficulty in the relationship start, and continue, to occur. The theory behind emotionally focused therapy considers the key principle in conflict among couples to be insecurity in the attachment one has with one’s partner. This insecurity may mean partners find themselves concerned by questions such as “Do you really love me?” “Am I important to you?” “Are you committed to our relationship?” “Can I trust you?” and so on. Emotionally focused therapy can help people address attachment-related insecurities and learn how to interact with their romantic partners in more loving, responsive, and emotionally connected ways, which can result in a more secure attachment. 

Emotionally focused therapy draws on Carl Rogers’ person-centered therapy, a non-directive approach to treatment in which people in treatment often gain a better self-understanding through speaking to a therapist who listens carefully and empathically. Emotionally focused therapy expands on techniques from person-centered therapy and uses a scientifically validated theory of adult bonding to help couples understand not only their own emotions but also how back-and-forth patterns of emotional reactions operate in, and affect, relationships.

Techniques Used In Emotionally Focused Therapy 

Emotionally focused therapy involves nine treatment steps. In the initial sessions of treatment (the first four steps), the therapist will assess interaction styles of the couple and help deescalate conflict. In the middle phases of treatment (steps five, six, and seven), the therapist and the couple work together to find ways to form new, stronger bonds in the relationship. Changes are consolidated in steps seven through nine as treatment concludes. 

A couple might start therapy by learning ways to deescalate conflict about a commonly debated topic, such as finances, for example. Then, the couple begins to learn ways to express deeper feelings often covered up by common relationship conflicts, such as a lack of trust. When couples are able to identify and discuss these deeper feelings with compassion, they are often able to form deeper bonds. The final stages of therapy help couples become better able to independently identify the attachment issues underlying conflict and to express related emotions in future interactions. The therapy is considered complete when couples can reliably engage in changed interaction patterns learned in therapy outside of the therapy environment.  

The stages and steps of emotionally focused therapy are outlined below: Emotionally focused therapy can help people address attachment-related insecurities and learn how to interact with their romantic partners in more loving, responsive, and emotionally connected ways, which can result in a more secure attachment. 

Stage One: Cycle Deescalation

  • Step 1: Identify key issues of concern. 
  • Step 2: Identify ways negative patterns of interaction increase conflict when key issues arise.
  • Step 3: The therapist assists in the identification of unacknowledged fears and negative emotions related to attachment underlying negative interaction patterns. 
  • Step 4: The therapist reframes key issues for the couple in terms of negative patterns of interaction, underlying emotions and fears, and each individual’s attachment needs.

Stage Two: Changing Interaction Patterns

  • Step 5: Individuals are assisted in voicing both their attachment needs and deep emotions. 
  • Step 6: Partners are coached in ways to express acceptance and compassion for a partner's attachment needs and deep emotions.
  • Step 7: Partners are coached in the expression of attachment needs and emotions while also learning ways to discuss those issues likely to cause conflict. 

Stage Three: Consolidation and Integration

  • Step 8: The therapist coaches the couple in the use of new communication styles to talk about old problems and develop new solutions.
  • Step 9: The couple learns ways to use skills practiced in therapy outside of session and develops a plan to make new interaction patterns a consistent part of life after therapy. 

Emotionally Focused Therapy for Families

Emotionally focused therapy has been expanded and developed as a type of family therapy. The approach has proven successful in increasing attachment and a sense of belonging among members of families. Accessing the emotions underlying interaction patterns between family members is a key goal in emotionally focused therapy for families. All family members participating in the therapy are coached in the identification and expression of attachment-related emotions linked to conflict within the family, acceptance and compassion toward the emotions of others, and healthy, positive expression of personal needs and desires. 

Researchers studying outcomes of therapy are beginning to focus attention on this approach as a family therapy. The developers recommend its use for families addressing major transitions, such as a child reaching adolescence. This type of therapy has also been examined as a potential treatment for bulimia, and preliminary results indicate it is likely to be a helpful approach for in the treatment of this eating disorder. 

Is Emotionally Focused Therapy Effective? 

Emotionally focused therapy has been studied extensively, and a strong empirical base of evidence supports the intervention, which is based on research that has identified differences in how couples relate to each other and how these differences are critical to relationship distress and success. Research examining outcomes for couples who have participated in emotionally focused therapy shows the therapy decreases distress within relationships and partners interact in more successful ways. Follow-up studies conducted with those who participated in emotionally focused therapy showed the positive effects of the treatment continued for years after the therapy concluded. 

References:

  1. Dankoski, M. E. (2003). Pulling on the heart strings: An emotionally focused approach to family life cycle transitions. Journal of Martial and Family Therapy, 27, 177-187. 
  2. Johnson, S. M. (2008). Emotionally focused couple therapy. In A. S. Gurman (Ed.), Clinical handbook of couple therapy (pp. 107-137). New York, NY: The Guildford Press. 
  3. Johnson, S. M. (2008). My, how couples therapy has changed! Attachment, love and science. Retrieved from https://www.psychotherapy.net/article/couples-therapy-attachment
  4. Johnson, S. M., Maddeaux, C., & Blouin, J. (1998). Emotionally focused family therapy for bulimia. Psychotherapy, 35, 238-247.
  5. EFT Research. (2015, April). Retrieved from http://www.iceeft.com/images/PDFs/EFTResearch.pdf
  6. Yalom, V. (2011). Sue Johnson on emotionally focused therapy. Retrieved from https://www.psychotherapy.net/interview/sue-johnson-interview