Emotionally Focused Therapy (EFT), also known as Emotionally Focused Couples Therapy (EFCT), was developed chiefly by Dr Susan Johnson, who perceived the need for a better way of doing couples therapy than what was available in the mid-1980s as she was finishing her doctoral work. The importance of supporting distressed couples cannot be underscored enough. Johnson noted that recent surveys in North America showed that most people rate finding a loving relationship as their main life goal, placing it ahead of career or financial success (2008).

EFT is an empirically supported humanistic treatment that includes elements of experiential, person-centred, constructivist, and systems theory, but is firmly rooted in attachment theory. In EFT, emotions are centrally important in the experience of self, in both adaptive and maladaptive functioning, and in therapeutic change.

EFT proponents claim that change occurs when individuals are able to become aware of, regulate, reflect on, and transform emotions taking place within the context of an empathically-attuned relationship. Emotions, so often viewed by distressed clients as “the problem”, are seen as a connection to our most essential needs, a rapid-alert system crucial for survival and advancement. Thus, the emotions themselves do not thwart the therapeutic process. Rather, the problem arises from people’s lack of skill in managing emotions.

Because EFT works on the principle that a client must identify with an emotion before disidentifying from it (that is: arrive at a place before being able to leave it), an important goal is to have the live experience of a maladaptive emotion – say, fear or shame – in order to transform it. The transformation comes from the client accessing a new emotional state (one that is primary and adaptive) in session (Wikipedia, 2013a; GoodTherapy.org, 2013).

EFT is currently used in treating depression, distressed relationships, and more. Private practices, hospital clinics, and training centres throughout the world use it, some under the auspices of the International Centre for Excellence in Emotionally Focussed Therapy (founded by Johnson in 1998). Although it is short-term therapy, 70-75 percent of couples effectively move from distress to recovery using EFT and about 90 percent of couples show significant improvement in their relationships.

Even under high stress these results are stable. Depression is significantly reduced, and the results have been obtained in a variety of populations and settings (GoodTherapy.org, 2013; Johnson, 2011). With such a high success rate, we can ask what the goals of EFT are. In this article we will focus on EFT in couples work.

Goals of EFT

Based as it is on attachment theory, EFT is concerned with fostering the creation of a secure bond between partners. It does this through goals of expanding and reorganising important emotional responses, which help to shift each partner’s position of interaction while initiating new cycles of interaction that are more beneficial for the relationship. Striving to reinforce positive bonds that already exist, EFT also helps engender lasting bonds in a partner or family relationship. A practical technique, EFT works to intervene where needed, creating change to help relationships work more effectively through a spirit of harmony and respect.

Techniques of Emotionally Focused Therapy

In session, the couple explores their emotions, behaviours, and reactions, thereby identifying the individual roles they each take up in the relationship, and the effect each role has on the total dynamic of the relationship. EFT therapists carefully maintain the boundaries of a secure ad non-judgmental environment, so participants are able to contact and express deep emotions and experiences.

By witnessing their partners release feelings and anxieties, participants gain new insights, perceiving differently the validity of their own actions and experiences, and how these impact the relationship as a whole. Partners are allowed to voice their deepest concerns and conflicts without criticism or consequences. Doing so allows the participants to address them and move on to developing behaviours which are more collaborative and productive (GoodTherapy.org, 2013). EFT techniques are based on a few clear basic principles.

Basic Principles

Let’s take our attention back for a moment to Jenny and George, whose typical interaction we presented in the introduction. They both acknowledge being unhappy with how the relationship is right now, and both sincerely want to improve it. Beyond that, each believes that the other person holds the key to improving the quality of their interactions, and that that person is unwilling to give what is needed to make things come right. Each feels psychologically unsafe in the relationship.

Thus, the task of the EFT therapist is to work in a process way to help each partner access their own emotions, and facilitate the responding of the other to those emotions. The goal is to change the stuck interactional patterns (including misperceptions) which have created an insecure bond and unworkable relational system. Those tasks are embodied in the following principles, which each partner gradually comes to understand experientially as the work progresses:

1. Relationships are attachment bonds. Effective therapy should address the security of the bond and the accessibility and responsiveness of each partner.
2. Change involves a new experience of the self, a new experience of the other person, and new relationship events
3. Rigid interaction patterns reflect and create emotional states; absorbing emotional states reflect and create rigid interactions (thus: a maintaining loop)
4. Emotion is the target and agent of change
5. The therapist is a process consultant
6. Partners are viewed as doing as well as they can given their current circumstances. Thus, the therapy is non-pathologising. Partners are not deemed to be either sick or unskilled; they are only stuck in habitual ways of dealing with emotions and engaging with others at key moments (Johnson, S., 2011; Wikipedia, 2013a).

Fleshing out those principles, we see that someone’s past (meaning, usually, an insecure attachment) comes to life in the presence of strong emotion. If that past trauma has not been worked through, it seems (to the partner experiencing the emotion) to justify his or her present-day fears, blocks, and styles of relating; these, of course, fuel conflict. Hence the saying in EFT work, that, rather than heal the past relationship, partners must become engaged in creating new relationship events, thus creating desired change.

This notion works in concert with the premise that attachment is maintained (including in adult couples) by perceived responsiveness and accessibility and by emotional engagement and contact. When a partner perceives these to be uncertain, the attachment is insecure. The partner then tends to exhibit protest, clinging, depression or despair and, eventually, detachment.

Such behavioural sequences become stuck in rigid patterns with unwanted maintaining cycles until the underlying need for secure attachment is addressed. Utilising the further EFT notion of emotion as both the target and agent of change, the therapist begins to transform maladaptive emotions with ones which move toward compassion and connection. EFT understands the importance of soothing (including self-soothing) and helps clients deal with unmet – often out-of-awareness – attachment needs. Clients learn to regulate their emotions through three major motivational systems central to the therapy: styles of attachment, working models of self and other, and attraction (Wikipedia, 2013a).

But why does EFT work? The evidence on attachment

Johnson claims that EFT has much empirical validation, especially if we include studies in related areas such as attachment. Examining bonding at a neurobiological level, Panksepp found that loss of connection to attachment figures triggers what he called “primal panic”, a special set of fear responses (Panksepp, 1998, in Johnson, 2008).

Johnson notes that the words “anxiety” and “anger” hail from the same etymological root, and both arise at moments of disconnection, when attachment figures are nonresponsive. Thus the need for emotional connection is not merely a sentimental one. We are social animals, and studies have now shown that emotional isolation is more dangerous for a person’s health than smoking; it also doubles the likelihood of heart attack and stroke (Johnson, 2008).

Similarly, eighteen months after the 9/11 attacks in the United States, Fraley et al (2006) found that securely connected survivors, those who could turn to others for emotional support, were able to deal with the trauma and grow from it, whereas insecurely attached survivors were experiencing significant mental health problems.

In laboratory experiments, neuroscientists Dr James Coan and colleagues (2006) studied the brain’s pain response in a group of happily married women by administering electric shock to their big toe (nice!) under three different conditions:

1. With no one holding their hand
2. With a stranger holding their hand when the shock was given
3. With their husband holding their hand while the shock was given.

An MRI scanner recorded how much pain activation occurred in the women’s brains. The results astounded even the researchers. While the electric shock was the same voltage for all three settings, the women felt pain when no one held their hand. They felt less pain when a stranger held their hand. But when their husbands held their hand, they felt significantly less pain.

Those who were most happily married (what Coan termed his “supercouples”, inasmuch as all the subjects had scored high on his test of marital satisfaction) were also most deeply soothed by their husbands’ hands. For those lucky women, not only the pain activation areas of the brain were attenuated with the husband hand-holding, but also, the regions of the brain which regulate emotion showed that the spousal hand had calmed and soothed them.

Research on bonding suggests that lovers are flooded with the cuddle hormone, oxytocin, which also is released during orgasm, breast feeding, or even just when attachment figures come close to us. Oxytocin is linked to the release of dopamine, a natural opiate connected to pleasure, which modulates the stress hormone cortisol.

Thus, the neurochemical basis of bonding – the physical source of the euphoric feeling associated with love – is no longer a mystery (Johnson, 2008). When couples can, through their interactions, form the kinds of attachments that generate these chemicals, they are creating a safe and happy bond. Clearly, then, to understand why a couples therapy based on attachment is so effective, we need to know about how attachment works.

This article was adapted from the upcoming “Emotionally Focused Therapy” Mental Health Academy CPD course. The purpose of this course is to acquaint with the basic premises and concepts of EFT, recognising when EFT may be an indicated therapy for someone. To learn more, visit www.mentalhealthacademy.com.au. 

References

• Coan, J., Schaefer, H.S., & Davidson, R.J. (2006). Lending a hand: Social regulation of the neural response to threat. Psychological Science, 17 (12), 1032-1039. Retrieved on 28 November, 2013, from: hyperlink.
• Fraley, C., Fazzari, D., Bonanno, G., & Dekel, S. (2006). Attachment and psychological adaptation in high exposure survivors of the September 11th attack on the World Trade Center. Personality and Social Psychology Bulletin, 32, 538– 551.
• GoodTherapy.org. (2013). Emotionally Focused Therapy. GoodTherapy.org. Retrieved on 21 November, 2013, from: hyperlink.
• Johnson, S. M. (2011). Emotionally Focused Therapy for couples: Key concepts. Lecture notes. Retrieved on 21 November, 2013, from: hyperlink.
• Johnson, S. M. (2008). My, how couples therapy has changed! Attachment, love and science. Psychotherapy.net. Retrieved on 13 November, 2013, from: hyperlink.
• Wikipedia. (2013a). Emotionally Focused Therapy. Wikipedia. Wikimedia Foundation, Inc. Retrieved on 21 November, 2013, from: hyperlink.