MODELS
EMOTIONALLY FOCUSED COUPLES THERAPY MODEL
Emotionally Focused Couples Therapy (EFT)
Emotionally Focused Couples Therapy (EFT) is a highly effective approach to couples therapy that assists couples in both understanding and regulating their emotions to deepen and repair their relationship.
This approach was developed in the 80’s by Dr. Sue Johnson and Les Greenberg. EFT developed alongside Gottman’s burgeoning research during the 1980s.
EFT has been extensively researched and validated over the past several decades in a highly decentralized brain trust of EFT researchers.
Why is EFT so Effective?
The strategic goal of Emotionally Focused Couples Therapy is to work with you both to identify and understand the emotions that underlie your interactions as a couple, and help you develop more positive patterns of emotional expression and communication.
This is achieved through a combination of emotional processing and experiential techniques, which are called enactments.
One of the key assumptions of EFT is that attachment is a critical component of human experience and our attachment style shapes and ultimately defines our ability to form and maintain intimate relationships.
Research has shown that emotion-focused interventions can be highly effective in improving the emotional well-being of individuals and couples, as well as in reducing relational distress and promoting positive relationship outcomes (Lebow, Chambers, Christensen, & Johnson, 2012).
The Difference between a Gottman Assessment and an EFT Assessment
Just as in the Gottman Method, The process of EFT begins with a thorough assessment of the couple's relationship, including their history, current concerns, and relationship goals. But the differences between the two models are apparent in their approach to assessment.
While a Gottman Assessment is wide ranging, and EFT assessment can be a bit narrower in focus. EFT assessments focus deeply on the attachment history of each partner. An outside the box understanding of this would not exclude cats, dogs, or G_d, for that matter.
Any effective EFT couples therapist works with the couple to map out the “demon dance” that are causing conflict or distress for the couple, and helps them to develop new, more positive ways of living with and loving one another.
One of the core techniques of EFT an enactment, which helps couple identify and understand emotions that underlie their behaviors and interactions.
This may involve exploring the primary emotions that are driving a particular behavior or reaction, as well as the secondary emotions that obscure and eclipse those primary emotions.
For example, if a partner becomes angry and defensive when their partner criticizes them, the therapist might help them explore the fear or vulnerability that is underlying that anger.
This can help the partner to express their emotions in a more constructive way, and can also help the other partner to respond in a more supportive and empathetic manner.
But a Gottman Therapist would tend to be more “top down” and notice the physiology of arousal. This, some of my colleagues have opined, holds the couple to a higher standard of noticing the role their nervous system plays in their habitual and unsatisfying communication patterns.
I remember my couples therapy professor in Antioch telling me that EFT is an easy model to do badly, and a hard model to do well. That’s probably why the Emotionally-Focused Couples Therapy community is so intently focused on training and best practices.
Because good Emotionally-Focused Couples Therapy can achieve impressive, measurable results.
Research has shown that Emotionally Focused Therapy is effective in helping couples improve their emotional connection and reduce overall conflict and distress.
In a meta-analysis of 22 outcome studies, Johnson and colleagues (2016) found that EFT was associated with significant improvements in relationship satisfaction and a reduction in the severity of relationship problems.
These gains were sustained over time, with couples maintaining their gains in satisfaction and functioning for up to two years after therapy. This kind of resilience is deeply impressive.
Focus on Emotional Regulation
One of the key strengths of EFT is its focus on emotion regulation and the development of new, positive patterns of interaction. This can help couples to build resilience and strengthen their relationship over time.
Clinical Research has repeatedly shown that couples who participate in EFT are more likely to maintain positive changes in their relationship and experience greater levels of marital satisfaction over the long term (Lebow et al., 2012).
In addition to emotion-focused processing, EFT also incorporates experiential techniques that help couples practice new patterns of interaction in a safe and supportive environment.
This may involve enacting specific situations or interactions, which allows the couple to practice new behaviors and responses in a structured and supportive context.
Much of good Emotionally-Focused Couples Therapy is the “practice-drill-rehearse” of deconstructing your particular “demon dance” patterns into more loving and connected outcomes.
Emotionally Focused Couples Therapy and Developmental Trauma
EFT research has demonstrated that these experiential techniques can be highly effective in helping couples change the way they interact with each other.
This is often critical for couples struggling with the impact of C-PTSD, also known as Developmental Trauma.
For example, in a study of EFT with couples in which one spouse had a history of childhood sexual abuse, researchers found that the use of these EFT experiential techniques was associated with significant reductions in attachment anxiety and depression for both partners (Makinen & Johnson, 2006).
Overall, EFT is a highly effective approach to couples therapy that is grounded in a strong theoretical and empirical foundation.
Emotionally-Focused Couples Therapy can perhaps be understood as a “bottom-up” approach.
The therapist is seen as a transitional attachment figure. This is a significantly more challenging therapeutic stance than the more “top-down” Gottman Method.
Emotionally-Focused Couples Therapy requires a therapist who is cool and slow, with plenty of precision.
I’ve watched hundreds of hours of Sue Johnson’s work.
With apologies to Jim Morrison, Emotionally Focused Couples Therapy has a backbeat that is narrow and hard to master.
She is the epitome of cool and slow.. deliberate as f*ck. She always knows what she is doing. Dr. Johnson has perfect situational awareness because she is always so profoundly present, inviting her couple into some new language.
Good EFT therapists are mindful of proxemics, and profound multi-level noticing.
I’ll never forget what my couples therapy professor at Antioch once told me:
“Daniel, much of the really bad therapy I‘ve seen was an effort made by the clinician to conduct Emotionally-Focused Couples Therapy while not truly grasping the complexity and intellectual rigor required by this model.”
By focusing on emotion regulation and the development of new, positive patterns of interaction, EFT can help you and your partner improve your emotional connection and build a stronger, more resilient relationship over time.
Good Emotionally-Focused Couples is heavenly in its brilliance.
That is why the EFT community is so powerfully focused on the kaizen of deeper training as a communal norm. I’ve had an outstanding EFT supervisor, Nancy Knudsen.
She was incredibly meticulous about asking how we were noticing and tracking clients. EFT therapists prize supervision because it functions as a “quality circle.”
Kaizen is a compound of two Japanese words that together translate as "good change" or "improvement." However, Kaizen has come to mean "continuous improvement" through its association with lean methodology and principles.
But as the Common Factors Model urges.. proper fit with your therapist is essential.
There are a lot of lazy therapists out there who think that because they read a $20 book from Amazon, they can do Emotionally-Focused Couples Therapy.
But make sure your therapist has advanced “Core Skills” training in Emotionally-Focused Couples Therapy from the ICEEFT institute in Ottawa.
There are way too many therapists who think that because they’ve read Sue Johnson’s books, they understand her model. Always ask about formal training.
The first level of training is called an “externship” which is typically conducted over a single weekend.
However it’s the next level, Core Skills, which distinguises a couples therapist serious about their training.
Core Skills is an expensive commitment of time and treasure over 5 weekends to acquire skill in the EFT model.
RESEARCH
Here are some of the most important research citations that support the effectiveness of Emotionally Focused Couples Therapy (EFT):
Johnson, S.M., Hunsley, J., Greenberg, L., & Schindler, D. (1999). "Emotionally Focused Couples Therapy: Status and challenges." Clinical Psychology: Science and Practice, 6(1), 67-79. doi: 10.1093/clipsy.6.1.67
Johnson, S.M., Makinen, J.A., & Millikin, J.W. (2001). "Attachment injuries in couple relationships: A new perspective on impasses in couples therapy." Journal of Marital and Family Therapy, 27(2), 145-155. doi: 10.1111/j.1752-0606.2001.tb01148.x
Furrow, J.L., Johnson, S.M., Bradley, B.A., Dalgleish, T.L., & Tilley, D.S. (2004). "The Efficacy of Emotionally Focused Couple Therapy with Distressed Couples: A Meta-Analysis." Journal of Marital and Family Therapy, 30(1), 67-86. doi: 10.1111/j.1752-0606.2004.tb01246.x
Johnson, S.M. (2004). "The Practice of Emotionally Focused Couple Therapy: Creating Connection (2nd ed.)." Routledge.
Johnson, S.M. (2019). "Attachment Theory in Practice: Emotionally Focused Therapy (EFT) with Individuals, Couples, and Families." The Guilford Press.
Lebow J.L., Chambers A.L., Christensen A., Johnson S.M. (2006). Research on the treatment of couple distress. Journal of Marital & Family Therapy. 2012 Jan;38(1):145-68. doi: 10.1111/j.1752-0606.2011.00249.x. Epub 2011 Sep 9. PMID: 22283385.
Makinen, J. A., & Johnson, S. M. (2006). Resolving attachment injuries in couples using emotionally focused therapy: Steps toward forgiveness and reconciliation. Journal of Consulting and Clinical Psychology, 74(6), 1055–1064. https://doi.org/10.1037/0022-006X.74.6.1055
These research studies have demonstrated the effectiveness of EFT in improving relationship satisfaction, communication, and attachment security, underscoring the fundamental significance attachment theory in promoting positive outcomes in couples therapy.