Emotionally Focused Therapy: How It Works & What to Expect

What Is Emotionally Focused Therapy (EFT)?

Emotionally focused therapy (EFT) is a psychotherapy method that was developed in the 1980s by Dr. Sue Johnson.¹ According to EFT, when we have unmet emotional needs, we tend to suppress our emotions or react to them in unproductive ways. EFT helps a person to understand their emotions so that they can meet their emotional needs and start to build healthier relationships.

Core Principles of Emotionally Focused Therapy

Emotionally focused therapy theorizes that our emotions exist to help us understand our patterns of interactions and reactions, as well as our needs. When we view our emotions as helping us to understand ourselves, we are less likely to suppress them or react to them in a negative way.¹

The core principles of emotionally focused therapy include:

Emotional Change

The first core principle of emotionally focused therapy states that emotional change is seen as the key to enduring cognitive and behavioral change.¹ By accepting our emotions and making space for them, we can understand ourselves and our own needs better. When we better understand our own emotional needs and accept that it is ok to have emotional needs, it is easier for us to meet our own

Self Acceptance

A major premise guiding intervention in emotionally focused therapy is that transformation is possible only when individuals accept themselves as they are. EFT is an approach designed to help clients become aware and make productive use of their emotions.¹ Emotionally focused therapy posits that our emotions can guide us; that is, when we can make space to feel our feelings, our feelings will help us know what we need.

Emotional Responsiveness

Emotional responsiveness is when we are able to respond to someone else with appropriate emotions, meeting them where they are and meeting their emotional needs as they arise.  Emotional responsiveness is when we can tune into the other person and help them meet their emotional needs with kindness and compassion and without blame or shame.

The Cycle of Negative Interaction

The cycle of negative interaction in emotionally focused therapy states that couples or families can trigger each other in negative ways; you trigger your partner or family member, your partner triggers you, and you respond to this hurt from a place of hurt. This cycle goes on and on. Identifying how you each contribute to this process so that you can do things differently is the first step in changing negative patterns of interaction.

Promotion of Secure Emotional Bonds

Emotionally focused therapy states that we sometimes act in ways from our past that get in the way of our forming positive interactions and may not be the best way of coping. EFT helps us to see those unhelpful patterns of interaction, helps us understand where they are coming from, and guides us through finding better, more helpful ways of interacting. This, in turn, helps us feel safer and helps us to get our emotional needs met.

What Can Emotionally Focused Therapy Help With?

Emotionally focused therapy is helpful for a range of conditions, including depression, anxiety, and PTSD. EFT is especially helpful for couples and family therapy because of its focus on shifting negative patterns of interaction.

Emotionally focused therapy can help with the following:

• Couples conflict
• Depression
• Interpersonal problems
• Abuse
• General anxiety
• Social anxiety
• Post-traumatic stress disorder (PTSD)
• Complex trauma
• Sexual dissatisfaction

Is Emotionally Focused Therapy Effective?

EFT has been studied for over 35 years and is recognized as one of the most effective approaches to resolving relationship distress.² Some studies have found emotionally focused therapy to have a success rate of 70%, with a reduction in symptoms for couples lasting over two years.^{3, 4} It is also highly effective in treating anxiety, depression, and complex PTSD.

What to Expect During Emotionally Focused Therapy

Emotionally focused therapy (EFT) is a short-term, structured therapy in which the client and therapist work collaboratively to resolve the client’s issues. The therapist helps the client evaluate the issue they are seeking help for and leads the client through a three-step process of de-escalation, restructuring, and consolidation. EFT can take between 8-20 sessions.

The three stages of emotionally focused therapy are:

Stage 1: De-Escalation

De-escalation is the process of taking the emotions out of a highly emotional reaction so that you can see the patterns of behavior behind the emotion. In emotionally focused therapy, it is thought that many maladaptive behavior patterns arise from unmet emotional needs, especially from the past.  When people can see their patterns of behavior clearly, then the trigger becomes less intense, and they are often better able to respond from a better place rather than react (or overreact) in a negative way.

Stage 2: Restructuring

Restructuring is the process of taking that new awareness of what is triggering and responding in a new and different way. So rather than continuously repeating negative patterns of behavior, this is a chance to do things differently and in a way that feels more helpful. The process of creating new behavior patterns is called restructuring the behavior.

As part of this process, the client will better understand the unmet emotional needs that have been the source of the emotional triggers and will work with these needs to understand them better and to heal them.

Stage 3: Consolidation

Consolidation is when those new patterns of behavior get more naturally integrated. In the beginning, it takes a lot of work and mental effort to shift long-standing maladaptive patterns of behavior. When those new ways of being begin to come more naturally and with less effort, it is said that the behaviors are consolidated.

With the client’s new understanding of previously unmet emotional needs and how they have been involved with creating unhealthy patterns of emotional interaction, the therapist helps the client create new cycles of emotional engagement, helping the client to get their emotional needs met.

Emotionally Focused Therapy Techniques

In emotionally focused therapy, the therapist uses special techniques to help the client learn more about their own emotions and emotional needs. This therapeutic approach guides the client to accept their own emotions and needs, empowering them to fulfill their own emotional needs in a productive and healthy manner.

Therapeutic techniques used in emotionally focused therapy include:

Reflective Listening

Reflective listening is when the therapist actively listens and reflects back to the client what they hear the client saying. This allows the client to hear and own their own feelings fully, more fully clarifying what the client is feeling.

Validation

Validation encourages and supports client’s direct experiences of their thoughts and feelings as valid. Many people minimize or deny their own inner experiences; validating the client’s own thoughts and feelings helps clients to know and understand that they are allowed their own thoughts and feelings.

An important part of treatment is honoring clients’ emotional needs and their valid desire to have them met. The therapist will work with the client to help them express their emotional needs productively and get their emotional needs met.

Restructuring Negative Patterns

Restructuring negative patterns refers to the process where clients become aware of their negative behavior patterns and work to shift them and respond differently. When clients can respond more empowered and with less emotional reactivity, this often leads to better outcomes.

Reframing the Problem

Reframing the problem is when the clinician helps the client see a situation from a different perspective or to have a different understanding of a problem. Often, this new perspective or this new understanding is what allows us to approach a problem from a new emotional place.

Heightening Emotions

The clinician will work with the client on the emotions they are experiencing in the session, highlighting how the client experiences emotional interactions. The clinician may help the client explore their challenging emotions so the client has a better sense of what attachment needs are triggering the intense emotion.

Sometimes, our challenging emotions derive from fear of abandonment or other relational fears, and sometimes, we are completely unaware of these deeper fears. In emotional-focused therapy, the clinician helps the client make sense of these challenging emotions and place these challenging emotions into a broader attachment-based context.

Is Emotionally Focused Therapy the Right Choice for You?

Before starting EFT, it is important to consider that you will be talking about and processing difficult emotions. However, you will not be alone in the process. The EFT therapist is there to teach you how to work with intense emotions. Another thing to consider is that understanding and making space for one’s emotions can be a long process, and EFT can take between 8 and 20 sessions for issues to be resolved.

Emotionally focused therapy (EFT) can be a good choice if you have trouble understanding or accepting your emotions as valid and if your interactions with others don’t produce a good outcome. EFT can help you understand what is triggering, why it is triggering, and what you can do differently to achieve the desired outcome.

It is important to note that although emotionally focused therapy can be a good choice for couples, it is contraindicated for couples where there is addiction, an active affair, or violence in the relationship.

What Is the Cost of Emotionally Focused Therapy?

Emotionally focused therapy costs the same as other types of psychotherapy, generally between $90-160 per session. Some health insurances cover therapy, which includes EFT. You will have to check with your own health insurance company to see what your benefits are and how much they will cover for behavioral health.

How to Find an EFT Therapist

To find an EFT therapist, you can use an online therapist directory to search for therapists certified in emotionally focused therapy. If you prefer the ease and convenience of online therapy, an online therapy platform can help you find an EFT-certified therapist who works with clients virtually. When choosing a therapist, you should look for someone who you feel comfortable and safe talking to.⁵

Here are a few questions to ask a potential EFT therapist:

• Are you certified in emotionally focused therapy?
• Have you treated other individuals/couples with this issue?
• How much experience do you have treating others with this issue?
• What is your success rate with this type of therapy?
• How much time should we allow between sessions for homework /worksheets, etc?
• Do you think this form of therapy will work for me? Why or why not?