Emotionally focused couples therapy is a short-term structured approach to psychotherapy, which usually requires between 8and 20 sessions. Its goal is to create a more secure emotional attachment between two individuals. EFT has been demonstrated as helpful for couples with a variety of problems, including post-traumatic stress disorder (PTSD), depression, frequent arguments, a history of infidelity, and chronic health conditions.1
What Is Emotionally Focused Couples Therapy?
EFT is based on the theory of attachment, the therapeutic conditions of experiential therapy (person-centered therapy), and elements of family systems therapy. The core concepts are the importance of emotions to our survival as humans, the role of emotion in attachment and relationships, and the ways in which attachment can be strengthened to allow for optimal inter-dependency and emotional regulation.
According to Gal Szekely, LMFT, Director of The Couples Center, “What is unique about Emotionally Focused Therapy is that it closely follows the main principles of Attachment theory, which has received ample scientific validation. Attachment theory claims that our need to feel securely attached to our caregiver in childhood, and later in life to our romantic partner, is a biological need. From this perspective, it makes sense why relationship challenges tend to cause us so much distress, because they can undermine our fundamental need to feel that our partner is there for us, available, and responsive to our needs. Partners’ complaints and demands actually represent a cry for help, a request to be loved in a certain way.”
Core Concepts of Emotionally Focused Couples Therapy
The need for secure attachment is seen as a life-long emotional need, beginning in infancy and persisting through adulthood. This primitive survival need develops into the adult need for a secure emotional bond. Being attached to another adult provides us with a strong sense of safety and security, both emotionally and physically.
Attachment theory states that isolation, whether physical or emotional, is traumatizing. All couples experience moments of emotional disconnection; these occur when needs aren’t clearly communicated or are misunderstood. There is neurological evidence for the changes in our brain activity during these moments of panic about being abandoned.2
How we respond during these moments of disconnection determines the quality of our relationships. Many couples get caught up in arguments that follow certain patterns that lead to escalation of the distress. In EFT for couples, these are called “demon dialogues” and they are recognized as increasing feelings of emotional aloneness.3
Szekely notes the specific communication model that often leads to relationship issues: “Emotionally Focused Therapy claims that most communication issues in relationships are a result of a pattern of interaction known as the Pursuer – Distancer. In this pattern, one partner tends to pursue the other, sometimes blaming and criticizing them while the other tends to back away, trying to ignore or avoid the conversation and take space. This dynamic tends to be self-reinforcing – the more one person pursues the more the other distances and vice versa. What the pursuer is actually looking for is feeling connected while the distancer is trying to avoid conflict and wanting to feel valued and appreciated.”
Learning to identify the pattern of argument is the first step in the process of therapy for couples. This is followed by more clear communication of needs and responding with greater empathy. These changes in dialogue allow the individuals to reestablish a secure connection with each other. In the context of emotional security, problem solving and conflict management follows naturally.
How Is Emotionally Focused Couples Therapy Different From Other Couples Therapy Options?
EFT differs from other couples therapy options in both focus and method. Other therapies involve extensive questionnaires, worksheets, and homework to identify sources of strength as well as conflict in the relationship. The EFT couples therapist relies minimally upon questionnaires and instead focuses upon the interactions that occur within sessions. The couples are guided to recognize how their patterns of communication are contributing to the conflict.
Other popular models of couples therapy, such as the Gottman Method and the Solution-Focused model, attempt to resolve couples’ conflicts by teaching problem-solving skills as well as by building the friendship within the couple. Although these may be useful skills, the EFT couples therapist would see that focus as inadequate. The issue, from the perspective of EFT, is emotional distance rather than conflict or control.
EFT for couples uses nine steps divided into three stages.4 The first stage is called “Stabilization” and it involves identifying the patterns that keep the couple stuck in their distress. A second goal of this stage is to de-escalate the conflict and encourage an understanding of basic attachment needs. In the second stage, “Restructuring,” the couple is guided toward creating a new bond by changing their communication patterns. In the final stage, “Consolidation,” old problems or issues are revisited using the new way of communicating so that new solutions may be found.
What Can Emotionally Focused Couples Therapy Help With?
EFT for couples has been used with many different populations and types of problems. Numerous outcome studies have shown that EFT is effective for couples coping with a range of problems including anxiety, post traumatic stress disorder (PTSD), depression, infidelity, frequent arguments, and health conditions.
Here are specific problems that EFT has been used to treat effectively:1
- Depression affecting the couple’s relationship
- Couples including a veteran with PTSD
- Couples that include a survivor of sexual abuse
- Patients with cardiovascular disease and their partner
- Patients with early breast cancer and their partner
- Couples coping with end-stage cancer
- Couples with general relationship dissatisfaction
- Couples coping with sexual dissatisfaction
- Couples with chronically ill children
Emotionally Focused Couples Therapy Examples
Below are a few examples of what emotionally focused couples therapy might look like and how it may help partners build a stronger, healthier relationship.
Loneliness After Birth of First Child
Emily and Eric are arguing more frequently since the birth of their first child a few months ago. Eric complains that he has lost his wife to their child and that their sex life has suffered, while Emily reports feeling exhausted by her responsibilities as a mother and needing more comfort from Eric.
The EFT therapist would reframe the conflict in terms of unmet attachment needs for both of them. Attachment needs and fears are particularly strong when a baby is born into the family. At the same time, most new parents are coping with sleep deprivation and the stress of learning how to care for the infant. Both would be encouraged to express their underlying need to know that the other is still there for them. They would work out new ways to show their compassion for each other in order to maintain a secure emotional bond.
Anxiety About Change in a Partner’s Job Status
Ray and Robin are both dedicated to their jobs and to each other. When Robin obtains a job promotion, he is required to spend much more time at work, causing him to be less available to Ray. Ray feels increasingly lonely, angry, and even foolish for missing his partner so much.
The EFT therapist would normalize the feelings expressed by Ray, and encourage him to let go of any shame related to his feelings of vulnerability. Once Ray is able to share the need for reassurance that Robin is still there for him, communication about the problem leads to new ways to cope with the changes in their routines.
Infidelity by One Partner
Joan and Joseph seek therapy to recover from an affair that developed between Joseph and a work colleague. Joan is understandably angry and hurt. When Joseph admitted to infidelity, he explained that it had not begun with any intent and that the relationship had just unfolded gradually. Joan was devastated and sobbing. In reaction to seeing her so upset, Joseph pointed out what was wrong with their marriage, leaving Joan to feel that she was being blamed for his disloyalty.
The EFT therapist would encourage them to express their deeper feelings related to their attachment to each other. In addition to being angry about being betrayed by Joseph, Joan felt abandoned by him. They would work toward rebuilding their trust in their own emotional bond and re-establishing the security of the relationship.
How to Find an Emotionally Focused Couples Therapist
A therapist trained in EFT can be located by using a therapist directory and adding EFT to the search filter. One might also start by asking a physician for a referral to a licensed therapist, and then contacting that therapist to ask about their training in EFT.
Who Is Able to Provide Emotionally Focused Couples Therapy?
A licensed mental health professional with additional training in Emotionally Focused Therapy is qualified to provide EFT for couples. While additional certification is not required, it is offered by the International Center for Excellence in Emotionally Focused Therapy (ICEEFT). This organization works with affiliated groups worldwide to provide training and certification to eligible therapists.
Cost of Emotionally Focused Therapy & Does Insurance Typically Cover it?
The cost of a couples counselor who practices emotionally focused therapy varies greatly depending upon therapist experience, geographic location, and other factors. Cost estimates range from $150 to $250 per session with sessions lasting from 60 to 90 minutes each. Insurance may cover the cost depending upon an individual’s policy, but often it does not. It is recommended to ask your insurance provider if they cover couples counseling.
Key Questions to Ask a Therapist When Considering Emotionally Focused Couples Therapy
Important questions to ask an EFT couples therapist include those related to the therapist’s experience with the EFT model, the cost of therapy, and average length of time to achieve results. It may also be important to establish guidelines for the confidentiality of information.
Key questions to ask an EFT couples therapist before beginning treatment include:
- Are you certified to provide emotionally focused couples therapy?
- If not, how much experience do you have with this method of couples therapy?
- What is your experience in treating our particular problem (e.g., infidelity, PTSD, depression)?
- What is the expected length of treatment or number of sessions for our problem?
- What is the fee per session that you charge?
- What are the guidelines for confidentiality among all three of us?
- How much time should we expect to allow for homework or worksheets?
- Do you offer remote sessions on occasion?
- Have you ever advised couples that this form of therapy is not recommended for them?
- Do you think that this form of therapy will be effective for us?
Is Emotionally Focused Couples Therapy Effective?
There exists over 35 years of peer-reviewed research on the effectiveness of emotionally focused couples therapy. It is backed by the American Psychological Association (APA) as an empirically supported method for couples therapy. This research has met the highest level of standards set up by the APA for clinical research. It has also been shown that EFT for couples works in the way that the theory predicts. For example, couples have been shown to improve their relationship-specific attachment after participating in EFT for couples.5
Criticisms of Emotionally Focused Couples Therapy
Criticisms of emotionally focused couples therapy are more broadly aimed at the potential flaws of all emotion-focused therapy. Emotion-focused therapists have made claims that both emotional arousal and the creation of new memories (based upon new emotional experiences) are key to change in psychotherapy.
A main critic of this claim is Bruce Ecker, the co-founder of coherence therapy, which is an alternative model of how therapeutic change occurs. Ecker argues that learned emotional reactions can be unlearned without emotional arousal. In other words, he finds fault with the theory of how change occurs in emotion-focused therapy.6
Others have criticized the emotion-focused approach for its lack of ability to predict which factors affect the outcome of treatment. They point out that the theory does not explain the causes of different mental health problems or what maintains mental health problems.7
History of Emotionally Focused Couples Therapy
The general theory of emotion-focused therapy was developed in the 1980s by two clinicians, Sue Johnson and Les Greenberg. They developed the theory after reviewing videos of their sessions of couples therapy and identifying the steps in the process which led to desired changes. Both saw the importance of in-the-moment emotional experience as a way to give new meaning to the couple’s interactions and to lead to change in behavior. In this way, they were influenced by the humanistic and experiential psychotherapies of Carl Rogers and Fritz Perls.
Johnson and Greenberg also noted that the behavior of each person depended upon the action or reaction of the other. This led them to perceive that problems develop as a result of repetitive patterns of interaction between two individuals. Sue Johnson has said that her understanding of these interactions was influenced by family systems theory, and particularly by the structural family therapy of Salvador Minuchin.
In the mid-1980s, Sue Johnson continued to develop EFT for couples with a strong influence from the attachment theory of British psychiatrist John Bowlby. She saw the critical need for a secure attachment bond in adults as an extension of this basic emotional need in childhood.
