Emotionally Focused Couples Therapy: How It Works & Who It Can Help

What Is Emotionally Focused Couples Therapy?

Emotionally focused therapy (EFT) is based on the theory of attachment, the therapeutic conditions of experiential 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.

“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.” – Gal Szekely, LMFT, Director of The Couples Center

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 throughout 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

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 leading to escalation of the distress. In EFT couples therapy, these are called “demon dialogues.” They are recognized as increasing feelings of emotional aloneness.³

Communication Models

According to studies, the specific communication model that often leads to relationship issues is 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 looking for is feeling connected while the distancer is trying to avoid conflict and wants 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 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 follow naturally.

Emotion Focused Therapy For Couples

Emotionally focused couples therapy can be helpful for couples who are dealing with expression of emotions and understanding emotions the way they are expressed. It is important to consider communication in any relationship, and EFT is built to help improve communication and manage relationship conflict in a healthier way.

Emotion Focused Therapy For Individuals

EFT for individuals is very helpful for those who are looking to learn more about their own human experiences and emotions. It can be really hard to face tough emotions and learning how to handle hard emotions is central to individual EFT. EFT can also help with learning what you may need to work through emotionally to show up for others, such as partners or children.

Emotion Focused Therapy For Families

EFT for families is based around understanding every family member’s unique emotional experience and creating space and safety for everyone. Families by nature have a power imbalance between parents and young children, however it’s important for parents and children to understand the vital role of emotions in any kind of relationship, and that learning to work through emotions is important for everyone’s wellbeing.

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, instead focusing on the interactions that occur within sessions.

Couples are guided to recognize how their patterns of communication contribute to 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 and 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 their perspective, is emotional distance versus conflict or control.

What Can Emotionally Focused Couples Therapy Help With?

Numerous outcome studies have shown that EFT can help couples cope with a range of problems including anxiety, 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

3 Emotion Focused Couples Therapy Techniques

EFT has a lot of different techniques when therapists are delivering this modality, however there are three central techniques therapists use during emotionally focused couples therapy:⁴

1. Stabilization/De-escalation

This stage 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. Stabilization/de-escalation also helps to recognize the ways in which their insecurities are driving action and find ways to recognize the ways in which their partner is showing up for them.

2. Restructuring

In the second stage, “Restructuring,” the couple is guided toward creating a new bond by changing their communication patterns. This stage is aimed to help couples receive each other in a more compassionate way with more acceptance and enhance their emotional attachment to each other.

3. Consolidation

In the final stage, “Consolidation,” old problems or issues are revisited using the new way of communicating so that new solutions may be found. This stage helps couples recognize the ways in which their communication wasn’t working and how the changes made are now working much better. It leaves couples feeling empowered and strengthened in their bond.

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. The scenarios explored here include loneliness after child birth, anxiety about a partner’s changing job status, and infidelity.

Loneliness After Birth of First Child

Emily and Eric have been 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 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 in the marriage, 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 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

You can find a couples counselor trained in EFT by using an online therapist directory and adding EFT to the search filter. You 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 on the therapist’s 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. 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, 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

Benefits of Emotionally Focused Couples Therapy

There are many benefits of EFT for couples. Couples have stronger connections emotionally which improves their attachment to each other. They also find more comfort in each other and that helps couples handle difficult situations better. They are able to consider conflict from different perspectives to minimize any negativity and view conflict as an opportunity for deeper understanding. Overall, it helps couples become more self aware and in turn aware of their partner’s feelings and needs.

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 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 on 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.