Emotional Focused Couples Therapy (EFT)

Emotionally Focused Couples Therapy is a revolutionary technique/intervention designed to help couples repair rifts and build strong bonds of connection and love. Distressed couples have had a 70% success rate with this technique and 90% have shown improvement.
It was created by Dr. Sue Johnson, clinical psychologist, author of the book and online program “Hold me tight” (7 conversations for a love life) and director of the International Center of Excellence in EFT: https://iceeft.com/

EFT is based on attachment theory (Bowlby 1957), systemic psychology and experiential psychotherapy. Cindy Hazan and Phillip Shaver have conducted studies indicating that adults show attachment patterns in couples, similar to those that children show towards their parents;.

The mother-child relationship is vital for survival, children in stressful situations turning to the figure of trust and security for comfort (strong emotions are co-regulated, in relationships); children then thrive/develop if the basic need for safety is met. On the other hand, insecure attachment interferes with the ability to regulate affect and explore the inner world (models about oneself and the world).

• Organized – Secure (I am valuable, competent, the world is safe and reliable),
• Anxious – Insecure (I am not valuable/unworthy, cannot rely on the world and others, strong need for closeness, fear of rejection)
• Avoidant – Insecure (self incompetent, not good enough, cannot be loved uninterested in relationships and prefers not to depend on anyone)
• Disorganized – Insecure (has no internal models)
  

“Identifying attachment styles is a safe and easy way to understand and predict the behavior of individuals in any couple relationship (we are programmed to act in a predetermined manner)”.
Emotional connection is what keeps us alive, we are social beings and isolation is the greatest punishment, like in prison. “Still experiments” shows the stress a child goes through when separation, disconnection and insecurity appear and several studies show the physiological, neurochemical and neuroanatomical changes between attachment and separation.
EFT uses specific steps and interventions to ensure that clients are heard, understood, normalized, accepted (approx. 10-15 sessions if there are no deep attachment wounds). The role of the therapist is to create a safe space and becomes a safe conversation partner (safe / secure base) for each of the parties. The method addresses partners’ responses, often helping them identify negative patterns and re-educating new responses.

The therapy stages include 3 main areas as follows:

• First step: De-escalation, including alliance and evaluation of the couple, identifying the negative cycle / attachment issues and accessing primary and secondary attachment emotions, as well as formulating the cycle as the problem (as opposed to the partner is/has a problem)
• Second step: Restructuring of the connection includes accessing needs, fears, mental models about oneself/the world (reintegration of renegade parts) and promoting partner acceptance, access to support or understanding and sharing needs
• Third step: Consolidation involves not engaging in the cycle and recording successes
  In the first sessions besides the x-ray of the couple and their current situation, what they want for the future and the alliance / chemistry with the therapist, words and images that describe emotions, fears and attachment needs are critical to be remembered and considered, formulating the nuances of their cycle of isolation and pain as main enemy.
  Each session would clarify the goal and review the cycle, and how emotions are experienced, both the visible one, as the deeper unmet needs, bringing them into the present to be described and triggers understood. The therapist becomes a partner to share emotions, that are then empathized with, validated, intensified as needed, reframing potentially the experience in terms of fears and attachment needs and used to restructure and shape differently the partners interactions.
  
• After a day of work, the partners experience disconnection and trying to connect they fail to express their attachment needs and basic emotions. It ends up in a negative cycle, pushing their wounds/buttons and often, one will try to understand and ask to be heard and supported, and the other will run away.
  
• Rejection triggers the pain center in our brain and as one partner becomes less receptive (Withdrawer/avoider), the other becomes more aggressive/protests (Pursuer/chaser).
  The Chaser most often has a hyperactivation / overcompensation strategy. He tries to understand, he pushes the discussion, he mobilizes, he worries, he gets fired up, he tries to fix, he fights. The Avoider has a strategy of turning off the emotional heat, most often denial, rejection, avoidance, hiding, letting the storm pass. In everyday life we encounter the Chaser/avoider dynamic, but also chaser-chaser or avoider-avoider, with some young couples where the role chaser – avoider are exchanged.
  There are 6 emotions: anger, sadness, surprise, disgust/shame, fear, joy and 4 ways to access the emotion:
  • The trigger (a look, a tone)
  • The meaning/thought you form (‘’he is again angry and overwhelmed, no calm left for the family )
  • Bodily sensation (freeze, fight, flight somatics)
  • Behavior (leaving or screaming, fight, flight)
    
• Unfulfilled basic needs are often not expressed explicitly, but the therapist will use themes and language to check with the client what exactly in his history creates his reactivity.
  • Fear of being rejected (inadequate or worthless) – Need for acceptance
  • Fear of being abandoned (lack of responsiveness, remaining alone) – Need for closeness
  • Fear of not living up to standard (fear of asking for help) – Need for understanding
  • Fear of being a failure (fear of asking for attention and expressing/admitting needs) – Need to be important
  • Fear of not being accepted (fear that you don’t exist, that you may be missing) – need to feel loved
  • Fear of not being loved (fear of lack of support, insecurity that you are important/priority) -Need for appreciation
  • Fear of being controlled – Need to be taken care of
    
• Using affect as way of promoting long-term changes in couple therapy (although the types of interventions differ) has been previously used in various types of therapy.
  • Ibct (integrative behavioral therapy – Jacobson & Christensen, 1996) – emphasize the expression of emotions in promoting acceptance by the partner
  • Imago (Hendrix, 1988) – encourages mutual understanding by partners of the relationship through the prism of childhood wounds – promotes the taming of exchanges and positioning in interactions
  • Ego-analytic therapy (Wile, 1995) – the integration and engagement of the couple’s emotions as the basis for connection and closeness (opposed to distancing)
  • EFT – emotional expression and attachment needs as a form of empathic closeness, and leading to increased acceptance and intimacy

Once the needs, emotions and negative cycle are objectified as the “problem” and understood, we can advance in to restructure the connection: Accessing the needs, fears, mental models about oneself/the world (reintegration of the renegade parts), Promoting acceptance by partner, accessing its support, Accessing and sharing needs.

A “softening” or taming event occurs when a previously hostile/critical partner asks for comfort/reassurance or for an attachment need to be fulfilled, from a position of vulnerability and experiencing a high degree of emotionality; the process of sharing and hearing between partners is then integrated by the therapist, making the partners slowly become more a source of security rather than stress.

Ineffective communication, mutual negativity, negative relational schemes, the difficulty of expressing emotions and basic needs, prevent the resolution of conflicts that are “soaked” with attachment wounds; couples interpret their interactions according to internal models and perpetuate individual and couple stress. Attachment wounds are a form of “betrayal”, through abandonment or breach of trust. It is not about trust in general, but certain situations in which one of the partners proved to be inaccessible or unresponsive to the other partner’s urgent need to be supported and cared for as by an attachment figure.

Unresolved, these events damage the attachment bond and prevent attachment and repair. Some events may be trivial or exaggerated to an outsider, or others may be more serious and obvious such as infidelity. These moments often occur in situations of transition, loss, danger (physical) or uncertainty (birth of a child, moving in together, pregnancy loss, diagnosis with an illness, death, retirement, immigration, etc.)
Once the partners have competences to express vulnerably their needs and reiceve acceptance from the other side, the consolidation and celebration of successes in the cycle is carried out.

Bibliography:

• Milijkovitch R., (2017), Chapitre 3 – La théorie de l’attachement : John Bowlby et Mary Ainsworth, Elsevier, Psychologie du Développement, Pag. 25-30
• Amir L. , Heller r. (2015), Attachment styles. A new theory of attachment, How to find and keep a happy couple relationship, Cluj-Napoca, Publishing House: ASCR, Pag. 48-53

• Academic Press, Behavioral Biology – an International Series, (1985), The Psychobiology of Attachment and Separation, Publishing House: Martin Reite
• Johnson S., (2008), Hold me tight – Seven conversations for a lifetime of love. Publishing House: Little Brown
• Johnson S., (2004), The practice of Emotionally Focused Couple Therapy – 2^nd edition, Publishing House: Taylor & Francis Books Inc.
• Journal of Marital and Family Therapy, April 2001, Vol 27, No.2, 145-155
• Journal of Marital and Family Therapy, April 2004, Vol 30, No.2, 233-246
• https://iceeft.com/