What is emotion-focused couples therapy (EFCT)?
Emotion-focused therapy is a therapeutic approach that originated in Canada in the 1980s, when Dr Sue Johnson and Dr Les Greenberg developed their psychological research and clinical applications to improve attachment and bonding in adult relationships.
After the initial collaboration, the work of Dr Sue Johnson and Dr Les Greenberg took slightly different paths; Greenberg re-focused his interest in clinical applications with individuals and developed his ‘emotion-focused’ approach, while Johnson continued to further develop ‘emotionally focused therapy’ in its clinical application with couples.
The approach is based on many years of research into bonding, both between mother and child and between romantic partners. With this wealth of research, EFT therapists are equipped with a map of relationships: how they work, how they go wrong, and what is needed to put them right.
Research suggests that EFCT can be an effective approach for many couples, including those experiencing depression, post-traumatic stress disorder (PTSD) and sexual dissatisfaction. One study found that around 70% of couples were symptom-free at the end of emotionally focused couples therapy, with improvements maintained for up to two years after treatment. Because of the growing body of research supporting its effectiveness, EFCT is considered an evidence-based treatment.
How does emotion-focused couples therapy work?
Our emotions help us understand what we need from ourselves and from others. They can alert us when something feels wrong in a relationship and motivate us to seek comfort, reassurance or connection. They can also steer us in these serious situations to take action towards meeting our needs. Attachment theory views emotions as essential in the experience of self.
According to attachment theory, we feel more secure in our relationships when our partner is emotionally available, responsive and engaged. When those needs aren't met, couples can become stuck in patterns of conflict, distance or misunderstanding.
This is why interactions of distressed couples are usually characterised by negative cycles, where one partner is pursuing while the other withdraws. These interactions can soon become stuck in rigid, dysfunctional patterns (what EF therapists call ‘negative cycles’) and stay that way until the underlying need for secure attachment is identified and addressed.
What can emotion-focused couples therapy help with?
Emotion-focused couples therapy (EFCT) can help couples who are experiencing:
- Frequent conflict or arguments
- Feeling emotionally disconnected
- General relationship dissatisfaction
- Depression affecting the relationship
- Trauma
- Infidelity or other relationship injuries.
While EFCT is suitable for many couples, it may not be the right approach for every situation. For therapy to be effective, both partners need to feel safe enough to explore their emotions and experiences together.
If there is domestic violence or emotional abuse or an active affair, it may be difficult for the therapist to create that sense of safety. In these situations, EFCT may not be recommended until the circumstances have changed.
If there's any uncertainty about whether EFCT is suitable, an initial assessment with an EFT therapist can help determine the safest and most appropriate course of action.
What is the purpose of emotion-focused couples therapy?
EFCT aims to do more than change the way people communicate; it can help them negotiate issues. An EFCT therapist can help couples create a more secure emotional bond, greater relationship satisfaction, intimacy, trust, and a general sense of safety with their partner.
EFCT focuses on the present. Sometimes past events are revisited because they are significant to the couple's history, but the emotions elicited by these events are in the present, and change happens in the present in the relationship.
Emotion-focused couples therapists sometimes give homework, but mostly it’s all about what happens in the session. They help clients go deeper into their emotional experience, make sense of it, and find aspects they usually don’t pay attention to. That experience is then reassembled so they can send new signals to their partners, and those partners can respond more positively.
What to expect from emotion-focused couples therapy
The first session is a joint session dedicated to exploring the couple’s background and current relationship difficulties. The next step is an individual session with each partner, during which the therapist explores each partner's family history and significant life events. The therapist will take an attachment history and interpret the client’s attachment style.
After their individual session, the partners will resume couples therapy together, and they will start identifying the negative cycles they get caught up in. With the therapist’s help, they will work towards changing their patterns of interaction and emotional responses to each other, with the aim of re-establishing emotional intimacy and connection in their relationship.
How long does emotion-focused couples therapy last?
EFCT is generally a short to medium-term approach, lasting between 12 and 20 sessions for couples with mild to medium relationship distress. The duration of the treatment can be much longer if there is infidelity, trauma or other complex presenting issues.
What are the stages of emotion-focused couples therapy?
Stage 1: De-escalation
The therapist works to create an alliance, presenting the conflict issues to the couple and their struggle to meet their attachment needs.
At this stage, the focus is on identifying the negative interaction cycle (the negative patterns that the couple gets caught up in). By revisiting difficult moments (negative cycles) together, the therapist helps each partner access the unacknowledged emotions that are contributing to the development of a negative cycle.
The therapist helps the couple reframe the problem in terms of underlying emotions and attachment needs. The negative cycle starts to be seen by the couple as the common enemy (rather than seeing the partner as the ‘bad guy’). At the end of this stage, the couple is de-escalated and, when caught in a negative cycle, can recognise it, come out of it and ‘repair’ their bond in a way that wasn’t possible before.
This stage is usually the longest and most important. Couples who are highly reactive and with complex presentations (such as a history of trauma) sometimes stay in this stage for many months.
Stage 2: Changing interactional positions
As the couple enters a less reactive stage, it is possible for the therapist to promote both individuals' ability to acknowledge and share with their partner more vulnerable emotions, such as the hurt that lies under the reactive anger. The therapist facilitates the expression of needs and aspects of self that were previously out of awareness or too difficult to share, so they can be integrated into their relationship interactions. The partners can be more emotionally vulnerable with each other.
At this stage, the therapist focuses on facilitating each partner's acceptance of the other’s emotional experience and helping the couple develop a more positive and attuned emotional response in their interactions. Through emotional engagement and bonding moments in sessions, the couple starts to feel emotionally secure.
Stage 3: Consolidation
At this stage, the partners experience a more emotionally attuned relationship. Now that they feel emotionally safe with each other, the therapist can facilitate the emergence of new solutions to longstanding relationship problems and help the couple consolidate their new positions and positive cycles of attachment behaviours.
Working with an EFCT therapist
EFCT therapists work to create safety in the session for both partners by ensuring they feel heard and understood. They support the couple in making sense of what’s going on “right here and now” in the session. They help couples identify and understand the underlying emotions that keep them stuck in rigid positions and negative cycles. Once these have been identified, they facilitate the development of a different kind of interaction within the session, which leads to a shift from reactive emotions to positive attachment emotions.
By transforming emotion with emotion, EFCT therapists support each partner in exploring and expressing emotions that elicit compassion and connection, promote soothing, and help clients address unstated and unmet attachment needs. They help couples to better identify, experience, make sense of, and flexibly manage their emotional experiences. The progressive change in the couple’s interactions occurs through awareness, regulation, reflection, and the transformation of emotion.
Content attribution
This page was written by an ICEEFT-certified EFT couple therapist, Mila Palma.
