The Contribution of Emotionally Focused Couples Therapy

First, the goal of therapy is more substantial than the alleviation of symptoms or pragmatic problem solving. The focus is on the whole person rather than the problem that brings the client to therapy. Health in this model is the ability to be open to experience, flexible in responding to one’s environment and to feel empowered to choose and actively construct one’s daily life and relationships with others. The humanistic therapist takes a stance that all clients are capable of growth and agency, if they are given support and validation.

Clinical experience and research results from Johnson and Greenberg (1985) suggest that distressed partners have the “skills” and resources necessary to communicate effectively and positively. They simply cannot access them when flooded with anxiety and trapped in negative self-reinforcing interactional cycles. Problems arise then from lack of or denial of awareness, constriction in processing ongoing experience so that this experience cannot be understood and trusted, a lack of coherence where emotion cannot be integrated with action and cognition, or where elements of the self are in conflict. In marital distress these issues result in partners showing and seeing less and less of each other, sending conflicting messages (e.g. asking in an attacking, belittling way for reassurance and connection), and being caught in negative interaction patterns, such as demand-withdraw. The humanistic therapist does not get caught in the trap of labelling and pathologizing partners or relationships and so is able to convey hope and the expectation that partners will be able to shape and improve their connection with each other.

Second, this model specifically outlines the therapeutic relationship that is a necessary condition for growth and change. It assumes that the therapist’s acceptance and empathy are powerful in and of themselves in that they create the safety where difficult experience can be encountered and assimilated and where risks can be taken. Empathy here is an active leap of imagination where the therapist connects with and processes core experiences with each client, discovering that experience as it unfolds. Both Rogers (1951) and Bowlby (1969) believed that all responses are basically reasonable and adaptive if they are understood in context. The humanistic therapist then joins each client where that client is and validates his or her attempts to survive, rather than assessing a “problem” and then asking clients to be somewhere else. So, an EFT therapist will accept and work with a client’s silence or rage, rather than offering immediate alternatives or attempting to modify this response. The necessity for defensive, rationalizing or justifying behaviours on the part of distressed partners is then minimized.

This model involves a way of being for the therapist, not just the implementation of a set of techniques. The therapist attempts to be open, egalitarian, authentic and transparent in session so that therapy becomes a safe haven where exploration is possible. The therapist is part of the process and the journey of change. The nature of the therapeutic alliance has been found to account for 20% of the variance in outcome in EFT (Johnson & Talitman, 1996). Each couple is then a learning opportunity for the therapist and a genuine human encounter. As clients explore the “frightening crannies of inner experience” (Rogers, 1961, p. 34) and risk connecting with each other, the therapist stands with them and discovers this experience.

Third, a humanistic intervention such as EFT is both parsimonious and salient, that is it gets to the heart of the matter as experienced by clients in distressed relationships in the present. Couples’ experience of the salience of EFT is reflected in the fact that drop-out rates are generally extremely low in EFT studies and clinical practice, and results appear to be stable, even for high risk couples (Clothier, Manion, Gordon Walker & Johnson, 2001). The focus of therapy is the moment to moment unfolding of salient emotionally laden experience and interactions as they occur and as they are newly constructed by the therapist and the partners. It is about immediate experience and a couple’s international dance as they are lived. The therapist slows down the drama of interaction and helps clients connect more fully with and expand inner experiences and interactional responses. The therapist does not get caught in the myriad of content issues that couples bring to a session or in the intricacies of past histories and unconscious desires. Instead, he or she focuses on being a process consultant who helps partners discover the “order in experience” (Rogers, 1961, p. 24), and then, step by step, create new responses that renew the relationship. Therapists have repeatedly criticised researchers and psychotherapy model builders for omitting a focus on what happens in session and how to pragmatically move each session in a positive direction. The EFT model outlines the process of change in 9 steps (Johnson, 2004) that capture a couples’ progress from the de-escalation of their negative interactional cycle, to the creation of new cycles that include powerful bonding interactions, to consolidation and integration. Key change events have also been outlined and therapist interventions that move these events forward delineated (Bradley & Furrow, 2004).

The focus on the present moment and “mining the moment” (Johnson, 2004), is an essential part of EFT. As Stern suggests (2004, p. 31), “the present moment has been relatively but not wholly ignored by psychology.” Experiential therapies make a powerful contribution here in stating the power of the present and offering ways to work with it. An EFT couple therapist, using reflection and evocative questions, will hold a moment up to the light and, with the couple, explore its rich and not yet articulated implications. The therapist can take, what Stern calls the “architecture” of the present moment and explicate the “emotional story” underlying it and the choices made as this moment unfolds. So when an isolated partner who is desperate for contact attacks her partner as he risks reaching for her, the therapist stays with this moment and, in a validating manner, helps her explore this response. Distrust and self-protection emerge as the backdrop to this response, but it is examined and chunked into cues, bodily responses, meaning construction, action sequences and the impact of her response on the relationship, which is that, as she pushes him away, he moves into further hopeless and inaccessibility. This one response can prevent the transformation of a couples’ negative cycle and the creation of trust. If it is expanded into a statement of fear and vulnerability that evokes the husband’s caring, this moment can be the beginning of a new relationship. These moments are rich. They show characteristic ways that partners connect with themselves and with each other.

Fourth, perhaps the greatest contribution of all is the humanistic focus on emotion. Emotions are the blueprints for interactions with attachment figures. They are the music of the attachment dance. There has been more and more acknowledgement in recent years of the power of affective engagement and new corrective emotional experience to create change in psychotherapy, even in cognitive therapy (Wiser & Goldfried, 1998). In couple therapy, however emotion has generally been marginalized (Johnson, 2005a, b), even though new research suggests that emotion is adaptive and essential in basic processes such as decision making and choice (Damasio, 1994). Emotion is powerful and compelling. and while more and more general research is emerging telling us that emotion is a force for adaptation and that the suppression of emotion is harmful (Gross, 2001), it is difficult to use emotion in the service of change unless you have a clear map to intervention.

EFT uses emotion to orient and focus the session on key moments and issues, to guide meaning making and to “move” partners into new actions and responses. New emotional signals reorganize and renew a distressed relationship. The EFT therapist focuses on the six key emotions: joy, surprise, shame, fear, anger and sadness. He or she helps partners access, engage with emotional responses while, at the same time, keeping a “working distance” so that these responses can be revised and evoked to create new positive interactions. The therapist works to create emotional safety and engagement. Emotional engagement and responsiveness is emerging more and more in the marital literature as the key predictor of marital happiness, rather than factors such as conflict containment. In marriage and in therapy, to simply label emotion or to have insight into it does not seem to be that useful. The EFT therapist tracks, reflects and often heightens emotion, moving partners from reactive secondary affects such as irritation/anger to more primary deeply felt underlying emotions such as fear and sadness. The therapist will also help couples engage with and “sort” emotional experiences and,thus, order them. For example, hurt is a mixture of anger, sadness and fear, but usually one of these emotions will stand out and organize a partner’s responses. The fear of abandonment, for example, may be crucial in hurt experiences for a partner in couple therapy. Deep emotional experiencing in key change events has been found to predict recovery from relationship distress in EFT (Johnson & Greenberg, 1988). In general, the EFT therapist works to deepen and distill primary emotions – to change the music and so change the dance of distress.

From the humanistic perspective, it is useful for all therapists to know how to empathically connect with clients, to stay in the present moment and reconstruct that moment, and how to use new emotional experience to build new emotionally salient interactions. We can now turn to look at the interventions that form the basis of the EFT model.

The two tasks of the EFT therapist are: (1) the accessing, deepening and distilling key emotional experience and (2) creating new responses and interaction patterns that allow for more secure bonding between spouses. These tasks are completed using the interventions given below:

The EFT humanistic focus on process moments and patterns and on universal emotions allows this model to be applied to different kinds of people from different cultures and a variety of problems and impasses. The therapist respects and unfolds each person’s idiosyncratic construction of reality and connectedness, while also using emotion and attachment needs and fears as the basis for empathic attunement. Problems that co-occur with relationship distress, such as depression, anxiety or traumatic stress are dealt with as they arise as an inherent part of unpacking and processing the present moment. A hopeless sense of despair, loss and unworthiness often accompanies withdrawal from an attachment figure, and fuels depression. Depression, in turn then heightens withdrawal and confirming negative feedback from the other partner.

Common impasses in couple therapy, such as blocks to the rebuilding of trust caused by key hurts, referred to as attachment injuries in EFT, can be effectively addressed in this model. A step by step process addressing the forgiveness of such injuries has been formulated (Makinen & Johnson, in press) by studying case examples in a “bottom –up” fashion, observing the successful and unsuccessful completion of this forgiveness task and then testing the effectiveness of the model as created. Results suggest that EFT is very successful in helping distressed couples resolve such injuries. Furthermore, once these injuries are resolved, couples can complete the key change events in EFT and recover from relationship distress. These results also appear to remain stable over time.

The real strength of an experiential model such as EFT is that it is structured and scientific and yet flexible, responsive to each client and so created anew with each couple. The essence of science is observation and the finding of patterns in that observation. The 9 steps that make up EFT are: (1) assessment, (2) identifying the negative cycle, (3) accessing primary emotions in this cycle, (4) framing the cycle as the common enemy and creating conflict de-escalation, (5) deepening engagement with primary attachment emotions, (6) structuring the acceptance of these emotions by the other partner, (7) enacting these “new” emotions to create new positive trusting cycles, (8) consolidating changes into new stories and (9) attachment rituals and resolving pragmatic problems from the new secure base offered by the restructured relationship. These are based on the observation of the emotional responses and interactional moves of couples moving through the change process. It makes sense then that EFT fits very well with other observational findings such as those outlining marital distress and satisfaction by researchers such as John Gottman (1999), with research on the nature of emotion (Plutchik, 2000; Tomkins, 1991) and with the plethora of recent research on adult attachment (Cassidy & Shaver, 1999). As well as being empirically tested, EFT interventions can be systematically taught (Johnson et al., 2005) and applied to varying populations of clients. Nevertheless, as a humanistic model, EFT couple therapy grounds every session in the safe haven of the relationship between therapist and client and in the shapes and colors of both partner’s experiencing and moves in the interactional dance. For therapists and clients, each session is a time of genuine encounter and discovery. With this genuineness comes unpredictability, and in this is the art of therapy. The therapist takes what he is offered in the moment and makes it, with his clients, into something new. The therapist and the couple enter into what Rogers termed “the stream of becoming” (1961). Art and science comes together in the service of transformation.