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Section 21
Emotionally Focused Couples Therapy

Question 21 | Test | Table of Contents

How does Emotionally Focused Therapy (EFT) go about rebuilding intimacy? It's a nine-step treatment that can take anywhere from 8 to 20 sessions (30,in very complex cases). The first four steps involve helping partners recognize that the problem is not their individual personalities per se, but the negative cycle of communication in which they're stuck. In the next three steps, the therapist works with couples to promote sharing, soothing and bonding, before helping the couple incorporate those acts into everyday life in the last two steps. This final process of showing couples how to keep their connection alive can help prevent relapse.

To better understand how EFT works, it's instructive to see it in action. Take the story of Mary and Harry, married seven years, with one child. Both are managers by profession and very competent, so when they showed up at my office they expressed that they were puzzled by their inability to "manage" their marriage. They said they had lost a sense of intimacy and were no longer making love. In addition, Mary had discovered what she described as "very friendly" e-mails to her husband from a female colleague of his. Although Harry wasn't having an affair--yet--Mary was distraught at the thought of her husband sharing more with this woman than he was with her. Both spouses were thinking about splitting up. But the key snippets of conversations below, taken from our sessions together, demonstrate how EFT helped restore their connection.

Step 1. Partners lay their problems on the table
Describing a recent fight in detail often helps partners begin to identify core problems. Most couples fight about pragmatic issues--doing laundry or paying bills, for instance--but it's the emotional needs underlying these tiffs that need attention. The following conversation between Mary and Harry illustrates their negative pattern of communication as the two argue about Harry's typical reaction to his wife's frequent mood swings: As she complains and criticizes, he gets defensive and withdraws.

Mary: He doesn't care about anything but work. He has a love affair with his computer. I've had enough. I don't even know who he is anymore. [To Harry] You never reach for me! Am I supposed to do all the work in this relationship?
Harry: You are so difficult. I try to talk to you, and all I get is how I can never do anything right. It's always the same: You're angry, and you lecture me a thousand times a day, so I guess I do go downstairs to my computer. I get a bit of peace that way.

Step 2. Partners recognize the cycle that's keeping them emotionally distant and try to identify the needs and fears fueling that cycle
As couples more carefully explore the underlying source of their arguments, they begin to realize that the enemy is not the partner but the unhealthy behaviors in their relationship. In this step, I encourage couples to use non-evaluative language to uncover any fears they might have--of rejection, say, or failure--which are driving the relationship dynamic. In the following exchange, note how Harry and Mary are beginning to explore each other's motivations.

Harry [to me]: Yes, I do turn away from her, I guess. I try to move away from the message that I'm a big disappointment--that's what I hear--and the more I move away, the madder she gets. Maybe she feels like she is losing me.
Mary: Right. I feel you've gone off, like, to another land. So yes, I bang on the door louder and louder, trying to get your attention, trying to tell you we need to do something.

Step 3. Partners articulate the emotions behind their behavior
At this point, my role is to help both partners understand and clearly explain what's driving their behaviors, while ensuring that the other is also gaining an accurate understanding. Below, Mary realizes that she's not really angry with Harry but frantic to gain his affection. Harry realizes that he withdraws not because he doesn't want to be with Mary but because he doesn't want to be criticized or face his fear that their marriage is in danger.

Mary: I start to feel really desperate. That's what you don't hear. If I can't get you to respond, well...[she throws up her hands in a show of defeat].

Harry: I shut down just to get away from the message that I am so disappointing for you. I can't let it in; it's upsetting. In a way, it's terrifying, so I move away and hope you will calm down.

Step 4. Partners realize they're both hurting and that neither is to blame
As the couple begins to see the negative dynamic as the source of their problems, they become more aware of their own needs for attachment, as well as those of their partner. Armed with empathy, partners can now approach their problems with a less combative mind-set. In the following exchange, Mary and Harry begin to see the cycle as a common enemy and discover new hope for the future.

Mary: The more desperate I get, the more I push; and the more scared you get, the more you shut down.

Harry: [Nods and smiles] That's it.

Mary: This thing we're doing, it's got us by the throat.

Harry: Maybe it's that we both get scared. I never knew you were so scared of losing me. I never knew you needed me that much.

Mary: Maybe we can step out of this, if we try it together.

Step 5. Partners identify and admit their emotional hurts and fears
At this stage of EFT, my role becomes even more integral in the couple's progress. Their honesty makes them feel increasingly vulnerable, and my job is to encourage and support them and to help them remain responsive to each other. In this exchange, Harry and Mary risk expressing their deepest feelings.

Harry: I don't know how to tell you how deep the pit is that I go into when I hear that I have failed, that I can't make it with you. I freeze. I shut down.

Mary: I never saw that you were hurting. I guess I saw you as calm and in control, almost indifferent, like you didn't need me at all, and that is the loneliest feeling in the world. There is no "us." I am alone, small. I feel like a fool.

Step 6. Partners begin to, acknowledge and accept me the others feeling and their own new responses to those feelings
After years of believing a partner's behavior indicates one thing, it's difficult to accept that it actually means another. In step six, couples learn to trust these newly revealed motivations and, in turn, experience new reactions to these motivations. Note how Harry and Mary now listen to each other and exhibit mutual compassion.

Harry: I never saw how small you felt. I guess you were screaming for me when I saw you screaming at me. I don't want you to feel small and alone.

Mary: I didn't think I was getting through to you. I feel awful when you tell me that you'd freeze up inside. I guess I was having an impact. I was trying to get you to let me in.

Step 7. Partners are drawn together through the expression of their emotional needs
At this stage, partners are willingly available to each other, so when talking about their vulnerabilities, they're able to assure each other and soothe hurt feelings. This becomes the most emotional part of the therapeutic process as couples like Harry and Mary create a new, bonding cycle that begins to replace the old, destructive one.

Harry: I want you to give me a chance to learn how to be close to you. I can't deal with being labeled a failure. I want to let you in--I want to be close--but I need to feel safe, like you are going to give me the benefit of the doubt.

Mary: It's scary to feel lonely when you turn away. I need reassurance. If I tell you "I need some holding, some 'us' time," I want to know that you'll be there. I want to feel safe again, [In response, Harry holds her tightly.]

Step 8. Partners create new solutions to their problems
In step eight, partners share the new story of their relationship and how hard they worked to rewrite it together. Processing this experience and viewing their history in a different light allows couples to find newer, healthier ways of approaching pragmatic problems. Here we see Harry--who once ran and hid from the relationship--actively create more opportunities to bond with Mary.

Harry: We can have time together in the evening, after the kids are in bed. Let's make coffee and sit together, and if you trust me a little, I'll make us a schedule for nights out. It makes me feel good to know you need time with me.

Step 9. Partners consolidate their new positions and cycles of behavior
After months of work, it's vital that the couple continues to remember what first got them off track and how they found their way back. Without reassessing this process, maintaining this new cycle will lose importance and ultimately lead to a relapse. As Harry and Mary reflect on their therapy experience, both clearly see how they first became distressed and what they did to repair the relationship.

Harry: It was when I got promoted that it all started. I needed to prove myself to everybody. I did get immersed in work, but now when I hear that tone in your voice I remember how much you need me, and I want to reassure you: I am here, Mary. I know we can do this now. We're learning to trust each other again. It's like we are finding the "us" we had when we got married. We still fight sometimes, but these close times make all the difference.

For the right people, EFT can work magic. In fewer than four months, it brought Karen and Mitchell Irving back from the brink of divorce. "We discovered that our marriage was built on these ludicrous underlying assumptions," Karen says now. "Mitchell had this sense of entitlement and believed I should be there for him no matter what. I, coming from a dysfunctional family, believed I wasn't worthy of more consideration than that. When we realized how off our perceptions were, we giggled about it."

More important than the levity these revelations brought were the changes that grew out of them. Mitchell cut back on his office hours and is enjoying spending more time with Karen. And they don't feel childish, as they had before, when asking each other for "close time." "We've learned not to sacrifice intimacy for independence," Karen concludes. "One of the greatest joys of marriage is discovering how much we need each other."

Sadly, for some couples it may be too late. EFT is not designed for people who have tried unsuccessfully to reconnect for so long that they've already mourned the lost relationship and become completely detached. It's also not appropriate for abusive relationships. But if, despite your obstacles, you still desire to make your relationship work, I encourage you to see an EFT-trained therapist.

- Johnson, Susan & Aviva Patz. Save Your Relationship. Psychology Today; Mar/Apr 2003, Vol. 36, Issue 2.

Therapeutic Presence in Emotionally Focused Couples Therapy

- Feuerman, M. L. (2018). Therapeutic Presence in Emotionally Focused Couples Therapy. Journal of Experiential Psychotherapy, 21(3). 22-32.
Reviewed 2023

Update
Emotionally focused couple therapy in cancer survivor couples with marital and sexual problems: a replicated single-case experimental design

van Diest, S. L., den Oudsten, B. L., Aaronson, N. K., Beaulen, A., Verboon, P., Aarnoudse, B., & van Lankveld, J. J. D. M. (2023). Emotionally focused couple therapy in cancer survivor couples with marital and sexual problems: a replicated single-case experimental design. Frontiers in psychology, 14, 1123821. https://doi.org/10.3389/fpsyg.2023.1123821


Peer-Reviewed Journal Article References:
Feuerman, M. L. (2018). Therapeutic presence in emotionally focused couples therapy. Journal of Experiential Psychotherapy, 21(3), 22-32.

Li, P. & Johnson, L. N. (2018). Couples' depression and relationship satisfaction: Examining the moderating effects of demand/withdraw communication patterns. Journal of Family Therapy, Supplement, 40, 63-85.

McNeil, G. D., & Repetti, R. L. (2023). “You okay, honey?”: Marital quality and mental health as correlates to couples’ compassion. Journal of Family Psychology, 37(6), 899–908. https://doi.org/10.1037/fam0001130

Robison, M. K., Miller, A. L., & Unsworth, N. (2018). Individual differences in working memory capacity and filtering. Journal of Experimental Psychology: Human Perception and Performance, 44(7), 1038–1053.

Ruan, Y., Le, J. D. V., & Reis, H. T. (2023). How can I help?: Specific strategies used in interpersonal emotion regulation in a relationship context. Emotion. Advance online publication. https://doi.org/10.1037/emo0001272

Sasaki, E., Overall, N. C., Reis, H. T., Righetti, F., Chang, V. T., Low, R. S. T., Henderson, A. M. E., McRae, C. S., Cross, E. J., Jayamaha, S. D., Maniaci, M. R., & Reid, C. J. (2023). Feeling loved as a strong link in relationship interactions: Partners who feel loved may buffer destructive behavior by actors who feel unloved. Journal of Personality and Social Psychology, 125(2), 367–396. https://doi.org/10.1037/pspi0000419

QUESTION 21
What are the nine steps of treatment for Emotionally Focused Couples Therapy? To select and enter your answer go to Test.

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