Emotionally Focused Couple Therapy

S.Varadharajan
Clinical Psychologist
Department of Clinical Psychology
Sri Ramachandra University
Outline
Introduction
Foundation
Theoretical
background
Basic overviews
Assumptions
Interventions
Treatment Process
Strengths
Research findings



Introduction
Emotionally focused couple therapy is a short
term, systematic and tested intervention to
reduce distress in adult love relationship
Emotion pulls for and organizes key responses
in close relationships
To create a safe, egalitarian relationship with
partners
Exploring how emotions direct the couples
dance and how the dance then shapes key
emotions
Constriction and rigidity is replaced by
expensiveness and flexibility

Focuses on key factors in relationship distress,
significant role of emotional communication in
the development of relationship distress

To make safe emotional engagement so that
partners can soothe, comfort and reassure each
other

Therapist to learning from clients what is
meaningful for them and how they view intimate
relations.

Founders..
1980s

Leslie Greenberg
Susan Johnson


Science of love &
attachment theory
Systemic & experiential
Theoretical Background
Humanistic
/Experiential
Systemic
Attachment
Theory
The Attachment Perspective
Attachment is an innate and primary
motivating force.

Secure dependence is a sign of health and
complements autonomy.

Attachment offers a safe haven.

Attachment offers a secure base

Accessibility and responsiveness build secure healthy
bonds

Fear and uncertainty activate attachment needs

Anxious attachment, manifests as extreme distress on
separation, clinging and aggressive attempts to obtain
a response from loved one.

Avoidant attachment- lack of safe emotional
engagement is to deactivate the attachment system
and suppress attachment needs.

Fearful avoidant seeking closeness with fearful
avoidance of closeness when it is offered.




These ways of engaging significant others are
self maintaining patterns of social interaction
and emotion regulation strategies.

Attachment involves inner cognitive working
models of self and other.

Isolation and loss are inherently traumatizing

Attachment is an integrative theory.
Basic elements of experiential model
Alliance is a key
An optimistic non-pathological stance is essential
Openness & engagement is healthy
Session focus on moment to moment process
There is a privileging of emotions
Significant change requires a new corrective
emotional atmosphere
Basic elements of systemic model
Causality is circular
Consider behavior in the context
Elements of a system have a predictable and
patterned relationship with each other
All behaviors has a communicative aspect
Task of the therapist is to interrupt negative
cycles of interaction, so that new, more adaptive
patterns can emerge.
Experiential & Systemic synthesis in EFT
Both focus on present experience
View people as the process not as the product
Focus the circular cycles of interaction between
people & the emotional experience of each
person at each steps of the cycle.
Basic Overview of EFT
EFT views couple distress as being maintained by
absorbing negative affect.

Absorbing negative affect both reflects and primes
rigid, constricted patterns of interaction.

These patterns make the safe emotional engagement
necessary for secure bonding impossible.
The goals of EFT are to:
Access, expand and re-organize key emotional
responses.

Create a shift in partners interactional positions.

Foster the creation of a secure bond between partners
through the creation of new interactional events that
redefine the relationship.
EFT Assumptions
1) Accessibility and responsiveness are the building
blocks of a secure attachment bond. Consequently,
Couples therapy is about
a) the security of the attachment bond,
b) accessibility,
c) the responsiveness of the partner.
A.R.E you there for me?

A
c
c
e
s
s
i
b
l
e

Can I
reach you?
Will you
open up to
me?

R
e
s
p
o
n
s
i
v
e

Can I
depend on
you?
Will you
come when
I call?

E
n
g
a
g
e
d

Are you
emotionally
present?
Do you
share?
Will you
keep me
close?
2) Emotion is a target and agent of change.
Emotion:
a) Source of information
b) Communicates - organizes social interactions
c) Orients & primes responses
d) Vital element in meaning - colors events
e) Has control precedence
3) Emotion frequently leads to adaptive actions
Asserting, defending
Anger often leads to:
Seeking support, withdrawing
Sadness
Attending, exploring
Surprise/Excitement
Hiding, expelling, avoiding
Disgust/Shame
Fleeing, freezing, giving up
Fear
Connecting, engaging
Joy
4) Negative emotions occur at two levels:
Primary and Secondary.
a) Primary Emotions are the deeper, more vulnerable
emotions such as sadness, hurt, fear, shame, and
loneliness.

b) Secondary Emotions are the more reactive emotions
such as anger, jealousy, resentment, and frustration.
They occur as a reaction to the primary emotions.

c) Primary emotions generally draw partners closer.
Secondary emotions tend to push partners away.
5) In trying to connect, distressed couples get caught in
negative repetitive sequences of interaction where
partners express secondary emotions rather than
primary emotions.

6) Insecure attachment leads to negative interaction
cycles and, in return, negative interaction cycles lead to
insecure attachment (it is circular).
7) Rigid interactions reflect and create negative
absorbing emotional states. Negative absorbing
emotional states reflect and create rigid interactions (it
is circular).

8) Partners are not sick or developmentally delayed.
They are stuck. Most needs and desires are adaptive.
9) Attachment needs are universal, although their
expression is culturally defined. The way we seek
and obtain support is defined different in various
cultures and even in different families and must be
understood and respected.

10) Change involves new experiences and new
relationships events. Therapy is about creating these
new relational experiences.
Interventions
3 tasks
1. Create and maintaining a therapeutic alliance.
2. Accessing and reformulating emotion.
3. Restructuring key interactions.

1. Create and maintaining a therapeutic alliance.
Empathic Attunement
Acceptance
Genuineness
Continuous active alliance monitoring
2.Accessing/Exploring and reformulating
emotion

Fostering an emotion focus
R-I-S-S-S-C(Repeat-Images use-Simple words-
Slow pace-Soft voice-Clients words)
Validation
Evocative Responding
Empathic Conjecture or Interpretation

3.Restructuring Interactions
Tracking, reflecting, replaying interactions
Reframing in the context of the cycle and
attachment processes
Restructuring and shaping interactions

Treatment Process
Stage 1:
De-
escalatio
n
1. Assessment
2. Identify negative cycle / Attachment issues
3. Access underlying attachment emotions
4. Frame problem cycle, attachment needs/fears
Stage 2:
Restruct
uring the
Bond
5. Access implicit needs, fears, models of self
6. Promote acceptance by other expand dance
7. Structure emotional engagement express attachment
needs.
Stage 3:
Consolida
tion
8. New positions / cycles enact new stories of problems
and repair
9. New Solutions to pragmatic issues
1. Alliance & assessment: Creating an alliance and
delineating conflict issues in the core attachment
struggle.

What are they fighting about and how are they
related to core attachment issues.
2. Identify the negative interaction cycle, and each
partners position in that cycle.

Goal is to see the cycle in action and then identify
and describe it to the couple and work to stop it.

3. Access unacknowledged emotions underlying
interactional positions.
Goal is to help each partner to access and accept
their unacknowledged feelings that are influencing
their behavior.
Both partners are to reprocess and crystallize their
own experience in the relationship so that they
can become emotionally open to the other
person.
4. Reframe the problem in terms of underlying feelings,
attachment needs, and negative cycle.

The cycle is framed as the common enemy
(externalizing the problem) and the source of the
partners emotional deprivation and distress.
5. Promote identification with disowned attachment
emotions, needs, and aspects of self, and integrate
these into relationship interactions.
Goal is to help the couple redefine their experiences
in terms of their unacknowledged emotional needs.
6. Promote acceptance of the other partners
experiences and new interactional responses.
Goal is to work to get each partner to accept,
believe, and trust that what the other partner is
describing in terms of underlying emotional needs is
accurate.
7. Facilitate the expression of needs and wants and
create emotional engagement and bonding events
that redefine the attachment between the partners.
Goal is to help couple learn to express their
emotional needs and wants directly and create
emotional engagement
8. Facilitating the emergence of new solutions to old
relationship problems.
Without the old negative interaction style and with
the new emotional connection and attachment, it is
easier to develop new solutions to old problems.
9. Consolidating new positions and new cycles of
attachment behaviors.

Help couple clearly see and articulate the old and
new ways of interacting to help the couple avoid
falling back into the old interactional cycle.

Strengths..
EFT is based on clear, explicit conceptualizations of
marital distress and adult love. These
conceptualizations are supported by empirical
research on the nature of marital distress and adult
attachment.
EFT provides a clear map that therapists can follow
to help couples and families become emotionally
connected and responsive to one another.
EFT is collaborative and respectful of clients,
combining experiential Rogerian techniques with
structural systemic interventions.
Strengths..
Change strategies and interventions are specified.
Key moves and moments in the change process have
been mapped into nine steps and three change events.
EFT is an empirically validated model for couple therapy.
There is also research on the change processes and
predictors of success.
EFT has been successfully applied to many different kinds
of problems and populations
Research findings
A recent meta analysis of the best studies found 70-73%
of couples to be recovered from marital distress and 90%
of couples to have significantly improved.
Relapse is not a significant issue with EFT

References
Becoming an Emotionally Focused Couple
Therapist by Susan M. Johnson





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