A Review of the Research in Emotionally Focused Therapy for Couples

• Date: 01 September 2016
• Published date: 01 September 2016
• DOI: http://doi.org/10.1111/famp.12229
• Author: Stephanie A. Wiebe,Susan M. Johnson

A Review of the Research in Emotionally Focused

Therapy for Couples

STEPHANIE A. WIEBE*

SUSAN M. JOHNSON

†

Emotionally Focused Therapy for Couples (EFT) is a brief evidence-based couple therapy

based in attachment theory. Since the development of EFT, efficacy and effectiveness

research has accumulated to address a range of couple concerns. EFT meets or excee ds the

guidelines for classification as an evidence-based couple therapy outlined for couple and

family research. Furthermore, EFT researchers have examined the process of change and

predictors of outcome in EFT. Future research in EFT will continue to examine the process

of change in EFT and test the efficacy and effectiveness of EFT in new applications and for

couples of diverse backgrounds and concerns.

Keywords: Couple therapy; Emotionally Focused Therapy; Evidence-based practice

Fam Proc 55:390–407, 2016

INTRODUCTION

Emotionally Focused Therapy for Couples (EFT) is a brief attachm ent-based couple

therapy that draws on humanistic and systemic principles to help couples improve

their relationship functioning by creating a more secure attachment bond in their rela-

tionship (Johnson, 2004). EFT conceptualizes the negative, rigid interaction patterns

and absorbing negative affect that typify distress in couple relationships in terms of

emotional disconnection and insecure attachment. This model integrates the intrapsy-

chic perspective afforded by experiential approaches with an interpersonal systemic per-

spective and uses both kinds of interventions to help distressed partners shape

emotional accessibility, responsiveness, and engagement—the key elements of attach-

ment security—in their relationships (Burgess Moser & Johnson, 2008; Johnson, 2004).

Couples are encouraged to explore here-and-now emotional experiencing, uncovering

primary emotions that are often blocked from awareness by reactive surface emotions

and responses, and share these with their partner in the session. Their partner will

then be shown how to listen and respond in an emotionally attuned way. The new emo-

tional music then elicits new responses and, gradually, changes the dance between

partners.

The process of EFT has been outlined in three stages by Johnson (2004). In the

first stage, cycle de-escalation, couples develop an understanding of the negativ e inter-

action cycle that drives distress in their relationship. The therapist tracks and reflects

*Ottawa Couple and Family Institute, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.

†

Ottawa Couple and Family Institute, International Centre for Excellence in Emotionally Focused Therapy,

Ottawa, ON, Canada.

Correspondence concerning this article should be addressed to Stephanie Wiebe, Ottawa Couple and

Family Institute, The Ottawa Hospital, University of Ottawa, Ottawa ON, Canada. E-mail: stephanie.a.

wiebe@gmail.com

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Family Process, Vol. 55, No. 3, 2016 ©2016 Family Process Institute

doi: 10.1111/famp.12229

the patterns of interaction, identifying the negative cycles, such as criticize/attack fol-

lowed by defend/distance, that constrain the responses of each partner. At the end of

this stage, the couple has a meta-perspective on their interactions and begins to see

their negative cycle as the problem that maintains their insecurity and emotional dis-

tress in their relationship. The second stage, restructuring interactions, involves the

shaping of new core emotional experiences, and new interactions that lead to more

secure connection. Partners are encouraged to explore and share their attachment vul-

nerabilities and needs with their partner in session, in focused, structured enactments.

They are guided to respond in an emotionally attuned and supportive way, and blocks

to this process are explored. Newly formulated emotional responses, for example, the

fear of failure and rejection that underlies withdrawal or a lack of responsiveness, are

expressed in such a way as to evoke new responses in the other partner, for example,

compassion rather than anger and blaming, that constitute a shift in interactional

positions. Withdrawer re-engagement is a key therapeutic event in which the partner

who previously avoided engaging with their partner in conflict now expresses their

attachment needs clearly and also becomes more open and responsive to their partner.

Blamer-softening is a second key therapeutic event in which the partner who would

previously pursue their partner with blame and criticism begins to express their more

vulnerable primary emotions, such as hurt, sadness, fear, or shame, in a soft but clear

way that invites connection. Their partner is then encouraged to listen and respond.

These events create new constructive cycles of contact and caring, fostering secure

attachment. The third stage of EFT, consolidation, involves helping couples use their

more secure attachment bond and improved relationship functioning to solve problems

in their everyday lives and creating a story of resilience and mastery in their relation-

ship (Johnson, 2004).

In EFT, the therapist is a process consultant who, by empathically attuning to and vali-

dating each partner, creates a safe place that allows each partner to become more engaged

with their own experience and with the other. Change in EFT is presumed to occur, not

from insight, catharsis, or improved skills per se, but from the formulation and expression

of new emotional experience that transforms the nature of the interactional drama, partic-

ularly as it pertains to attachment needs and emotions. The EFT therapist stay s close to

the “leading edge” of the client’s experience and uses the experiential interventions of

reflection, evocative questions, validation, heightening emotion, and empathic conjecture

to expand that experience. Systemic interactions of reframing (the problem is your con-

strained dance, not your personality or your differences with your lover), reflecting inter-

actional patterns and their self-perpetuating nature, and directing and sculpting new

interactions are also used. Since its development in the 1980s, EFT has accumulated

strong empirical support with a substantial evidence base of efficacy and effectivenes s

studies. Furthermore, EFT research has a strong tradition of examining key therapeutic

factors in the process of change. What follows is a review of this research from 1985 to the

present.

EFFICACY RESEARCH IN EFT

Emotionally Focused Therapy for Couples has a long tradition of efficacy research

across a variety of settings with distressed couples coping with a range of difficulties.

Johnson and Greenberg (1985a) were the first researchers to examine the EFT model

and found, for the first time, that explicitly focusing on emotions and using them to

shape new interactions in couple therapy resulted in more favorable outcomes than a

strategic problem-solving approach. Specifically, they compared couples randomized to

receive either EFT, the strategic problem-solving approach, or to be on a wait-list

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