Attachment therapy is based on the idea that early emotional attunement of a mother/caregiver (or lack of it) profoundly affects the child's psychological development .During the last 15 to 20 years, attachment theory has exerted more influence in the field of psychotherapy than just about any other model, approach, or movement.
Research supports that people who are insecurely attached are likely to demonstrated emotional, social and cognitive problems (Siegal, 2010). The Adult Attachment Interview, which takes about 1 hour to administer allows the therapist to determine the nature of the attachment type of the client and work appropriately based on the results. Furthermore, the interview has been found capable of targeting, with more than 80-percent predictability, 18 months before the child is even born, how a child of the adult interviewee would be attached to his/her parent.
The insecurely attached infant never got the maternal neural imprinting that would help her learn to regulate their own nervous system, thus making them susceptible to uncontrollable storms of inconvenient and unpleasant feelings throughout much of her life gets a chance at neurobiological-psychological repair from an attuned therapist, ready to meet them emotionally where they were—via nonverbal, affect-mediating, right-brain-to-right-brain communication—to help them undertake a kind of affective makeover. An emotionally rich connection with a therapist can also change both brain and mind in a positive way.
Though not a clinical methodology, it has justified a whole range of therapeutic perspectives and practices. Among them are a particular sensitivity to the role of traumatic or neglectful ties with early caregivers; the fundamental importance of affect regulation to successful therapy; the importance of establishing relationships with clients characterized by close, intense, emotional, and physical attunement; and the ultimate goal of recreating in therapy an attachment experience that makes up, at least to some degree, for what the client missed the first time around. That attachment theory itself has amassed a vast body of empirical evidence is often taken, by extension, to cast a glow of scientific credibility on attachment-based therapy.
Adapted from Wylie & Turner, (2013)
Couples come into therapy when they are experiencing distress. Most often, they are caught in a circular argument over a particular issue or issues. Over and over again they keep repeating the same negative interaction the leaves them feeling disconnect, distant and emotionally isolated from their partners.
When we are caught in theses negative patterns, it is difficult to see, that the negative cycle is causing more distress than the original difference or argument.
Marriage counselling or couples therapy provides a place where both partners can share their thoughts, feelings and concerns with an unbiased other who can help weed throughout the distress to uncover what's really going on for each partner. Couples therapy helps by slowing things down allowing for a new conversation to emerge.
The model I use while working with couples was originally created 30 years ago by Sue Johnson of Ottawa University and Les Greenberg of Toronto (York University) and is call Emotionally Focused Therapy. Since that time Sue Johnson and her colleagues Gail Palmer and Alison Lee of the Ottawa Couple and Family Institute have made EFT what it is today - one of the most used models of couples therapy.
Emotionally Focused Therapy for Couples (EFT) offers a comprehensive theory of adult love and attachment, as well as a therapy process for healing distressed relationships. It recognizes that relationship distress results from a perceived threat to basic adult needs for safety, security, and closeness in intimate relationships. EFT helps couples by working to strengthen attachment bonds. Having strong attachment bonds means couples feel safe together, know they are most important to their partner, are more flexible in problem solving, communicate, and feel securely connected. The same old fight is finally resolved. The walls that kept you away from each other crumble away and the feelings that brought you together in the beginning revive and grow.
EFT research has been published in professional journals proving its effectiveness. As a model of therapy, it is respected widely in the field as is the therapy co-originator, award winning psychologist, Dr. Susan Johnson. Over the past 30 years many research studies have proven EFT works!
It is less about the content/issues that couples fight about and more about how couples fight/ interact that makes them feel unsafe and therefore defensive.
EFT helps couples de-escalate, slow things down and start to feel, think and express to their partner, what is really going on for them under the surface, to help them connect in a more powerful and loving way.
MORE ABOUT EFT
Emotionally Focused Therapy was created by Sue Johnson and Les Greenberg almost thirty years ago. Today it has been proven that it is an effective treatment for distressed couples and is considered a short term therapy. In EFT research studies, most couples (over 70%) turned their relationship around in 15 – 20 sessions and over 90% of couples “significantly improved” when seeing a trained EFT Therapist.
Following the short summary is a list of studies and commentaries on Emotionally Focused Therapy research.
Short Summary of EFT Research
Question: Does EFT conform to any “Gold” standard in terms of research validation and the standards set out for psychotherapy?
In terms of the gold standard set out by bodies such as APA for psychotherapy research, EFT epitomizes the very highest level set out by this standard. Over the last 25 years, the EFT research program has systematically covered all the factors set out in optimal models of psychotherapy research.
The meta-analysis (Johnson et al, 1999) of the four most rigorous outcome studies conducted before the year 2000, showed a larger effect size (1.3) than any other couple intervention has achieved to date. Studies consistently show excellent follow-up results, and some studies show that significant progress continues after therapy. EFT has a body of process research showing that change does indeed occur in the way that the theory suggests. This level of linkage between in-session process and rigorous outcome measurement is unusual in the field of psychotherapy.
EFT is the only model of couple intervention that uses a systematic empirically validated theory of adult bonding as the basis for understanding and alleviating relationship problems. The generalizability of EFT across different kinds of clients and couples facing co-morbidities such as depression and PTSD has been examined and results are consistently positive. Outcome and process research addressing key relationship factors, such as the forgiveness of injuries, has also been conducted with positive results. EFT studies are generally rigorous and published in the best peer reviewed journals.
In brief, EFT researchers can show that, as set out in the Johnson 2004 seminal text, Creating Connection: The Practice of Emotionally Focused Couple Therapy, EFT works very well, results last, we know HOW it works so we can train therapists to intervene efficiently and we know it works across different populations and problems. It also links congruently to other bodies of research such as those examining the nature of relationship distress and adult attachment processes.
Recent research involves outcome studies of couples facing trauma (the Dalton and MacIntosh studies, and a study on EFT effects on attachment security with an FMRI component.) The FMRI component shows that EFT changes the way contact with a partner mediates the effect of threat on the brain. There is an outcome study in progress of the new educational program based on EFT (Hold Me Tight® Program: Conversations for Connection). A pilot study has also just been completed at the VA in Baltimore on EFT with veteran couples dealing with PTSD.
Completed and ongoing EFT research consistently supports the efficacy of the Emotionally Focused Therapy model. Rev. 5 – August 2012
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1. Greenman, P.S., & Johnson, S.M. (2012). United We Stand: Emotionally Focused Therapy (EFT) for Couples in the treatment of post-traumatic stress disorder. Journal of Clinical Psychology: In Session, Vol.68(5), 561-569.
2. Denton, W.H., Wittenborn, A.K., & Golden, R.N. (2012) Augmenting antidepressant medication treatment of depressed women with emotionally focused therapy for couples: A randomized pilot study. Journal of Marital and Family Therapy, Vol.38, Supplement s1, 23-38.
3. Naaman, S., & Johnson, S. M., & Radwan, K. (in review) Evaluation of the clinical efficacy of emotionally focused therapy on psychological adjustment of couples facing early breast cancer. Psychiatry: Biological and Interpersonal Processes.
4. Dalton, J., Greeman, P., Classen, C., & Johnson, S. M. (manuscript under review) Nurturing Connections in the Aftermath of Childhood Trauma: A randomized controlled trial of Emotionally Focused Couple Therapy (EFT) for Female Survivors of Childhood Abuse. Couple and Family Psychology: Research and Practice.
5. Greenman, P.S., Faller, G., & Johnson, S.M. (2011). Finding the words: Working with men in Emotionally Focused Therapy (EFT) for couples. In D.S. Shepard & M. Harway (Eds.), Engaging men in couples therapy (pp. 91-116). New York: Routledge.
6. McLean, L.M., Walton, T., Rodin, G., Esplen, M.J., & Jones, J.M. (2011) A couple-based intervention for patients and caregivers facing end-stage cancer: outcomes of a randomized controlled trial. Article first published online: Sept.14, 2011 in Psycho-Oncology.
7. Halchuk, R., Makinen, J. & Johnson, S. M. (2010) Resolving Attachment Injuries in Couples using Emotionally Focused Therapy: A 3 year follow-up. Journal of Couple and Relationship Therapy, 9, 31-47.
8. Honarparvaran, N., Tabrizy, M., & Navabinejad, Sh. (2010) The efficacy of emotionally focused couple therapy (EFT-C) training with regard to reducing sexual dissatisfaction among couples. European Journal of Scientific Research, 43(4), 538-545.
9. MacIntosh, H.B. & Johnson, S. (2008) Emotionally focused therapy for couples and childhood sexual abuse survivors. Journal of Marital and Family Therapy, 34, 298-315.
10. Couture-Lalande, M.-E., Greenman, P.S., Naaman, S. & Johnson, S.M. (2007) Emotionally focused therapy (EFT) for couples with a female partner who suffers from breast cancer: an exploratory study. Psycho-Oncology, 1, 257–264. (Journal of the Psychological, Social and Behavioral Dimensions of Caner).
11. Couture-Lalande, M.-E., Greenman, P.S., Naaman, S. & Johnson, S.M. (2007) La therapie de couple axe sur l'emotion (EFT) our traiter les couples donts la femme a le cancer du sein: une etude exploratoire. Psycho-Oncologie, 1, 1-8.
12. Makinen, J. A. & Johnson, S. (2006) Resolving Attachment Injuries in Couples using EFT: Steps Toward Forgiveness and Reconciliation. Journal of Consulting and Clinical Psychology. 74(6), 1055-1064.
13. Dessaulles, A., Johnson, S. M. & Denton, W. (2003) Emotion Focused Therapy for Couples in the Treatment of Depression: A Pilot Study. American Journal of Family Therapy, 31, 345-353.
14. Clothier, P., Manion, I., Gordon-Walker, J. & Johnson, S. M. (2002) Emotionally Focused Interventions for Couples with Chronically Ill Children: A two year follow-up. Journal of Marital and Family Therapy, 28, 391-399.
15. Denton, W., Burleson, B., Clark, T., Rodriguez, C. & Hobbs, B. (2000) A Randomized Trial of Emotionally Focused Therapy for Couples in a Training Clinic. Journal of Marital and Family Therapy, 26, pp. 65-78.
16. Johnson, S., Hunsley, J., Greenberg, L. & Schindler, D. (1999) Emotionally Focused Couples Therapy: Status & challenges (A meta-analysis). Journal of Clinical Psychology: Science and Practice, 6, 67-79. NOTE: Also listed under Meta-Analyses
17. Johnson, S., Maddeaux, C. & Blouin, J. (1998) Emotionally Focused Family Therapy for Bulimia: Changing Attachment Patterns. Psychotherapy: Theory, Research & Practice, 35, 238-247.
18. Gordon-Walker, J., Johnson, S., Manion, I. & Cloutier, P. (1996) Emotionally Focused Marital Intervention for Couples with Chronically Ill Children. Journal of Consulting & Clinical Psychology, 64, 1029-1036.
19. McPhee, D. & Johnson, S.M. (1995) Marital Therapy for Women with Low Sexual Desire. Journal of Sex and Marital Therapy, 21, 159-182.
20. Dandeneau, M. & Johnson, S. (1994) Facilitating Intimacy: Interventions and Effects. Journal of Marital & Family Therapy, 20, 17-33.
21. Goldman, A. & Greenberg, L. (1992) Comparison of Integrated Systemic and Emotionally Focused Approaches to Couples Therapy. Journal of Consulting and Clinical Psychology, 60(6), 962-969.
22. James, P. (1991) Effects of a Communication Training Component Added to an Emotionally Focused Couples Therapy. Journal of Marital & Family Therapy, 17, 263-276.
23. Johnson, S. & Greenberg, L. (1985) Emotionally Focused Couples Therapy: An Outcome Study. Journal of Marital & Family Therapy, 11, 313-317.
24. Johnson, S. & Greenberg, L. (1985) The Differential Effectiveness of Experiential and Problem Solving Interventions in Resolving Marital Conflict. Journal of Consulting & Clinical Psychology, 53, 175-184. (EFT, CBT and controls tested.)
Process & Predictors Research
1. Furrow, J.L., Edwards, S.A., Choi, Y., & Bradley, B. (2012) Therapist presence in emotionally focused couple therapy blamer softening events: promoting change through emotional experience. Journal of Marital and Family Therapy, Vol.38, Supplement s1, 39-49.
2. Wittenborn, A.K. (2012) Exploring the Influence of the Attachment Organizations of Novice Therapists on their Delivery of Emotionally Focused Therapy for Couples. Journal of Marital and Family Therapy, Vol.38, Supplement s1, 50-62.
3. Zuccarini, D.J., Johnson, S.M., Dalgleish, T. & Makinen, J. (submitted for review) Forgiveness and reconciliation in EFT for couples: The client change process and therapist interventions. Submitted to the Journal of Marriage and Family Therapy.
4. Denton, W., Johnson, S. & Burleson, B. (2009) Emotion-Focused Therapy-Therapist Fidelity Scale (EFT-TFS): Conceptual Development and Content Validity. Journal of Couple and Relationship Therapy, 8, 226-246.
5. Bradley, B. & Furrow, J. L. (2004) Toward a Mini-theory of the Blamer Softening Event: Tracking the Moment-by-Moment Process. Journal of Marital and Family Therapy, 30(2), 233- 246.