The Contribution of Emotionally Focused Couples Therapy

1 JContempPsychother(2007)37:47 52 DOI PAPERThe Contribution of Emotionally Focused Couples TherapySusan M. JohnsonPublished online: 22 February 2007C Springer Science+Business Media, LLC 2007 AbstractThis article describes Emotionally Focused coupletherapy and the Contribution of this model to the field of cou-ple Therapy . A focus on emotional processing in the presentmoment, on process factors and on a genuine empathic con-nection with both clients is at the heart of this model. Thecreation of new patterns of emotional responses results inthe creation of key new interactional responses. EFT is em-pirically validated on several levels: on the level of treatmentoutcome, and on the levels of the relational theory in which itis based and key moments and factors in the change therapyWhat does the humanistic approach, exemplified by Emo- tionally Focused Therapy (EFT, Johnson,2004)offerthecouple therapist? In general, it offers a systematic, welldocumented, empirically validated model of interventionthat is integrated with systemic perspectives, and so com-bines intrapsychic and interpersonal dimensions.

2 It is also amodel that stands firmly on a rich and well researched the-ory of close relationships, namely attachment theory (John-son, Hunsley, Greenberg, & Schindler,1999;Johnson,2006;Johnson,2003 ) and is consonant with the recent observa-tional research on the nature of marital distress and satis-S. M. JohnsonUniversity of Ottawa,Ottawa, CanadaS. M. JohnsonAlliant University,San Diego, USAS. M. Johnson (!)Ottawa Couple & Family Institute, Center for EFT,Ottawa, Canadae-mail: (Gottman,1999;Huston,Caughlin,Houts,Smit h,&George,2001). More specifically though, what do thehumanistic elements of EFT offer the practising couple ther-apist? The humanistic Contribution might be summarized asfollows:Basic elements of EFT for couplesFirst, the goal of Therapy is more substantial than the allevi-ation of symptoms or pragmatic problem solving. The focusis on the whole person rather than the problem that bringsthe client to Therapy .

3 Health in this model is the ability to beopen to experience, flexible in responding to one s environ-ment and to feel empowered to choose and actively constructone s daily life and relationships with others. The humanistictherapist takes a stance that all clients are capable of growthand agency, if they are given support and experience and research results from Johnson andGreenberg (1985)suggestthatdistressedpartnershavet he skills and resources necessary to communicate effectivelyand positively. They simply cannot access them when floodedwith anxiety and trapped in negative self-reinforcing inter-actional cycles. Problems arise then from lack of or denialof awareness, constriction in processing ongoing experienceso that this experience cannot be understood and trusted, alack of coherence where emotion cannot be integrated withaction and cognition, or where elements of the self are inconflict. In marital distress these issues result in partnersshowing and seeing less and less of each other, sending con-flicting messages ( asking in an attacking, belittling wayfor reassurance and connection), and being caught in neg-ative interaction patterns, such as demand-withdraw.

4 Thehumanistic therapist does not get caught in the trap of la-belling and pathologizing partners or relationships and so isSpringer48 JContempPsychother(2007)37:47 52able to convey hope and the expectation that partners willbe able to shape and improve their connection with , this model specifically outlines the therapeuticrelationship that is a necessary condition for growth andchange. It assumes that the therapist s acceptance and em-pathy are powerful in and of themselves in that they createthe safety where difficult experience can be encountered andassimilated and where risks can be taken. Empathy here isan active leap of imagination where the therapist connectswith and processes core experiences with each client, dis-covering that experience as it unfolds. Both Rogers (1951)and Bowlby (1969)believedthatallresponsesarebasi-ca lly reasonable and adaptive if they are understood in con-text. The humanistic therapist then joins each client wherethat client is and validates his or her attempts to survive,rather than assessing a problem and then asking clientsto be somewhere else.

5 So, an EFT therapist will acceptand work with a client s silence or rage, rather than of-fering immediate alternatives or attempting to modify thisresponse. The necessity for defensive, rationalizing or jus-tifying behaviours on the part of distressed partners is model involves a way of being for the therapist, notjust the implementation of a set of techniques. The therapistattempts to be open, egalitarian, authentic and transparent insession so that Therapy becomes a safe haven where explo-ration is possible. The therapist is part of the process and thejourney of change. The nature of the therapeutic alliance hasbeen found to account for 20% of the variance in outcomein EFT (Johnson & Talitman,1996). Each couple is then alearning opportunity for the therapist and a genuine humanencounter. As clients explore the frightening crannies ofinner experience (Rogers,1961, )andriskconnectingwith each other, the therapist stands with them and discoversthis , a humanistic intervention such as EFT is both par-simonious and salient, that is it gets to the heart of the matteras experienced by clients in distressed relationships in thepresent.

6 Couples experience of the salience of EFT is re-flected in the fact that drop-out rates are generally extremelylow in EFT studies and clinical practice, and results appearto be stable, even for high risk Couples (Clothier, Manion,Gordon Walker & Johnson,2001). The focus of therapyis the moment to moment unfolding of salient emotionallyladen experience and interactions as they occur and as theyare newly constructed by the therapist and the partners. Itis about immediate experience and a couple s internationaldance as they are lived. The therapist slows down the dramaof interaction and helps clients connect more fully with andexpand inner experiences and interactional responses. Thetherapist does not get caught in the myriad of content issuesthat Couples bring to a session or in the intricacies of pasthistories and unconscious desires. Instead, he or she focuseson being aprocess consultantwho helps partners discoverthe order in experience (Rogers,1961, ),andthen,step by step, create new responses that renew the relation-ship.

7 Therapists have repeatedly criticised researchers andpsychotherapy model builders for omitting a focus on whathappens in session and how to pragmatically move eachsession in a positive direction. The EFT model outlines theprocess of change in 9 steps (Johnson,2004)thatcaptureacouples progressfromthede-escalationoftheirnegat iveinteractional cycle, to the creation of new cycles that includepowerful bonding interactions, to consolidation and integra-tion. Key change events have also been outlined and thera-pist interventions that move these events forward delineated(Bradley & Furrow,2004).The focus on the present moment and mining the mo-ment (Johnson,2004), is an essential part of EFT. As Sternsuggests (2004, ), thepresentmomenthasbeenrel-atively but not wholly ignored by psychology. Experien-tial therapies make a powerful Contribution here in statingthe power of the present and offering ways to work withit. An EFT couple therapist, using reflection and evocativequestions, will hold a moment up to the light and, with thecouple, explore its rich and not yet articulated 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 when an isolated partner who is desperate for contactattacks her partner as he risks reaching for her, the therapiststays with this moment and, in a validating manner, helps herexplore this response.

8 Distrust and self-protection emerge asthe backdrop to this response, but it is examined and chunkedinto cues, bodily responses, meaning construction, action se-quences and the impact of her response on the relationship,which is that, as she pushes him away, he moves into furtherhopeless and inaccessibility. This one response can preventthe transformation of a Couples negative cycle and the cre-ation of trust. If it is expanded into a statement of fear andvulnerability that evokes the husband s caring, this momentcan be the beginning of a new relationship. These momentsare rich. They show characteristic ways that partners connectwith themselves and with each , perhaps the greatest Contribution of all is the hu-manistic focus on emotion. Emotions are the blueprints forinteractions with attachment figures. They are the music ofthe attachment dance. There has been more and more ac-knowledgement in recent years of the power of affective en-gagement and new corrective emotional experience to createchange in psychotherapy, even in cognitive Therapy (Wiser&Goldfried,1998).

9 In couple Therapy , however emotionhas generally been marginalized (Johnson,2005a,b), eventhough new research suggests that emotion is adaptive and es-sential in basic processes such as decision making and choiceSpringerJContempPsychother(2007)37 :47 5249(Damasio,1994). Emotion is powerful and compelling. andwhile more and more general research is emerging telling usthat emotion is a force for adaptation and that the suppres-sion of emotion is harmful (Gross,2001), it is difficult to useemotion in the service of change unless you have a clear mapto uses emotion to orient and focus the session onkey moments and issues, to guide meaning making and to move partners into new actions and responses. New emo-tional signals reorganize and renew a distressed EFT therapist focuses on the six key emotions: joy,surprise, shame, fear, anger and sadness. He or she helpspartners access, engage with emotional responses while, atthe same time, keeping a working distance so that theseresponses can be revised and evoked to create new positiveinteractions.

10 The therapist works to create emotional safetyand engagement. Emotional engagement and responsivenessis emerging more and more in the marital literature as thekey predictor of marital happiness, rather than factors suchas conflict containment. In marriage and in Therapy , to sim-ply label emotion or to have insight into it does not seem tobe that useful. The EFT therapist tracks, reflects and oftenheightens emotion, moving partners from reactive secondaryaffects such as irritation/anger to more primary deeply feltunderlying emotions such as fear and sadness. The thera-pist will also help Couples engage with and sort emotionalexperiences and,thus, order them. For example, hurt is amixture of anger, sadness and fear, but usually one of theseemotions will stand out and organize a partner s fear of abandonment, for example, may be crucial inhurt experiences for a partner in couple Therapy . Deep emo-tional experiencing in key change events has been found topredict recovery from relationship distress in EFT (Johnson&Greenberg,1988).