Emotionally Focused Therapy

Intro to Internal Emotionally Focused Therapy

Do you feel as if you and your partner are stuck in a negative cycle of anger, criticism, or indifference? Maybe over time, one or both of you seem to have become more irritable with the other and lash out at seemingly minor issues. Perhaps find yourself questioning if your partner still loves you, if you can rely on them, or how much they value your relationship. Perhaps the negative cycle feels uncontrollable, yet there is something keeping you together. Maybe part of you wants to end the relationship, while another part of you feels stuck.

Dr. Sue Johnson, the pioneer of Emotionally Focused Therapy (EFT), discovered that this negative cycle might result from the lack of stable, safe connections. EFT builds on attachment theory, recognizing that emotionally gratifying and secure relationships are essential components of the human experience and a cornerstone of mental and physical health.

By first identifying the negative cycle and striving to understand one another’s needs and unaddressed emotions, individuals can begin to experience each other in healthier and more compassionate ways that nurture growth and acceptance. The result may be a powerfully transformative view of self and others that can, ultimately, lead to more authentic relationships and secure emotional bonds.

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Origins of EFT

Dr. Sue Johnson developed Emotionally Focused Therapy in the mid-1980s as an alternative method of traditional couple’s therapy after receiving her doctorate in counseling psychology. She noticed that negative emotions, particularly anger and conflict, were often disregarded from interventions. Johnson disagreed with this approach as she believed that all emotions, including anger and conflict, are an integral aspect of understanding attachment bonding. Thus, she developed a therapy model that focused on the client’s emotional experience while helping them communicate their emotional experiences in healthier ways. 

Johnson began developing EFT by studying videos of couples therapy sessions. Johnson observed that the majority of couples were overwhelmed with emotion, often resulting in either shutting down or lashing out while the root of the conflict remained unresolved. For example, it may seem as if an escalating argument is about dirty dishes piling up in the sink. Still, after some analysis, she discovered that the underlying tension is often displaced from a deeper unresolved issue such as feeling unloved or unappreciated. Discussing the emotions behind the argument is what brings about lasting change. Johnson then launched the first EFT outcome study. It was highly successful, but she had not understood why it had worked so well just yet. Why would a partner lash out instead of communicating those emotions?

Johnson attended a talk given by Dr. Neil Jacobson, the pioneer of cognitive-behavioral marital therapy. He spoke about how relationships were a bargain, and negotiating that bargain is the key to successful relationships. A “you do the dishes and I do the laundry” contract was the basis of couples therapy at the time. Johnson left the conference feeling something wasn’t correct about that approach. She concluded that you could not bargain for safety, love, and responsiveness. 

Johnson began to develop this insight further, adapting it to John Bowlby’s attachment theory. According to attachment theory, human infants are biologically hardwired to need a secure attachment to at least one caregiver. Therefore, a healthy relationship with a caregiver in infancy and early childhood should lead to a secure attachment style. However, when an infant’s relationship with their caregiver is disrupted in some way, various types of insecure attachment styles may develop. As people grow older, this attachment style can transfer to romantic relationships. For example, if emotional distance is perceived within a close relationship, someone with an insecure attachment style may become triggered if a situation is interpreted as a threat. When a person experiences a threat or even a perceived threat, the part of the brain called the amygdala is activated, resulting in various instinctive emotional reactions and defense mechanisms, such as flight, flight, or freeze responses. Johnson identified that at the root of many arguments is an intense human need for safe and secure bonding. She posited that underlying fears of abandonment and insecurity pave the way for negative cycles of interaction and unfulfilled emotional needs. Johnson refers to this cycle as a “dance” and the emotions as the “music”; thus, if you can change the music, you can change the dance.  

EFT is described as an intersection of:

  • Carl Roger’s humanistic approach, which recognizes the importance of acceptance, genuineness, and empathy.  
  •  Salvador Minuchin’s structural family therapy, which maps relationships and interactions between different members of a family.
  •  John Bowlby’s attachment theory, as previously described.

The American Psychological Association (APA) recognizes EFT as a gold standard approach to couples therapy, and ample clinical research supports its efficacy. 

Summary of EFT: What is EFT?

EFT aims to improve emotional bonds by learning to address and communicate one’s core emotional needs and issues. The foundational part of EFT is to explore how an individual experiences their relationship. Often, this experience has never been adequately addressed, which can lead to a disconnect and various displaced conflicts between partners. EFT helps clients reflect more deeply upon their own emotional experience and that of their partner. This form of therapy aims to enable couples to establish the genuine, empathetic, and accepting type of relational bond that humans biologically require for emotional wellbeing.

If the negative cycle is the dance and the emotions are the music, then the therapist is the choreographer. The therapist creates a safe container through validation and unconditional support in which a couple can feel safe enough to be vulnerable and express their deepest thoughts and emotions. EFT is typically achieved through 9 stages: 

Step 1: Stabilization: Assessment and De-escalation

The goal of Step 1 is to build mutual trust between therapist and clients in order for the therapist to identify the positive and negative emotional dynamics and experiences within the relationship. The therapist begins to facilitate a relational shift from a mindset of “you against me” to “you and me against the problem.”   

Stage 1: Identify the conflicts and areas of concern within the relationship.

Stage 2: Identify the reactions of each partner and how they are expressed.

Stage 3: Evaluate emotions in conjunction with the position each partner takes.

Stage 4: The therapist reframes each individual’s conflict, reactions, and emotions to identify needs. 

Step 2: Restructuring the Bond: The “Hold Me Tight” Conversations

The goal of Step 2 is to realize one’s own, needs and emotions, as well as one’s partner’s needs and emotions, to foster an environment of mutual fulfillment. As with any new behavior, it may seem unnatural at first, but couples adapt with practice as they are better able to recognize when old patterns start to occur.

Stage 5: Learn to express implicit and explicit needs, emotions, and viewpoints. Learn to listen to one’s partner talk about fears, needs, and vulnerabilities.

Stage 6: Foster an environment in which each partner accepts and validates the other’s emotional experience.

Stage 7: Reframe the interaction based on the new information of each other’s needs and emotions; create bonding opportunities.

Step 3: Integration: Creating a New Narrative

The goal of Step 3 is to reflect on new emotional experiences, both internal and external. Johnson described this stage as the creation of a new love story that incorporates the couple’s goals for the future while remaining mindful of their issues from the past.  

Stage 8: Encourage the creation of new thought patterns and new solutions to old problems.

Stage 9: Continuous reinforcement of new positive cycles of behavior in various situations.

The Inaura Key Pathways


Research & Science supporting EFT

Science and research for EFT are very extensive. Listed below are a few exemplary studies that support the effectiveness of EFT.

Emotionally Focused Couples Therapy: A Systematic Review of Its Effectiveness Over the Past 19 Years

This meta-analysis, published in the Journal of Evidence-Based Social Work, investigated the effectiveness of EFT. Before this study, the last meta-analysis on the effectiveness of EFT was published in 1999, so this analysis aimed to determine if it was still an effective intervention 20 years later. The study concluded that EFT is effective in facilitating lasting change. 

The study can be read in full here: 


Emotionally-Focused Therapy and Treatment as Usual Comparison Groups in Decreasing Depression: A Clinical Pilot Study

This study, published in the American Journal of Family Therapy, recognized the effects depression could have on a couple’s relationship. The objective of this study was to examine the extent to which EFT can decrease symptoms of depression in conflicted couples. The research showed a significant decline in depressive symptoms during and after EFT. 

The study can be read in full here: https://onlinelibrary.wiley.com/doi/abs/10.1111/famp.12229

Soothing the Threatened Brain: Leveraging Contact Comfort with Emotionally Focused Therapy

This fMRI study, published in the US National Library of Medicine, examined the effectiveness of EFT for regulating perceived threat using hand-holding. Results showed EFT aided in regulating perceived threats when an individual was close to a romantic partner. 

The study can be read in full here:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835900/ 

Potential Drawbacks/Criticisms

EFT will most likely only be effective if the couple has an investment in their relationship and a willingness to learn. EFT is not recommended for couples if there is violence, aggression, or anything that will put a vulnerable individual at a higher risk.

The Seeker Experience

It can be helpful to go into your first session with an open mind and a few examples of what needs to be addressed within the relationship; however, if you feel confused or unsure, your therapist can help guide you. A consultation prior to booking your first session can help you to determine if the therapist and modality might be a good fit for you and your partner. This practice typically requires 8–20 in-person sessions. Clients are encouraged to apply the skills learned in therapy to their relationship between sessions. Participating in EFT requires a willingness to build mutual trust between partners and therapist in order to express vulnerability. After this level of trust is established, your therapist may begin asking questions based on their observations and assessments, such as, “Why did you pull away when your partner touched your arm?” or “You seem to shut down when your partner raises her voice. Could you share with her what you’re experiencing and how that makes you feel?” This process will help to bring awareness to body language, verbal communication patterns, and how these dynamics affect your relationship.  

Finding a Guide & Guide Perspectives

For EFT to be effective, both partners will have to feel safe enough to be vulnerable and open about emotions and thoughts. Thus, it might take a few attempts to find a therapist with whom both individuals feel safe, which is normal for all types of therapy. EFT therapists are required to have a minimum of a Master’s degree and an EFT certification in which the therapist has completed all available supervised training, coursework, and background checks. 

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Works Cited

Bejar L. Emotionally-Focused Therapy: Therapy 101. MyWellbeing. https://mywellbeing.com/therapy-101/emotionallyfocusedtherapy . Published October 17 ,2018. Accessed November 13, 2020. 

EFT Resource Center. http://www.eftresourcecenter.com/ . Accessed November 13, 2020. 

Emotionally focused therapy. Wikipedia. https://en.wikipedia.org/wiki/Emotionally_focused_therapy. Published October 6, 2020. Accessed November 13, 2020. 

Get Help. GoodTherapy. https://www.goodtherapy.org/ . Published 2007. Accessed November 13, 2020. 

 ICEEFT. https://iceeft.com/ . Published 2020. Accessed November 13, 2020. 

Johnson S, Yalom V. Sue Johnson on Emotionally Focused Therapy. An Interview with Sue Johnson, EdD. https://www.psychotherapy.net/interview/couples/sue-johnson-interview. Published 2011. Accessed November 13, 2020. 

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