Emotionally focused couples therapy (EFT): what it is and how it works

“You don’t care anyway.”

She says it in the kitchen, half turned away, in a voice sharper than she intends. He does not answer. He puts the glass in the dishwasher, picks up his phone and goes out onto the balcony. She calls after him something about how he always runs away. He closes the door. Both are convinced the problem is the other one: her, because she criticises all the time; him, because he is never really there.

If this couple went to a therapist who works with emotionally focused therapy for couples, the therapist would begin by saying something unexpected: that neither of them is the enemy. The enemy is the dance they are dancing — and in which they are both trapped. This post is about that approach, known as Emotionally Focused Therapy or EFT: where it comes from, how it understands love, what happens in therapy and what the research says. And because people often ask me whether I work this way myself, at the end I also look at how EFT differs from relational family therapy, in which I am training.

Where emotionally focused therapy comes from

Emotionally focused therapy for couples was developed in Canada in the early 1980s by the psychologists Sue Johnson and Leslie Greenberg. At the time, couples therapy was dominated by the belief that a couple settles down most easily by learning better skills: how to talk, how to negotiate, how to argue by the rules. Johnson noticed that couples did pick up the skills in sessions, but forgot them at home at the first serious row. As if something stronger than the rules were pulling them back into their old reactions.

That something stronger was emotion. So EFT does not teach a couple how to talk; it helps them reach the emotions that drive their behaviour and show those emotions to each other. Later Johnson connected the approach with attachment theory, and that connection became its core.

Today EFT is one of the best-researched approaches in couples therapy. In 1999, Sue Johnson, John Hunsley, Leslie Greenberg and Dirk Schindler summarised the most rigorous studies available at the time in a meta-analysis. After therapy, 70 to 73% of couples were no longer in distress, and around 86% showed significant improvement. The figures need to be read with care — they came from a small number of studies, mostly carried out by the developers of the approach themselves — but for couples therapy, where outcomes are often more modest, these are very good results.

Love as attachment

In the middle of the last century, the British psychiatrist John Bowlby described how a young child attaches to a caregiver and how they react when the caregiver is not available: first they protest, cry and call out, then they despair and withdraw. In 1987 the psychologists Cindy Hazan and Phillip Shaver showed that adult romantic love works on very similar principles. A partner becomes our secure base — the person we turn to when we are hurting, and from whom we dare to go out into the world.

From this, Sue Johnson drew a simple but radical idea: when partners argue, they are not really arguing about the dishes, money or the mother-in-law. They are arguing about a question as old as humanity: Are you there for me? Can I trust you to respond when I need you? Johnson condensed this into three qualities we look for in a partner: accessibility, responsiveness and emotional engagement.

When the answer to that question becomes uncertain, the same alarm goes off in us as in a child who cannot find their mother. Some people start calling out more loudly — the path I describe in Anxious attachment: why a partner’s silence sets off the alarm. Others withdraw, because withdrawing once proved the safer option, as I describe under avoidant attachment. For a basic overview, the knowledge base has an entry on attachment, and there is a broader post on Attachment styles.

The negative cycle: the enemy is the dance, not your partner

The central concept in EFT is the negative cycle. It is a repeating sequence in which one person’s reaction triggers the other’s, which in turn triggers the first person’s again. The most common form is the dance of pursuit and withdrawal: the more one pushes, the more the other withdraws; the more the other withdraws, the more the first one pushes.

In her book Hold Me Tight, Johnson described three such dances, which she called “demon dialogues”. In the first, partners look for the bad guy and take turns attacking. In the second, the most common, one protests and demands while the other defends and pulls away. In the third, both are already so exhausted that they have frozen: they no longer argue, but they no longer touch either.

When a couple first sees their dance as a dance, something often loosens. Suddenly they are no longer prosecutor and defendant, but two people caught in the same whirlpool. I wrote about how the same argument keeps coming back in different disguises in It is not about the dishes: what really lies underneath recurring arguments.

Underneath anger there is often fear

EFT distinguishes between two layers of emotion. Secondary emotions are the ones your partner sees: anger, criticism, coldness, contempt. They are a reaction to something lying beneath them. Primary emotions are the ones underneath: the fear that you do not matter; the sadness of being alone; the shame of not being enough. These are more vulnerable, and so we rarely show them.

When the wife says “you don’t care anyway”, the husband hears an accusation and defends himself. If he could hear what lies underneath — “I’m afraid I’ve become a stranger to you” — he would most likely respond differently. And when the husband goes out onto the balcony, the wife sees indifference. If she could see what lies underneath — “I don’t know how to please you, and every time I try, it’s wrong” — she too would most likely respond differently.

A large part of the work in EFT is precisely this translation. The therapist slows the conversation down, stays with the moment when something happens, and helps each partner find words for what they feel beneath the surface. The point is not for the anger to disappear. The point is for the partner to see what the anger is hiding as well. I describe a similar path from a different angle in From blame to needs: how a couple learns a new language, and the entry on vulnerability explains why showing this layer is so hard.

How therapy unfolds: three stages

EFT is a relatively structured approach. Therapy usually lasts between eight and twenty sessions and goes through three stages:

• De-escalating the cycle. Together with the therapist, the couple recognises their negative dance, names the roles and begins to see the emotions underneath. Once this happens, arguments often become shorter and less harsh, even though nothing has yet been resolved in terms of content.
• Restructuring the bond. This is the heart of the therapy. The withdrawing partner slowly comes back into contact and begins to speak about their needs. The pursuing partner softens and shows the fear that used to hide behind criticism. Johnson calls these moments softening, and research suggests they are linked with the most lasting change.
• Consolidation. With their new way of connecting, the couple tackles old practical problems — money, parenting, housework — and shapes a new story about who they are to each other.

A softening moment might sound something like this (a composite, not a real person):

“When you go out onto the balcony, it feels like you’re not interested in me any more. And then I shout, because it’s better for you to hate me than not to see me.”
“I don’t go because I’m not interested. I go because I don’t know what to do. Every time I say something, it’s wrong.”
“I didn’t know you felt like that.”
“And I didn’t know you were afraid.”

None of this settles who will do the washing-up. But once partners see fear in each other instead of attack, the washing-up suddenly becomes a much smaller question.

What the research says — and what it does not

Research on EFT has advanced considerably over the past twenty years. A review published in 2016 by Stephanie Wiebe and Sue Johnson summarises a range of controlled studies and follow-ups: improvement in relationship satisfaction was large in most studies and, for most couples, held up at follow-ups after therapy ended. EFT has also been tested with couples in which one partner has depression, with couples after infidelity and with parents caring for a chronically ill child.

An interesting strand of research deals with attachment injuries — moments when one partner betrayed or abandoned the other at a crucial time, for example during a miscarriage, an illness or an affair. Johnson and her colleagues described how such injuries stay open and block trust again and again until the couple works through them together.

But it is only fair to mention the limitations too. Most of the studies were carried out by people who developed the approach or trained in it, which can make results look somewhat better. Samples were often small and mostly North American. And although EFT is one of the best-researched approaches, that does not mean other approaches do not work — it mainly means the others have been studied less. Research on couples therapy in general shows that the relationship between the therapist and the couple matters regardless of method.

For a couple choosing a therapist, this is good news: they do not have to find one particular approach. They need to find someone who can create a safe space and will not leave them to the old dance.

EFT and relational family therapy: relatives, not twins

I want to be clear here: EFT is not my approach. I am training in relational family therapy, developed by Christian Gostečnik at the Franciscan Family Institute in Ljubljana. I wrote about what marriage and family therapy is in What marriage and family therapy is, and who it is for. But because the two approaches meet in many places, a comparison is useful.

They have a lot in common. Both put emotions at the centre, not just behaviour. Both draw on attachment theory. Both see the couple as a system in which reactions go round in a circle, and both believe that change happens in the relationship, not only in understanding. Both give great weight to co-regulation — partners being able to calm down in each other’s presence.

The differences lie mainly in how far the gaze reaches. EFT stays largely in the present: with the cycle that is happening now and the emotions the couple feels in the room. The past comes in when it helps to understand why someone is so sensitive to withdrawal or criticism. Relational family therapy goes deeper more systematically: it explores how partners repeat patterns from their families of origin within the relationship, how they unconsciously stir old emotions in each other, and how emotional atmospheres pass from one generation to the next. You can read more about why the same fight keeps coming back in Why the same fight keeps coming back: the intrapsychic in relationships.

In relational family therapy the therapist also plays an important role in their own right: what they sense in the presence of the couple is a source of understanding, which we work through in supervision. In EFT the therapist is more of a guide through a process with clear steps. Neither path is “the right one” for everybody. Some couples are well served by a clear structure and a focus on the present. Others reach a point where they cannot move on without understanding where their reactions come from.

Exercise: catch your dance

You can do this exercise on your own or with your partner, when you are both calm — not in the middle of an argument. It takes fifteen minutes.

1. Think back to your last argument that followed a familiar route. Do not pick the worst one, pick a typical one.
2. Write down what you did — behaviour only, no explanation. “I raised my voice.” “I left the room.” “I started laying out the facts.”
3. Write down what your partner did straight after, and what you did next. Try to find the loop: my reaction → their reaction → my reaction.
4. Under your behaviour, write down what you felt underneath. Not anger, but what lies beneath it: fear, sadness, shame, loneliness. If you cannot find the word, the sentence “In that moment I was afraid that …” can help.
5. If you are both ready, show each other your notes. Each of you speaks only about yourself; the other only listens and at the end says what they heard. No correcting and no defending.

If you get stuck at the fourth step because you cannot find anything underneath, or because it overwhelms you, that is a good sign that a therapist could help with it.

When EFT is not the right choice

Like every approach, EFT has limits, and Johnson herself sets them out clearly.

Where there is violence in the relationship, couples therapy is not appropriate. EFT asks partners to show vulnerability. If one of them is violent, that would put the other in danger. Safety comes first — in Slovenia, help is available on the SOS helpline for women and children victims of violence, 080 11 55, and in immediate danger on 113.

When one partner is in another relationship they are hiding, or when one has already decided to end things, the goal of reconnection is not realistic. In that case it makes more sense first to clarify whether the couple still wants to work on the relationship at all — I wrote about that path in When you decide to separate.

With severe addiction or an untreated mental illness, that often needs to be addressed first, and the relationship afterwards. If one partner is in serious distress or has suicidal thoughts, the first step is a doctor or psychiatrist. In Slovenia, help is also available from the crisis line Klic v duševni stiski on 01 520 99 00 (from 7 pm to 7 am) and from the Samarijan helpline on 116 123 (24 hours).

And finally: not every argument is a negative cycle. Some couples argue not because of a wounded attachment but because of genuinely different values or life goals. Some arguments are healthy. I wrote about how to argue safely in How we argue safely in couples therapy.

If you want to work specifically with EFT, look for a therapist trained in this approach — the international EFT association keeps a directory of therapists. If you are drawn to an approach that goes further into family history, there are relational family therapists. Both are legitimate choices.

What to remember

• Emotionally focused therapy (EFT) understands adult love as attachment: in our arguments we are really asking whether our partner is there for us.
• Couples get caught in a negative cycle — most often pursuit and withdrawal. The enemy is not your partner but the dance.
• Beneath anger and withdrawal lie more vulnerable emotions: fear, sadness, shame. When partners show them, the dance can change.
• A 1999 meta-analysis found that 70 to 73% of couples were no longer in distress after EFT — but the research also has its limits.
• EFT and relational family therapy are relatives: both rely on emotion and attachment, while the latter goes deeper into patterns from families of origin.