2 people at a table, one is the therapist, the other is the patient.
Illustration by Marta Pucci

Emotionally-Focused Therapy (EFT)

Photo of Dr Katherine Hertlein
Reviewed by Dr Katherine Hertlein,
created by Blueheart
created by Josh Green
created by Sophie Browness
Date published:
1/14/2022
Last updated:
1/14/2022
Photo of Dr Katherine Hertlein
Reviewed by Dr Laura Vowels,
created by Blueheart
created by Josh Green
created by Sophie Browness
Date published:
1/14/2022
Last updated:
1/14/2022

TL;DR

  • The occasional disagreement in a relationship is normal, but if you're arguing more and more, you and your partner may have opposing interaction styles. When one partner pushes towards the relationship, the other pulls away.
  • These interaction styles are based on attachment theory, which is deeply connected to our core fears and anxieties about self-worth and abandonment. 
  • Emotionally-focused therapy (EFT) addresses this by shifting the blame for the couples' problems to the negative patterns between them, instead of the couple or individual partners themselves.
  • A three-stage emotional therapy approach helps partners to hear and understand one another with love, empathy and compassion.
  • EFT is an effective, evidence-based approach that results in more secure attachment, stronger bonds and more positive emotions between couples.

Communication within intimate relationships isn't always smooth sailing. Whether it's rehashing the same old argument, or somehow spiralling into a new one when just seconds ago everything was fine, it's quite normal for couples to occasionally fall out of step with one another.

However, frequent arguments can often point to opposing communication styles and, if left unchecked, one or both partners can end up feeling unheard, unloved and unappreciated, which only adds more fuel to the argument fire. Couples stuck in this cycle often feel frustrated, or even hopeless, concluding that "this is just the way things are". However, emotionally-focused therapy (EFT) can not only break the damaging argument cycle, but also help create better emotional awareness for a stronger, more loving bond between partners. 

What is Emotionally-Focused Therapy?

Emotionally-focused therapy is often a short-term, structured approach to psychotherapy, usually lasting between eight and 25 sessions.

EFT was developed in the 1980s by psychologists Sue Johnson and Leslie Greenberg, who discovered a new experiential approach after identifying the same, repeated argument patterns during couples counselling sessions.

EFT is largely based on attachment theory, which focuses on the bonds and relationships between individuals, and the impact these have on an individual's journey through life. At its heart, attachment theory states that we all have a critical need for secure attachments, beginning in infancy with a primitive survival need, developing into an adult need for safety and security, both emotionally and physically. 

Feeling connected to and loved by our romantic partner is a primary need that we all share. But when we fight with our partner, it can feel like that sense of connection and love goes away. This can trigger a deeply-rooted fear of abandonment, and our emotional response to this can be harmful to the relationship. When intimate partners are not able to meet each other’s emotional needs, they can become stuck in negative patterns of interaction driven by ineffective attempts to get each other to understand their emotions and what it is they really need from their partner. 

This pattern of interaction can often result in questions such as "Do you love me?", "Am I important to you?" and "Are you happy you met me?" which can, depending on each person's communication style, create further tensions (even if they do love and value their partner very much). Therefore, the cycle repeats itself.

Emotionally-focused therapy addresses this pattern directly and focuses on the emotions that are often left out of therapy for couples. What makes EFT different from any other approach to couples' therapy is that it uses the emotional bond that already exists between individuals in relationships as a powerful tool to resolve differences and promote better connection through positive emotional experiences.

Determining communication style

The theory of EFT says that when individuals feel insecure in their relationship, there are two main emotional response categories: pursuer and withdrawer, each very different patterns of emotion regulation. Our propensity to either of these types depends on a lot of factors, although the foundations are usually laid down in our childhood, based on the adaptive emotions we formed with the attachment styles we created with our caregivers, and by observing the relationships of those around us. 

Pursuers

Pursuers are likely to verbally attack their partner, lashing out with words and raising their voice. This is often driven by deep fears of being left alone. "I'm going to be alone" > "I'm not wanted or worthy" > "I need reassurance". The conflict then arises when the reassurance doesn't come in a way that satisfies this need, either because of their partner's own emotional response, or simply because they don't know how best to act. 

Withdrawers

The withdrawer response is the opposite of the pursuer. During emotional conflict, the withdrawer becomes quiet and retreats inside themselves. "I'm inadequate" > "I'll never be good enough for my partner" > "I need to feel accepted". 

The more one person pursues, the more the other withdraws. The more one withdraws, the more the other pursues. And this pattern can often spiral out of the simplest interactions. Let's look at an example.

Sarah: What shall we do this weekend?

David: *Distracted* I don't mind, whatever is fine with me.

Sarah: Okay, we'll do nothing then, shall we?

David: *Sighs, leaves the room*

At face value, it looks like Sarah is annoyed because David has little interest in something that's important to her, and David is annoyed because he feels like he's being criticized for his response. This is certainly true, but it's not the whole story. 

Sarah (the pursuer) takes David's distracted non-committal reply to mean he doesn't really value her, so it would be easy for him to end the relationship, leaving her alone. David (the withdrawer) interprets Sarah's irritation as a sign that she'll leave him, and therefore he withdraws to protect himself against feeling the pain of this. 

From an outside perspective, this might seem like a trivial, albeit snippy, interaction. But for Sarah and David, who feel trapped in this pattern of communication, it's just another reason to feel unhappy in themselves and with each other when all they want is to feel loved and connected.   

An emotionally-focused approach helps couples to identify these cycles, learn what they really need from one another, and to communicate their needs in a way that creates secure bonds and connections. 

How does Emotionally-Focused Therapy work in practice?

Okay, so you've identified the unhelpful emotions, now it's time to put this emotionally-focused approach to work. 

At its heart, EFT shifts the blame for the couples' problems to the negative patterns between them, instead of the couples or individual partners themselves.

This change process is mapped into a system of nine steps across three stages, each helping the therapist to guide and track progress.

Stage one: De-escalation

The first stage is focused on identifying and reframing the negative interaction patterns that lead to conflict, and the negative emotions related to attachment issues. During this stage, partners begin to see one another's undesirable behaviours (such as withdrawing or becoming angry) as "protests of disconnection", rather than intentional attacks, and start learning how to be more empathetic and engaged with one another's feelings.

The typical steps of stage one are outlined below.

  • Step one: Identify key areas of concern
  • Step two: Identify the way negative patterns of interaction increase conflict
  • Step three: Explore and identify unacknowledged fears and negative emotions related to attachment style
  • Step four: Reframing key patterns of interaction and underlying emotions to each person's attachment needs

Stage two: Restructuring

Throughout the second stage, each partner learns to share their deep, underlying emotions from a place of vulnerability, and to show acceptance and compassion for their partner's experience.

  • Step five: Each person is encouraged to voice their attachment needs with the therapist helping clients to express their deep emotions
  • Step six: Partners learn to express acceptance and compassion for their partner's attachment needs and interaction style
  • Step seven: Partners explore and learn ways to reach for their partner to ask for their needs to be met

Stage three: Consolidation

During the final stage, the couple's therapist helps them work on new communication strategies and guides them in practicing their new skills when interacting with each other. Old negative patterns of 'pursue-withdraw' are replaced with new patterns of bonding, and these positive cycles become reinforcing, leading to permanent change. 

  • Step eight: The couple discusses old problems with the therapist guiding clients to use new communication styles and solutions
  • Step nine: The couple develops a plan to make their new interaction patterns a consistent part of life outside therapy

What are the benefits of Emotionally-Focused Therapy?

First and foremost, the biggest benefit of EFT is, of course, improved communication with your partner. Not just in day-to-day interactions but in truly feeling that you're being heard and understood. This in itself yields a range of further benefits. 

A closer, more intimate relationship

EFT helps couple's create a language for healthy interdependency, understanding and respect. Learning about your partner's deep internal experience, and feeling comfortable expressing your own individual experiences, can create secure bonds and a closeness you may not have felt before. 

Stress relief

EFT is based on attachment theory, which says that positive attachments between people provide comfort, security and a safe haven away from the stress of life. Additionally, EFT enables individuals to focus on emotions and the processing of emotions in a healthy and sustainable way, which also contributes to overall wellbeing. 

Better interpersonal relationships

The purpose of EFT is to help create a greater awareness of emotions, enabling you to become more aware of one another's needs, and to listen and discuss problems from a place of empathy, instead of defensiveness or anger. The skills you learn during EFT can be applied to all of your relationships, improving your emotional intelligence to help you become a better, more compassionate and more patient listener. For this reason, the guiding principles of EFT are also often used in family as well as individual therapy.

What issues can Emotionally-Focused Therapy help with?

EFT is designed to tackle the emotional pain caused by negative interaction patterns both in everyday life and during specific life events. EFT has proven effective in treating a wide variety of problems, including:

  • Depression, anxiety and PTSD affecting a couple's relationship
  • Infidelity
  • Infertility
  • Chronic and acute illness affecting the couple's relationship
  • Disagreements over parenting
  • Financial stresses
  • Anxiety over major life events such as moving house or changing jobs
  • Addiction affecting a couple's relationship
  • Sexual dissatisfaction

How can EFT improve your sex life?

Couples undertaking EFT often report an improved sex life due to new feelings of closeness and emotional intimacy. However, EFT can itself be used to treat sexual problems, as it addresses the negative cycles that a couple's sex life can fall into, as well as the avoidance and anxiety that arises from talking about feelings of sexual dissatisfaction. 

Is EFT an effective treatment?

EFT is supported by extensive studies, with a substantial body of research outlining the efficacy of the treatment.

Studies (1) show EFT improves interactions between partners and reduces the amount of stress people experience in their relationships. While a 2019 systematic review (2) into the treatment concluded it was effective in improving marital satisfaction, with lasting results and "little evidence of relapse back into distress".

In fact, EFT is widely-regarded as the most evidence-based therapy model for couples, with 90% of couples undertaking EFT showing improvement in their interaction patterns. And 70%-73% of couples overcoming their issues completely, compared to a recovery rate of just 35% for couples undertaking cognitive-behavioral therapy. 

Things to consider before undertaking Emotionally-Focused Therapy

Like all therapeutic approaches, EFT can be emotionally challenging, particularly at the beginning. Because EFT involves exploring negative emotions from a place of vulnerability, the process can lead to stressful and intense emotional experiences which can be upsetting. As such, each partner needs to be committed to the process and willing to work through it together, with an open-minded approach to treatment. The outcome of EFT may be less effective if one partner is less willing to participate. 

Additionally, because the process of EFT involves exploring deeply-rooted fears, it's not uncommon for participants to unearth trauma or emotions that may benefit from further individual therapy after the EFT process is completed with their partner.

(1). Wiebe, S. and Johnson, S., 2022. A Review of the Research in Emotionally Focused Therapy for Couples.
(2). Beasley, C.C. and Ager, R. (2019). Emotionally Focused Couples Therapy: A Systematic Review of Its Effectiveness over the past 19 Years. Journal of Evidence-Based Social Work, 16(2), pp.144–159.
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