Psychology in Action

Bringing Emotionally Focused Couples Therapy to Russia

Simakhodskaya, a bilingual clinical psychologist in New York City and certified supervisor in emotionally focused therapy, has begun training Russian therapists in EFT.

By Zoya Simakhodskaya, PhD

It is May 2013 and I am sitting on the plane that just took off from a Moscow airport flying back to New York. A part of me cannot believe that the events of the last six months, and in particular, the last few days, were real. Twenty-one years ago I left the former Soviet Union as a Jewish refugee, barely an adult, and starting a life I could not yet imagine. I always wanted to be a psychologist, but knew that it was not possible in my motherland. Immigrating to the United States gave me that opportunity, but I could never have foreseen that I would return many years later to teach emotionally focused couples therapy (EFT) to Russian-speaking therapists.

EFT is an empirically validated short-term treatment for couples. It was originally formulated in the early 1980s by Susan Johnson and Les Greenberg. Johnson further developed the model, which integrates attachment theory, systems theory and experiential approach. At the time, the notion of focusing on emotion and attachment between partners in couples therapy was revolutionary. Since then, numerous research studies have been published to support the use of EFT with different populations and various problems: PTSD, depression, anxiety, parents of chronically ill children, women with histories of childhood abuse and distressed couples struggling with stage II breast cancer. Research studies find that 70-75 percent of couples move from distress to recovery and approximately 90 percent show significant improvements. A recently completed study showed that EFT can successfully change the security of the bond between couples, and an accompanying brain scan study suggesting that with EFT, we can change the way partners’ brains respond to contact comfort and perceive threat. Emotionally focused therapy for couples, families and individuals, as well as training in EFT are now conducted all over the world, and the basic textbook "The Practice of Emotionally Focused Therapy: Creating Connection" has been translated into 10 languages. In addition to several textbooks on EFT, Sue Johnson had written two books for couples: "Hold Me Tight" (available in 20 languages) and the upcoming, "Love Sense."

After receiving my PhD in clinical psychology from the Graduate Center of the City University of New York, I worked for many years at the Comprehensive Psychiatric Emergency Program at New York City’s Bellevue Hospital, while at the same time learning EFT and working with couples in private practice. I often thought that there is some similarity between working with a couple and in a psychiatric emergency room: you have to manage chaos, be prepared for anything, find a way to put a puzzle together to determine what is happening and then find a way to get to the core of the issue. Learning other models of couples or family work often left me dissatisfied: cognitive behavioral therapy and communication-building techniques would only last for a brief time, psychodynamic interpretations brought insight but no significant change and systemic or structural interventions made sense on an intellectual level but did not touch me or the couple emotionally. Something was missing. The attachment perspective resonated with me because it “focuses the therapist on what matters, which is safe emotional engagement and responsiveness and I believe that this is what makes EFT interventions so effective” (Johnson 2006).

The EFT model not only provides the map and theory behind its interventions, it has developed a structured way of training to learn this deceptively simple model. The International Centre for Excellence in EFT (ICEEFT) in Ontario, Canada provides the oversight and continued improvements for the trainings, as well as certification of therapists around the world and research. Since being trained and becoming a certified EFT therapist and then supervisor, I have lectured on EFT and have trained more therapists. My colleagues and I have developed a non-profit New York EFT Center with the mission of training EFT therapists and treating couples in the greater New York area. At the same time, I was seeing many bilingual Russian-speaking couples, and wondered whether anyone knew about this model in Russia or other eastern European countries.

Through a circuitous route involving a Russian therapist in Canada, I was introduced to Lucy Mikaelyan, a psychologist in Moscow who had taken EFT training in London and wanted to bring it to Russia. She is a senior faculty member and the director of International Development at the Center of Systemic Family Therapy, a postgraduate training institution in Moscow that provides individual, couples and family therapy, often at low cost. They teach different models of therapy through lectures, seminars, workshops, observations of live sessions of experienced therapists, live supervision and case presentations. Modern therapeutic models (e.g., narrative therapy and brief solution-focused therapy) are taught alongside the traditional psychotherapies (e.g., Bowenian family therapy, structural and strategic family therapies and experiential approaches). The field of Russian psychology and psychotherapy has a long tradition dating back to Pavlov and Vygotsky, in addition to an established psychoanalytic field. According to Lucy Mikaelyan, “There is a growing understanding among clinicians and trainers of the advantages of brief and focused models and their better fit to the needs and lifestyle of clients.” There is also more interest now in integrative models that can be more effective with different populations.

Simakhodskaya with psychologists who translated and edited the Russian edition of Practice of Emotionally Focused Therapy. From left to right: Konstantin Yagniuk, Christina Voskanova, Zoya Simakhodskaya and Lucy Mikaleyan. A group of therapists gathered in the training room to watch Simakhodskaya (on screen) conduct a live EFT therapy session

A few months later I was on the plane to Moscow to conduct a two-day workshop on an “Introduction to EFT” as the first international training program at the center. Nearly fifty therapists attended the training, most of them from Moscow, but some coming from St. Petersburg, Voronezh, Saratov and other cities in Russia. On the first day, through a PowerPoint presentation and video examples, I reviewed attachment theory, foundations of EFT and steps and stages of the approach. We did our first exercise of sharing participants’ attachment history with a person sitting next to them. I was very impressed with the quality of self-awareness and openness in the room. While most of the attendees were familiar with aspects of attachment theory referring to the parent-child relationship, the body of theoretical and empirical work on adult attachment was largely new to them.

The second day started with a live session involving a young couple who responded to a Facebook ad. Here I was, an American therapist, sitting in a small room with a couple I had never met, with a room full of therapists watching us on a screen. The couple shared their struggles, which included raising a son that the husband had from a previous relationship with a woman who had died, dealing with the husband’s recent mugging and lengthy hospitalization for serious injuries, moving past previous infidelity, and repeatedly getting stuck in conflicts they were unable to resolve. The process became a conversation about two human beings in pain who were trying to find their way back to each other, and me helping them on that journey. When I walked back into the training room, there was a certain hushed quality that conveyed having been touched on a human level. Some therapists had tears in their eyes as they spoke about their amazement that emotions can be touched so deeply in such a short time, and that seeing the power of emotions and attachment brought to mind their own relationships. In the afternoon we reviewed EFT interventions, did a role-play of reflecting and validating while tracking the negative cycle between the couple, and spent time discussing issues of self-of-a-therapist.

It was clear that there was a wide range of training levels in the room. Some attendees were senior faculty members who teach systemic family therapy or psychoanalysis, others had received substantial training in child and parent therapy or art therapy, and still others were students learning the basics of psychotherapy. There was a psychiatrist from St. Petersburg who runs a family therapy and research program for those suffering from schizophrenia. Russia still does not have licensing laws, and the initial training for psychologists and psychotherapists is purely academic. One might have an equivalent of a master’s degree in psychology without having ever seen a patient, yet might decide that they are qualified to open their own private practice and start seeing patients. The need for hands-on training and supervision is enormous.

At the end of the training many therapists signed up for continued supervision and future workshops.  They have already started a Russian EFT Facebook page and a biweekly EFT journal club. "There is a strong will among Russian therapists to proceed with learning EFT and to become a part of the international community. Maybe the heart of the matter is secure attachment — the basic need across all counties and nationalities in the times of quick changes and shifts in almost all areas of life,” says Inna Khamitova, faculty and the director of education at the Center of Systemic Family Therapy. Only a few weeks later, "The Practice of Emotionally Focused Therapy for Couples" was published in Russian (Lucy Mikaelyan was one of the scientific editors alongside with Konstantin Yagniuk). Cross-cultural integration continues, as Christina Voskanova, who was the translator of the book, is now a PhD student in Marriage and Family Therapy program at Virginia Tech. We are now planning an online group supervision and future externship in EFT and core skills advanced training.

The need is present. Russia remains first in the world in divorce rate, followed by Belarus and Ukraine (U.N. 2011 statistics). These rates are explained in part by difficult economic conditions and increased alcohol and drug use. “Professionals in psychology are in great demand in medical care systems, social and educational institutions, and business corporations,” states Lucy Mikaelyn. “It is especially true in large cities where people are learning that in challenging situations it is worth finding a specialist who can help cope with crisis and stress. If problems arise in close relationships, people are beginning to seek psychological help and look for qualified family or couple therapists.” However, given the history of misuse of psychiatry for political reasons in the Soviet Union, there is still a long road ahead to decrease the stigma of mental illness and the fear of mental health providers.

As I sat on the plane returning to New York, I marveled at the universality of emotions and human connection. I came to Moscow a stranger and left feeling that I had known some of those people for years. It was also an incredible personal journey for me. After 21 years away from my homeland and being trained in English, I had struggled to convey the concepts of EFT accurately in Russian. However, I also realized that my fear and anxiety had less to do with my mastery of the language than it did with my identity. Would I again regress to the awkward adolescent I was before I left? Would the expertise and competence I feel when I teach in English be the same in Russian? To experience such a coalescence of my two worlds was, and will continue to be, life changing. I am aware that there are many cultural nuances and differences that I will continue to learn through this process.

To learn more about Simakhodskaya’s work, visit the Center for Psychological and Interpersonal Development website.