Emotionally Focused Couple Therapy for Clients Dealing With Infidelity

Emotionally focused couple therapy (EFT) is a brief, integrative approach that focuses on helping couples step out of distress and establish more secure attachment bonds. It is a humanistic–experiential approach that focuses on how partners construct their emotional experience, and it also takes a systemic perspective on how partners shape patterns of interaction that then become self-sustaining feedback loops that define the quality of a close relationship.

Emotion and emotional signals link self and system, organizing patterns of interaction and each partner's experience of connection and disconnection. Emotion is seen as the music of a couples' dance. The EFT therapist is a process consultant, helping couples expand constricting inner emotional realities and responses and interactional patterns.

In terms of interventions, EFT reflects the influence of Carl Rogers and Sal Minuchin; however, the overall framework for understanding love relationships is taken from John Bowlby's attachment theory.

The strengths of EFT are as follows:

• This model targets the elements of relationship distress delineated by recent research on emotion, relationship distress, and relationship satisfaction. EFT offers a clear map of relationship problems and strengths and is viewed as relevant and on target by distressed couples.
• This model offers a systematic set of strategies and interventions supported by process research studies into the nature of change. The change process is mapped into three stages: a) de-escalation of problem cycles, b) restructuring of attachment interactions, and c) consolidation, along with nine specific steps within these stages. Process research has outlined in-session change events that predict outcome and key interventions.
• This model has considerable empirical validation as to outcome. The first outcome study of EFT was published in 1986, comparing EFT to behavioral interventions and a wait list control. A meta-analysis of the most rigorous studies shows that at least 7 out of 10 couples move out of distress during treatment and that results are stable over 2 to 3 years even with couples who are at high risk of relapse. The effect sizes found in EFT studies appear to be the largest in the field. Outcomes have included increased trust, intimacy, empathy, and the forgiveness of injuries that block trust and connection.
• The model has a high level of validation in that it has been tested by different researchers across different settings and couple problems using rigorous research techniques. Effectiveness appears to generalize to many different kinds of problems that co-occur with relationship distress such as serious illness, depression, and post-traumatic stress disorders.
• EFT is broadly applicable. It is used in many different countries (from Finland to China) and across many different cultures. It is also used with families (EFFT) and with different kinds of couples varying in age and educational status, as well as with gay couples and military couples. There is a workshop educational version of EFT designed for use by military postdeployment couples as well as a more general relationship educational program, Hold me Tight: Conversations for Connection.
• EFT is arguably unique in that it is based on a rich and extensively validated theory of adult love relationships—attachment theory. This theory informs the view of dysfunction that is seen in terms of emotional dysregulation and disconnection and recurring patterns that generate emotional distance and insecurity. Attachment theory offers a map to each partner's fears and longings. It also informs change processes and goals in that change is seen as occurring from not only de-escalating cycles such as demand–withdraw that generate distress, but from shaping new experiences and responses that create more secure bonding and positive mutual affect regulation.

The goals of EFT are:

• to expand and reorganize key emotional responses (for example, changing reactive anger to more deeply felt sadness or anxiety about rejection or abandonment) and
• to shape interactional patterns in the direction of the open responsiveness that is the defining feature of a secure attachment bond.

The therapist reflects patterns of interaction and uses evocative questions, validation, and the systematic unfolding of emotional responses to create enactments where partners send each other new messages and lead each other into a new dance characterized by safe emotional connection.

Sue Johnson, CPsych, EdD, is a clinical psychologist, researcher, professor, author, popular presenter and speaker, and one of the leading innovators in the field of couple therapy. She presents and writes on attachment and bonding, the science of love, interventions to repair relationships, trauma couples, and forgiveness.

Sue holds professorships at the University of Ottawa in Ontario, Canada, and at Alliant University in San Diego, California. She is one of the originators and the main proponent of emotionally focused couple therapy (EFT), a powerful, tested intervention to help couples repair rifts and build strong loving bonds. She is also the director of the Ottawa Couple and Family Institute and the International Center for Excellence in Emotionally Focused Therapy, which has 10 affiliated centers in North America and Europe.

Sue received her doctorate in counseling psychology from the University of British Columbia in Vancouver, Canada, in 1984. Her professional books are considered to be among the leading texts on couples therapy and she serves on the board of many professional journals. Her 2008 book Hold Me Tight: Seven Conversations for a Lifetime of Love, written for the general public, outlines her last 25 years of research and the new science of adult bonding. This book is the basis for a program for postdeployment military couples created for the U.S. military and a relationship education program, Hold Me Tight: Conversations for Connection.

She has received numerous honors for her work, including the Outstanding Contribution to the Field of Couple and Family Therapy Award from the American Association for Marriage and Family Therapy and the Research in Family Therapy Award from the American Family Therapy Academy. She is an invited fellow of APA, and her work has been noted and elaborated upon in publications such as The New York Times (an article on her program for the U.S. military), The Washington Post, USA Today, and The Globe and Mail, More, and Psychology Today magazines.

Sue has an active media presence. For example, her favorite radio interview to date was her conversation about love on the Canadian Broadcasting Corporation's (CBC's) Ideas in November of 2009. Her favorite TV spot is on the CBC talk show Stephen and Chris. She blogs on Hold Me Tight Blog, which also shows video clips of Sue presenting her work, and Psychology Today.

Sue's passions are her family, her work, and Argentinean Tango.

• Cassidy, J., & Shaver, P. R. (2008). Handbook of attachment: Theory, research, and clinical applications, 2nd ed. New York, NY: Guilford Press.
• Furrow, J., Johnson, S., & Bradley, B. (in press). An casebook in emotionally focused couple therapy. New York, NY: Brunner/Routledge.
• Johnson, S. M. (2008). Hold me tight: Seven conversations for a lifetime of love. New York, NY: Little Brown.
• Johnson, S. M. (2004). Creating connection: The practice of emotionally focused marital therapy, second edition. New York, NY: Brunner Routledge.
• Johnson, S. M. (2002). Emotionally focused couple therapy with trauma survivors: Strengthening attachment bonds. New York, NY: Guilford Press.
• Johnson, S. M., Bradley, B., Furrow, J., Lee, A., Palmer, G., Tilley, D., & Woolley, S. (2005). Becoming an emotionally focused therapist: The workbook. New York, NY: Brunner/Routledge.
• Johnson, S. M., & Whiffen, V. (Eds.). (2003). Attachment processes in couple and family therapy. New York, NY: Guilford Press.

Web Resources

• Training tapes of EFT, available from the International Center in Excellence in Emotionally Focused Therapy

Audiovisual Resources

• Facilitator's guide for small groups and accompanying DVD – Hold Me Tight: Conversations for Connection. This program is available through ICEEFT, the International Center in Excellence in Emotionally Focused Therapy.

APA Videos

• Couples at an Impasse
  Jon Carlson
• Couples Therapy for Extramarital Affairs
  Don-David Lusterman
• Emotion-Focused Therapy for Depression
  Leslie S. Greenberg
• Emotion-Focused Therapy Over Time
  Leslie S. Greenberg
• Emotionally Focused Therapy With Couples
  Leslie S. Greenberg
• Process Experiential Psychotherapy: An Emotion-Focused Approach
  Leslie S. Greenberg
• Schema Therapy With Couples
  Jeffrey E. Young
• Three Approaches to Psychotherapy With a Female Client: The Next Generation
  Judith S. Beck, Leslie S. Greenberg, and Nancy McWilliams
• Three Approaches to Psychotherapy With a Male Client: The Next Generation
  Judith S. Beck, Leslie S. Greenberg, and Nancy McWilliams

APA Books

• Emotion-Focused Couples Therapy: The Dynamics of Emotion, Love, and Power
  Leslie S. Greenberg and Rhonda N. Goldman
• Emotion-Focused Therapy
  Leslie S. Greenberg
• Emotion-Focused Therapy: Coaching Clients to Work Through Their Feelings
  Leslie S. Greenberg
• Emotion-Focused Therapy for Complex Trauma: An Integrative Approach
  Sandra C. Paivio and Antonio Pascual-Leone
• Emotion-Focused Therapy for Depression
  Leslie S. Greenberg and Jeanne C. Watson
• Learning Emotion-Focused Therapy: The Process-Experiential Approach to Change
  Robert Elliott, Jeanne C. Watson, Rhonda N. Goldman, and Leslie S. Greenberg
• Working With Narrative in Emotion-Focused Therapy: Changing Stories, Healing Lives
  Lynne E. Angus and Leslie S. Greenberg