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262 Person-Centered and Experiential Psychotherapies, Volume 7, Number 4

The Integration of Systems and Humanistic Approaches in EFT for Couples


Burgess Moser & Johnson 1477-9757/08/04262-17
Melissa Burgess Moser
School of Psychology, University of Ottawa, Ontario, Canada
Susan Johnson
Ottawa Couple and Family Institute, Ottawa, Ontario, Canada
The Integration of Systems and
Humanistic Approaches in Emotionally
Focused Therapy for Couples
Author Note. Address for editorial correspondence: Melissa Burgess Moser, School of Psychology, University of
Ottawa, 145 Jean-Jacques Lussier Street, Ottawa, Ontario, K1N 6N5, Canada. Email: <mburges2@uottawa.ca>
Abstract. Emotionally focused couple therapy (EFT) is an integrative approach which combines theory
and techniques from experiential and client-centered approaches with attachment theory and systems
theory. The following paper will outline the humanistic foundations of EFT, and will demonstrate how
systems and attachment theory strongly complement the client-centered and experiential underpinnings
of this approach. The paper will go on to show how specific aspects of these theories combine to provide
a comprehensive framework in which to conceptualize and treat relational distress. Finally, clinical examples
will be provided on how the combined techniques from these approaches are used in the treatment of
relationship distress.
Keywords: emotionally focused therapy for couples, experiential theory, systems theory, attachment theory,
integrative approach
Die Integration von systemtheoretischen und humanistischen Anstzen in die emotionsfokussierte
Paartherapie
Emotionsfokussierte Paartherapie (EFT: Johnson, 1996/2004) ist ein integrativer Ansatz, der Theorie
und Techniken aus experienziellen und klientenzentrierten Anstzen mit der Bindungstheorie und der
Systemtheorie kombiniert. Dieser Artikel skizziert die humanistischen Grundlagen der EFT und
demonstriert, wie hervorragend Bindungs- und Systemtheorie die klientenzentrierten und experienziellen
Grundlagen dieses Ansatzes ergnzen. Der Artikel zeigt im Weiteren, wie sich spezifische Aspekte dieser
Theorien verbinden und damit einen umfassenden Rahmen schaffen, in dem man Beziehungsstress
konzeptualisieren und behandeln kann. An klinischen Beispielen wird schlielich gezeigt, wie man die
kombinierten Techniken dieser Anstze in der Behandlung von problembelasteten Beziehungen verwendet.
Burgess Moser and Johnson
Person-Centered and Experiential Psychotherapies, Volume 7, Number 4 263
La integracin de enfoques sistmicos y humanistas en la terapia de parejas enfocada a la emocin
La terapia de parejas centrada en la emocin (EFT: Jonson, 1996/2004) es un enfoque integrador que
combina la teora y las tcnicas de los enfoques experienciales y centrados en la persona con la teora del
apego y la de sistemas/sistmica. Este escrito presenta los fundamentos de la EFT y demuestra cmo la
teora sistmica y del apego complementan con mucha fuerza las bases/los fundamentos centrados en el
cliente y experienciales de este enfoque. El escrito muestra como aspectos especficos de estas teoras se
combinan para dar un marco integral para conceptualizar y tratar los problemas de relacin. Por ltimo
se dan ejemplos clnicos de cmo las tcnicas combinadas de estos enfoques se usan en el tratamiento de
relaciones problemticas.
LIntgration dApproches Systmiques et Humanistes dans la Thrapie Centre-sur-lEmotion pour
des Couples
La thrapie centre sur lmotion (EFT: Johnson, 1996/2004) est une approche intgrative qui allie la
thorie et les techniques des approches exprientielles et centres sur le client avec la thorie dattachement
et la thorie systmique. Cet article retrace les fondements humanistes de lEFT et dmontre la manire
dont la thorie systmique et la thorie dattachement compltent fortement les fondements centrs-
sur-le-client et exprientiels de cette approche. Larticle dmontre ensuite la manire dont des aspects
spcifiques de ces thories fournissent ensemble un cadre global dans lequel on peut centraliser et
traiter la dtresse relationnelle. Finalement, des exemples cliniques sont fournis, dmontrant lutilisation
de la combinaison des techniques de ces approches dans le traitement de relations douloureuses.
A integrao de sistemas e abordagens humanistas na terapia de casais focada na emoo
A terapia de casal focada na emoo (EFT: Johnson, 1996/2004) uma abordagem integrativa que
combina teoria e tcnicas das abordagens experiencial e centrada no cliente com a teoria do apego e a
teoria sistmica. Este artigo reala as bases humanistas da TFE e demonstra como as teorias do apego e
dos sistemas complementam solidamente os alicerces centrados no cliente e experienciais desta abordagem.
O artigo demonstra de que forma aspectos especficos destas teorias se combinam para fornecer um
enquadramento abrangente com vista a conceptualizar e tratar o sofrimento relacional. Por ltimo, so
fornecidos exemplos clnicos de como as tcnicas combinadas das diversas abordagens so usadas no
tratamento de relaes disfuncionais.
Emotionally focused couple therapy (EFT) (Greenberg & Johnson, 1988; Johnson, 1996/
2004) views relational distress as resulting from negative interaction cycles created and
maintained by partners unmet attachment needs for love, care and acceptance. Throughout
the process of EFT, partners are encouraged to explore their unacknowledged emotional

(EFT: ]ohnson, 1996]2004)

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The Integration of Systems and Humanistic Approaches in EFT for Couples
needs and express these needs to their partner. Individuals expressions of these unmet needs,
and partners accompanying responses of support, have been demonstrated to shift couples
negative patterns of interactions into more flexible and positive cycles that facilitate relationship
satisfaction (Bradley & Furrow, 2004; Johnson & Greenberg, 1988).
In order to conceptualize partners distress and apply the series of interventions needed
to guide partners out of negative interaction cycles, EFT draws theoretically from the
humanistic approaches of experiential and client-centered therapy (Elliott, Watson, Goldman,
& Greenberg, 2004; Rogers, 1965) and from family and systems therapy (Bateson, 1980;
Minuchin & Fishman, 1981). Further, over the last 15 years, EFT has also integrated adult
attachment theory (Bowlby, 1988; Hazan & Shaver, 1987) into its conceptualization of
healthy relationship functioning.
EFT has been empirically validated through a series of outcome studies (Johnson,
Hunsley, Greenberg, & Schindler, 1999), and has demonstrated efficacy with couples
whose partners suffer from post-traumatic stress disorder and depression (Dessaulles,
Johnson, & Denton, 2003; Johnson & Williams-Keeler, 1998). MacIntosh and Johnson
(2008) also outline promising preliminary results for EFT with adult survivors of childhood
abuse. Further, results with parents of chronically ill children have demonstrated a high
level of stability in relationship satisfaction over a 2-year follow-up (Clothier, Manion,
Gordon-Walker, & Johnson, 2002). The efficacy of EFT cross-culturally and in gay-lesbian
relationships has yet to be systematically evaluated; however clinical experience suggests
that EFT can be successfully applied within these populations. Josephson (2003) provides
a theoretical and clinical description of how EFT can be applied within same-sex
relationships.
The goal of this paper is to demonstrate how the integrative approach applied in EFT
provides a comprehensive therapeutic approach for the treatment of distressed relationships.
Specifically, this paper outlines how aspects of attachment and systems theory are woven
together with client-centered and experiential approaches without sacrificing the experiential
foundation of EFT. The first sections of the paper will review the main aspects of humanistic,
systems, and attachment theories that have influenced the development of EFT. A brief
description of how humanistic and systems techniques are combined in EFT follows. Next,
a description is offered on how humanistic, systems, and attachment theories complement
one another in the treatment of relational distress. The last section of the paper briefly outlines
the steps and stages of EFT, and provides a case example of how clinical techniques are used
with a couple during the first stage of therapy.
HUMANISTIC THEORIES
EFT is strongly grounded in humanistic approaches. This section reviews the integral
aspects of client-centered and experiential principles that form the foundation of EFT for
couples.
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Person-Centered and Experiential Psychotherapies, Volume 7, Number 4 265
The therapeutic relationship
In EFT, a collaborative therapeutic relationship is essential. Humanistic therapeutic
relationships are characterized by nonjudgmental caring, acceptance, and respect (Cain,
2002). The therapeutic climate thus created can be considered therapeutic within itself,
but more significantly, these characteristics foster the safety clients need to process difficult
emotional experiences in therapy (Elliott et al., 2004). Research has demonstrated that
when therapists actively display empathic and accepting attitudes towards their clients
they are more likely to develop a collaborative treatment relationship in terms of the tasks
and goals of therapy (Watson & Geller, 2005). Similarly, the therapeutic alliance in EFT
has been demonstrated to account for 20% of the variance in therapeutic outcomes (Johnson
& Talitman, 1997).
A focus on emotions
In EFT, the main focus is clients emotional experiences. Emotions organize an individuals
goal-directed behavior (Frijda, 1986; Greenberg, Rice, & Elliott, 1993), color the creation of
meaning, and inform individuals of their needs. Emotions also communicate they signal
intentions and needs to others. Carl Rogers (1965) highlighted the congruence between
emotional needs and the expression of these needs as a major contributor to the improved
family life of his patients after therapy.
Process versus content
Humanistic therapies focus more on the process of therapeutic interactions rather than the
content (Seeman, 2002). Therapists understand that the client is the expert regarding
their emotional experience (Johnson, 2004). A major task in experiential therapy is to
track and follow clients emotional processing to understand how they construct personal
meanings and formulate goals based on their emotional experiences with others (Elliott et
al., 2004).
Present and growth-oriented
Within humanistic approaches, interventions are focused on the present. The clients immediate
and ongoing construction of experience is the focus of therapy (Elliott et al., 2004; Johnson,
2004). Research has demonstrated that clients present-focused emotional experiencing
influences the development of new insights and changes in interpersonal relationships
(Kennedy-Moore & Watson, 2001).
Similarly, humanistic interventions are growth-oriented. Rogers (1965) believed that
clients can effectively cope with their life experiences when the difficulties or emotional
experiences arising from these situations are brought into their conscious awareness. Recent
humanistic conceptualizations of this growth-oriented approach include the understanding
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The Integration of Systems and Humanistic Approaches in EFT for Couples
that clients have experienced life events which have led them either to be unaware of, or to
deny their own emotional experience as trustworthy and directive (Greenberg, Korman, &
Paivio, 2002). One of the main goals of experiential approaches is to help clients to examine
their previously inaccessible emotions and to use these emotions to guide new ways of being
with others (Elliott et al., 2004).
SYSTEMS THEORY
Individual versus system
In order to understand and treat the interpersonal aspects of relational distress, EFT also
draws theoretically from aspects of systems theory. The most influential contribution of early
systems theorists (Bateson, 1980; Bertalaffy, 1973) was that the family is itself an organism,
or a system, in which the whole is not equal to the sum of its parts. Within systems theory it
is understood that family interactions take on a life of their own, and trying to understand an
individuals behavior outside the context of their family system is meaningless (Bertalaffy,
1973). Despite this useful concept, some systems approaches can tend to overlook the influence
of individual personality on communications and behavior. This approach characterized
individuals within the system as helpless and constricted (Nichols, 1987), instead of
emphasizing individual growth and self-actualization. In an effort to encourage more
exploration of the self in the system, Nichols (1987) noted what is also a key position of
EFT, namely, that in order to shift family functioning, change needs to occur at both the
individual and the system levels.
Circular causality and process
Systems theory also focuses on the concept of circular causality (Nichols & Schwartz, 2006).
Circular causality describes how one partners behavior triggers the behavior of the other, and
vice versa. An obvious example is seen in one of the most commonly recognized presentations
of distress within partnerships, the blamewithdrawal interaction cycle (Christensen, 1987).
In this cycle, one individual tends to pursue their partner in a critical or attacking manner.
The other partner then responds by defending themselves and by avoiding interactions with
their partner. However, this withdrawing behavior encourages the pursuing partner to heighten
their criticism and complaining, which in turn increases the level of avoidance in the
withdrawing partner. Observing the process by which individuals engage each other in this
blamewithdrawal cycle allows the therapist to elucidate the circular, self-perpetuating nature
of the pattern in which the partners are caught.
Systems theory suggests that interpersonal processes often define outcomes (Segal &
Bavelas, 1983). Therefore, in systems approaches, the attention within the session is less on
the content of communications, and more on how the roles that partners play in their cycle
create and maintain their relational distress. Indeed, in order to shift distressed interaction
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cycles, Michunin and Fishman (1981) highlight the importance of accepting and
understanding partners engagement in their interaction roles, rather than challenging and
criticizing partners responses.
ATTACHMENT THEORY
Adult attachment theorists (Rholes & Simpson, 2004) hold that individuals develop consistent
strategies to regulate their affect in interpersonal relationships based on their past and current
relationship experiences. These habitual strategies of interpersonal responding include
expectations and biases about how to engage in close relationships (Hazan, Campa, & Gur-
Yaish, 2006). These strategies are typically referred to as attachment orientations (Hazan &
Shaver, 1987). If individuals feel loved, protected, and secure in their relationships then they
tend to develop secure attachment orientations. On the other hand, if they feel their partners
are consistently unresponsive in times of need, insecure attachment orientations are developed
(Brennan, Clark, & Shaver, 1998).
Attachment orientations have a significant impact on individuals internal cognitive-
affective processes, as well as on partners behavior in the relationship (Bouthillier, Julien,
Dube, Belanger, & Hamelin, 2002; Shaver & Mikulincer, 2002). Further, individuals
attachment orientations have been conceptualized as underlying affective processes which
determine how often the need for felt security arises and the strategies used to soothe this
need (Pietromonaco & Feldman Barrett, 2000). For example, secure individuals are more
likely to report stable relationships, confidence, and a desire to connect with others (Hazan
& Shaver, 1987). They are also more likely to support, validate, and openly express their
emotions to their partner when discussing a conflict (Bouthillier et al., 2002). Insecure
individuals either tend to report low levels of self-confidence and a fear of abandonment in
close relationships (Hazan & Shaver, 1987) or describe themselves as being independent and
deny their need for close relationships (Feeney, Noller, & Hanrahan, 1994). Similar research
has also demonstrated that insecurely attached individuals dismiss their attachment needs by
controlling their expression of emotions, such as anger and sadness, towards their romantic
partners (Feeney, 1999).
EMOTIONALLY FOCUSED COUPLE THERAPY
EFT and attachment theory
Drawing from the attachment theory literature (Rholes & Simpson, 2004), EFT therapists
understand relationship distress as resulting from the frustration of an individuals innate
need to maintain a sense of close emotional connection with others. According to Bowlby
(1988), when this connection to a loved one is threatened, individuals seek proximity to
their partners. When partners consistently fail to respond to this search for proximity,
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The Integration of Systems and Humanistic Approaches in EFT for Couples
individuals typically develop secondary, less effective, affect regulation strategies to cope with
their feelings of abandonment and isolation. The developed secondary strategies are either
hyperactivating strategies which include clinging, pursuing, or demanding behaviors, or
deactivating strategies which involve the numbing of emotions, the avoidance of emotional
involvement, and a denial of a need for intimacy (Shaver & Mikulincer, 2002).
In EFT, the similarity between these secondary attachment strategies and partners
behavior within the previously described blamewithdrawal interaction cycle does not go
unnoticed. Specifically, therapists empathically join individuals in their emotional reactions
in an effort to have them explore the unmet attachment needs and fears underlying their
critical or withdrawing behavior. Then partners are encouraged to express these needs to
their partner. It is the expression of these underlying needs and partners accompanying
supportive responses that have been demonstrated in research to foster the development of
new, more flexible, forms of engagement (Bradley & Furrow, 2004; Johnson & Greenberg,
1985). Partners are able to leave their positions in the negative interaction cycle and
authentically reach for and respond to their own and their partners attachment needs. In
EFT, healthy relationship functioning is conceptualized as being less about the containment
of conflict and increase in cooperation, and more about emotional responsiveness and secure
attachment between partners.
Humanistic theories and EFT
Therapeutic relationship
As in most humanistic approaches, the therapeutic relationship in EFT is characterized by
empathic attunement, acceptance, and genuineness (Johnson, 2004). In EFT, the therapists
attuned empathic stance places clients emotional experience within a normalized,
understandable, context. To achieve this level of empathic attunement, therapists focus on
viewing interactions through the lens of the clients perceptions and experiences. The therapists
empathic attunement also sets the stage for partners to take a more open and accepting
attitude towards their own and their partners emotional exploration.
EFT therapists focus on accepting and validating clients responses, seeing these responses
as stemming from a natural desire for connectedness and fear of emotional isolation, rather
than on judging clients as enmeshed or overdependent. This helps clients to feel understood
and respected, providing them with the space to disclose previously unexplored emotions.
Emotionally focused
In EFT, it is understood that partners behavior within their interaction cycle is due to
unexplored, unexpressed feelings of sadness, fear, shame, and anger, which have resulted
from unmet attachment needs. These emotions are gradually accessed, explored and fully
articulated between partners. It is through the ordering and reflection of emotional experiences
that new, more open and responsive forms of engagement are created between partners. The
therapist will pay careful attention to the moments where partners become stuck in negative
cycles, where they cannot reach for, or respond to, one another. They draw attention to the
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key behaviors in these moments, deepen primary emotions, and highlight the attachment
needs underlying these behaviors, while helping partners shape powerful interactions in the
session (Johnson, 2004).
Process versus content
The EFT therapist acts as a process consultant (Johnson, 2004) to partners, following
them through the unfolding of new emotions, unmet needs and new responses to their
partner. Therapists do not act as experts who are teaching partners the right way to be in
relationship rather, therapists work collaboratively with partners to help them unpack
and reorganize their emotional perceptions and reactions. When a couple engages in their
relationship cycle in session, EFT therapists use this opportunity to slow down, focus on, and
dissect partners affect-laden interactions. The therapists goal is to be completely tuned into
partners experience during the session, so they can identify the moments in which they start
to feel threatened and retreat from emotional engagement with their partner. Therapists are
encouraged to reflect these moments to the clients, to have them better understand their
behavior and to have them gather the courage to express their fears within the moment
rather than retreating to old interactional patterns.
Present and growth-oriented
EFT is focused on the present. Clients describe their experience of EFT as being relevant and
salient to their distress. This is reflected in the low dropout rates in EFT research studies and
clinical practice, even with high risk couples (Clothier et al., 2002). Further, the absence of
communication training in EFT holds true to the clients as growth-oriented model of
humanistic therapies. Therapists within EFT assume that clients possess the ability to
communicate effectively with their partners; however when partners are caught in their
absorbing and rigid interactional positions that are fuelled by fears of relational abandonment,
these skills are harder to utilize.
Systems theory and EFT
The major influence of systems theory on the formulation of EFT is the idea that individuals
behavior cannot be understood outside the context of the system in which they exist (Minuchin
& Fishman, 1981), and that each partners behavior is co-created by the others responses.
Critical behavior in one partner pulls out withdrawing behavior in the other. The presentation
of the circular pattern that has taken over a couples relationship helps partners to explore
how they maintain this cycle, and accept that finding who is to blame for the distress is
impossible.
Once the negative cycle is understood and the couple joins together, seeing the cycle as
the enemy that creates distress in their relationship, the EFT therapist gradually supports
partners to enact moments of an alternate positive cycle which has them sharing their
attachment vulnerabilities and needs. These interactions culminate in powerful bonding
events. The EFT therapist assumes that the best way to reorganize partners interactions is to
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The Integration of Systems and Humanistic Approaches in EFT for Couples
restructure the emotional responses and signals that shape and order the couples relationship
dance. EFT then incorporates a focus on intrapsychic experience into a systems perspective.
Interpersonal changes occur when individuals are encouraged to express attachment needs to
their partner, and when their partner responds in a supportive and accepting manner.
Experiential techniques
Therapists use experiential techniques such as empathic reflection, evocative responding,
heightening, and empathic conjectures to help clients to order and further explore their
emotional reactions (Elliott et al., 2004; Johnson, 2004).
Empathic reflections
In EFT, empathic reflections slow down the process of therapy, allowing partners time to
fully process their experience, providing them a chance to better understand and organize
their emotional reactions. Empathic reflections can be used to validate and order clients
emotional experiences. For example: When Jason says he needs more of you, all you can
hear is that you are not good enough, that you are a disappointment, that you are defeated
and damned, is that it Laura?
Evocative responses
Evocative questioning and responding involves asking clients open-ended questions about
emerging or tentative aspects of their emotional experience. Specifically, these techniques can
be used in EFT to encourage partners to explore their own emotional reactions to their
partners behavior. For example: Sarah, what is it like for you when you feel Julie starting to
withdraw? You open your mouth like you want to scream Pay attention to me. Is that it? As
in other client-centered, experiential approaches these empathic reflections and evocative
responses are offered in a tentative, rather than a declarative manner.
Heightening
Heightening is used by EFT therapists to highlight the deeper emotional reactions that
underlie partners negative interaction cycles, for example, the fear of abandonment that
triggers critical rage. It is also used to heighten engagement in session where couples take new
risks, engage fully with their deeper emotions and ask for their needs to be met in a way that
pulls the other towards them.
Rick: It is just easier to keep her out; it is lonely, but it feels better than being rejected.
Therapist: It feels safer to keep her on the other side of the door, far away so she cant hurt you,
but it also makes you feel so terribly alone, completely isolated from her.
Rick: Yes, it is very lonely.
Therapist: Can you say that to her; can you tell Sarah, I am so lonely and sad without you, but
I am so afraid of you not being there, that I want to keep you out, I want to keep that door
closed?
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Empathic conjectures
Empathic conjectures are inferences made by therapists about a clients unexpressed emotional
experience. Conjectures are offered within the context of a therapists empathic attunement
with a client, based on previous information held about the clients inner experiences and inter-
actional pattern with their partner. The goal of these inferences is increased exploration of emotional
experience. These statements typically reflect partners unexpressed attachment needs and fears,
such as a fear of being shut out and abandoned, linked together with a view of self as unlovable.
These experiential techniques highlight how EFT uses emotions as both the target and agent
of change. Change does not occur through insight, but rather through shifts in partners
attachment-related affect, such as panic at the threat of rejection, their emotional exploration,
and new disclosures in key interactions.
These disclosures provide individuals with a chance to articulate their own attachment
needs, as well as a chance to see their own partner, who they perceive as distant or critical, as
also needing intimacy and connection. It is these corrective emotional experiences that occur
between partners in therapy that lead to long-term changes in partners interaction patterns.
Systems techniques
Track, reflect and reframe
One of the main tasks in EFT is to help partners restructure and reshape their interactions
within the negative communication cycle to develop more flexible and positive patterns of
engagement. In order to highlight this cycle to partners, the EFT therapist observes, tracks
and reflects partners moves in their relationship dance. Early in therapy, therapists work
with each of the partners to better understand their role in maintaining the distressed
relationship cycle. These interaction patterns and sequences are reflected back to partners to
clarify the nature of their communication cycle, and to externalize the cycle as the common
enemy that prevents intimate engagement. These reflections also allow partners to observe
the circular nature of their relationship cycle.
While tracking and reflecting partners roles in their communication cycle, the EFT therapist
works to reframe partners behaviors in attachment terms. Specifically, the individuals behavior
is reframed within their need to establish closeness to their partner. For example, an individuals
demanding behavior may be reframed as their desire to connect with their partner, and their
partners withdrawing behavior may be reframed as fear of being unable to please the individual.
Enactments
The EFT therapist continues to guide partners in the restructuring and shaping of new interaction
patterns through another systems technique of enactments (Nichols & Schwartz, 2006). Through
enactments, partners literally enact poignant and specific moments in their cycle while reflecting
on the attachment-related aspects of their experience. Slowing down partners interactions,
while having them directly express the attachment-related affect underlying their behavior, can
highlight the thoughts and emotions that maintain the relational distress.
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The Integration of Systems and Humanistic Approaches in EFT for Couples
Therapists use experiential techniques such as evocative responding, reflections and
heightening, as well as systems techniques such as tracking, reflecting and enactments, to
assist partners in reaching and transforming their new emotional experiences into new forms
of engagement with their partner. Experiential techniques help individuals to articulate their
new emotional experiences and systems techniques guide individuals to express these emotions
to their partner. It is through the use of these different sets of techniques that withdrawing
individuals become more accessible and responsive to their partners while the critical and
pursuing individuals become less blaming in their cries for connection and can finally approach
their need for connection even from a position of vulnerability.
ATTACHMENT, SYSTEMS, AND EXPERIENTIAL THEORIES
It is clear that experiential, systems, and attachment approaches have different foci. Systems
theory focuses on the interpersonal nature of couple relationships, and how a therapist must
work within a pre-established system to establish therapeutic change. Experiential approaches
focus on internal affective processes and on how to work with these emotions within a
clienttherapist relationship. Attachment theory provides a conceptual framework for the
understanding of intimate relationships. Despite these differences, the following section
demonstrates how these approaches complement rather than conflict with one another in
the conceptualization and treatment of relational distress.
Although systems theory provides EFT therapists with a guide for understanding and
restructuring interaction cycles, it has been criticized for its impersonal, technical stance on
the nature of close relationships (Nichols, 1987). Experiential theory expands systems theory
by focusing on the inner emotional experiences that underlie couples interaction patterns. It
is the experiential techniques that foster exploration, acceptance, and expression of partners
attachment-related affect, such as the need for love and acceptance from another.
A potential danger in integrative approaches is that a coherent theoretical framework in
which to understand clients distress is lost. However, the similarities that exist between
attachment theory, humanistic, and systems approaches lend themselves well to thorough
theoretical conceptualizations. Experiential, client-centered, and systems approaches have
developed in contrast to the psychological Zeitgeist that clients functioning is based on
pre-determined psychogenetic factors. In contrast to this view, these approaches see
individuals as ever-changing, as their development is in constant flux. Both approaches are
focused more on process, or how individuals interact with one another, and less on the
content of their interactions. Systems theory and attachment theory view interactions in
intimate relationships as cyclic. Systems theory holds that partners engage in interaction
feedback loops that are informed both by individual factors and system factors (Nichols,
1987; Nichols & Schwartz, 2006). Attachment theory also stresses the intrapsychic and
interactional nature of couple interactions, specifically, how an individuals attachment
orientation organizes their inner experiences, and how these inner experiences create
interaction patterns, and vice versa.
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Both client-centered and systems approaches focus on partners potential for growth. Rogers
(1965) held that clients had sufficient capacity to manage the aspects of their lives in which they
were consciously aware (p. 25). Systems theory conceptualizes individuals distress as resulting
from constricting and absorbing negative affective states and interaction patterns (Nichols,
1987), rather than individuals inherent inability to effectively engage with others. Attachment
theorists also hold a non-pathologizing stance towards clients behavior. Bowlby (1969) believed
that all responses are reasonable and adaptive if they are understood in context.
EFT draws concepts from attachment theory to understand healthy couple functioning,
and uses experiential, client-centered approaches and systems theory for its theory of
intervention and change. This integrative framework provides a map for clinicians to
understand and treat both the intrapsychic and interpersonal nature of close relationships.
EMOTIONALLY FOCUSED COUPLE THERAPY
Stages and steps
The process of EFT has been outlined in a series of three stages and nine steps that can be
completed within 8 to 20 sessions (Johnson, 2004; Johnson et al., 1999). These stages and
steps lead to three major change events; cycle de-escalation, withdrawer reengagement, and
blamer softening. In order to better understand how the process of change occurs in EFT, the
following section briefly reviews the steps and stages of this approach.
In Stage One, therapists focus on (Step 1) creating an alliance with both partners, and
understanding conflictual issues within the negative relationship cycle; (Step 2) identifying
the couples interaction cycle; (Step 3) understanding the emotions underlying each partners
position in the cycle; and (Step 4) reframing conflicts in the relationship in terms of the
negative cycle, the underlying emotions and the attachment needs. These first four steps
accumulate into partners first major change event in EFT: cycle de-escalation. This change
event has occurred when partners are able to identify their position in the cycle, and when
they begin to be less rigid in their reactions to one another (for example: withdrawing partners
may risk more engagement; critical partners are less critical and angry).
In Stage Two, therapists (Step 5) focus on having partners understand and accept their
attachment-based emotions and needs, and how these emotions and needs play into the
relationship cycle; (Step 6) encourage partners to accept their partners emotional experiences
and new forms of responding within the relationship cycle; (Step 7) facilitate partners
expression of their unmet emotional needs to their partner, and encourage each individual to
accept and empathize with their partners expression of vulnerability. Within Stage Two, the
next two change events occur withdrawer reengagement and blamer softening. In
withdrawer reengagement the withdrawing/avoiding partner starts to express to his partner
his need for acceptance and care. In this stage, the withdrawing person also becomes more
accessible to their partners cries for attention (Johnson, 2004). In blamer softening, the
critical person begins to trust their partners newly responsive behavior, which encourages them
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to express their own needs for security in the relationship. Research into the process of change
in EFT has demonstrated that it is through these two change events that new bonding events
and interactional patterns are formed (Bradley & Furrow, 2004; Johnson & Greenberg, 1988).
In the last stage of EFT, therapists (Step 8) encourage and coach partners to use their
new ways of interacting to solve old relationship concerns to (Step 9) help partners strengthen
their new relational positions and attachment behaviors.
Although the preceding section describes the steps and stages of EFT in separate and
sequential fashion, in practice these stages and steps are interwoven and mutually determining.
Furthermore, although the blamewithdrawal interaction pattern is the main cycle described
through this paper, couples can present in therapy with variants of this cycle, such as blame
blame, or withdrawwithdraw. However, as therapists work with these couples to further
clarify their interaction pattern, partners previous positions of pursuewithdraw often reemerge
(Johnson, 2004).
Case example
The following section will briefly review the experiential and systems techniques used in
Stage One of EFT with a prototypical couple, Sally and Steve. During the first sessions, Sally
described feeling angry and frustrated at Steves apparent lack of emotional involvement in
the relationship. The therapist asked Sally to describe how her disagreements with Steve
typically start.
Sally: I tell Steve that he is never around, and that he doesnt even care about me, or our
relationship.
Therapist: Steve, can you tell me what happens after Sally approaches you with these concerns?
Steve: I tell her I dont even know what she is talking about! I am always driving the kids
around, taking out the garbage, fixing the car. I get so sick of hearing the same thing over
and over again. Eventually, I get frustrated, and I walk out of the house to work in the
garage.
Using the systems intervention of tracking and reflection, the therapist responds to the couple
to get a better sense of the negative interaction cycle developed between the partners.
Therapist: So, lets see if I understand. What usually happens is, Sally, you approach Steve
telling him that he is being distant, and Steve, you get frustrated and withdraw from Sally
because you dont understand what she means, since you feel like you are always available
to take care of things around the house. Is that how disagreements typically unfold between
you both?
Based on this intervention, further tracking and reflections, and the partners clarifying
responses, it is determined that the couple is displaying the classic pursuewithdraw interaction
cycle, where Sally has adopted the role of the pursuer, and Steve the withdrawer. The more
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Sally complains, the more Steve withdraws which then evokes further distress and complaining
from Sally. This cycle is framed as the problem which actively creates disconnection and
insecurity in the relationship.
The experiential techniques of evocative questioning and empathic reflections can then be
used to communicate an understanding of the partners emotional experiences within the
relationship and to explore the attachment needs underlying the partners interactional roles.
Therapist: Sally, what is like for you when Steve walks out of the house in frustration after one
of these discussions? (evocative question)
Sally: I feel angry that he just can walk out of the house as if my feelings dont even matter to
him.
Therapist: So when he walks out of the house, you feel angry, and as if your feelings are not even
important to him? (empathic reflection)
Sally: Yes, it is as if he doesnt even care about me anymore.
The therapist uses evocative questions to highlight particular responses or interaction patterns
within the couples interaction cycle.
Therapist: Is it that you feel as though he has left you all alone to deal with your pain, or is that
too much? (evocative question)
Sally: No, that is it, right on; I am left all alone to deal with my pain.
Therapist: Steve, what is happening to you right now as you hear Sally talk about how alone
she feels? (evocative question)
Steve: I dont know, I guess I feel bad that she feels so alone, but I also feel helpless about the
whole situation.
Therapist: It makes you upset that you cant do anything to help her? (evocative question/
responding)
Steve: Yes, exactly. I feel like I try my best to keep her happy, but it feels like nothing is ever good
enough for her, that is why I always retreat to the garage, at least there I can be useful.
Here the therapist uses heightening to help Steve engage more deeply with his emotional
experience.
Therapist: (softly and slowly) You feel like nothing you do is ever good enough for her, you feel
like you cant please her. (heightening) I would imagine it feels very upsetting for you, even
scary, to feel as though you can never please your wife? (evocative question)
Steve: Yes, it is upsetting. I hate feeling that way; that is why I leave, it is better than feeling as
though I am not good enough for her.
Therapist: It is better to be alone in the garage, feeling useful, than feeling helpless and not good
enough. Being in the garage alone is better than being inside worrying about whether or
not Sally will leave you and find someone else who can keep her happy, is that right Steve?
(heightening and empathic conjecture)
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Steve: Exactly, I am so afraid she will go and find someone else who is better with this relationship
stuff. I am so afraid of losing her.
At this point, the systems technique of reframing can be used to spotlight the attachment
fears underlying Steves withdrawing behavior. Further heightening can be used to highlight
Steves new level of emotional engagement to Sally.
Therapist: So when she comes to you, trying to tell you that she misses you, and that she feels as
though you are distant in the relationship, you dont understand and feel helpless that you
cant fix things to make her happy. Is that right? It is so hard for you to feel helpless, and you
start to worry that Sally will find someone else to keep her happy, so you withdraw into the
garage to try to cope with your fears of losing her, is that right Steve? (reframing cycle in
attachment terms)
At this point, the therapist could have the partners engage in a systems-based enactment in an
effort to expand their interactional positions.
Therapist: Steve, can you turn to Sally and tell her how afraid you are of losing her? How you
retreat in the garage because you feel helpless and that she is going to leave you for someone
better? (setting-up enactments)
In this case example, it is the combined use of experiential and systems techniques that lead
partners to deeper forms of emotional engagement and the beginnings of new interactional
patterns.
CONCLUSION
Attachment and systems theory, client-centered, and experiential perspectives and interventions
are needed in couple therapy to help partners shift their subjective emotional reality and
interactional patterns. These perspectives are used to shift partners attachment-based affect,
cognition, and behavior into more secure styles of relating. The integration of self and system
allows the EFT couple therapist to facilitate change to basic perceptions of self and other,
affective responding, and interactional cycles. In its unique approach to target changes at
both the individual and systems level, EFT demonstrates the successful integration of
attachment, systems, and experiential theory.
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