Emotions are one of the most complex biological processes of humankind.
The word dates back to 1579 from the French word emouvoir, which means “to stir up” (Dixon, 2003).
Emotions are experienced physically, influenced by thoughts, and guide our actions and behavior. They are powerful. They can be debilitating but also beautiful, allowing us to connect to others in a way that heals, gives life, and produces joy.
Since emotions are so impactful, Emotionally Focused Therapy can be a beneficial tool, especially for relationships. We look at what Emotionally Focused Therapy is and include techniques and worksheets for you to use.
Before you continue, we thought you might like to download our three Emotional Intelligence Exercises for free. These science-based exercises will not only enhance your ability to understand and work with your emotions but will also give you the tools to foster the emotional intelligence of your clients, students, or employees.
This Article Contains:
- What Is EFT and Is It Effective?
- Steps in EFT
- 5 Foolproof EFT Techniques
- 4 Useful Worksheets for Your Sessions
- A List of EFT Interventions
- Top 3 Activities and Interventions
- Couples and Family Counseling
- Strengths and Critiques of EFT
- Top 4 Books and Workbooks
- A Note on Training in EFT
- PositivePsychology.com Tools
- A Take-Home Message
What Is EFT and Is It Effective?
Emotionally Focused Therapy and Emotion-Focused Therapy (EFT) are a set of approaches to therapy for individuals, couples, and families. They incorporate elements of experiential therapy such as gestalt and person-centered approaches, systemic therapy, and attachment theory (Corey, 2013).
These therapies are based on the idea that human emotions are connected to human needs, and working through them can help individuals change distressful emotional states and improve interpersonal relationships (Johnson & Greenberg, 1992). EFT is typically a short-term treatment of 8–20 sessions (Johnson, 2008).
Emotionally Focused Therapy was developed in the 1980s by Canadian psychologist Sue Johnson, who focused on emotions because they are typically left out of interventions, especially those focusing on relationships (Johnson, 2008).
This type of therapy is designed for couples working to develop an understanding of their partner’s and their own emotions. While Emotionally Focused Therapy addresses the needs of couples, Emotion-Focused Therapy was developed by Leslie Greenberg and Robert Elliott to address individual needs (Yalom, 2011).
Johnson and Greenberg (1992) developed the EFT approach by reviewing videos of couple therapy sessions and performing task analysis to identify what elements led to positive change. They took an experiential–systemic approach by viewing problems as a cyclical reinforcement of patterns and interactions between partners.
Emotions are seen both as a within-individual phenomena and as part of an entire system created by the interactions between partners (Johnson, 1998).
EFT is considered to be an empirically supported treatment for depression, interpersonal problems, avoidant personality disorder, and trauma according to the American Psychological Association (2020).
Practitioners claim that both individuals and couples demonstrate significant improvement after therapy, suggesting that it is an effective way to lead individuals into safe and secure bonds with lasting results (Johnson & Brubacher, 2016).
A meta-analysis of EFT studies found that Emotionally Focused Therapy with couples had a higher success rate than any other couple intervention at the time and that it reduces the brain’s response to threat from a romantic partner (Johnson, Hunsley, Greenberg, & Schindler, 1999).
Steps in EFT
The purpose of EFT is to help people address attachment-related insecurities and learn how to interact with other people.
There are nine steps within three stages of EFT.
Stage 1: Cycle de-escalation
This stage helps the couple identify and understand how their negative interactions create a cycle of distress.
In Step 1, the key issues of concern are identified.
Step 2 reveals the negative patterns of interaction that arise when these key issues arise. This is where the therapist looks for the actual problem that causes detachment or stress between the couple.
Step 3 is the recognition of unacknowledged fears and negative emotions related to attachment underlying negative interaction patterns. Partners will explore each other’s feelings and how they are related to the detrimental interaction cycle.
In Step 4, the therapist reframes key issues, negative patterns, and underlying emotions and fears as they relate to each individual’s attachment needs.
Stage 2: Changing interaction patterns
This is the stage of identifying the underlying attachment styles that are leading to negative emotions. In this stage, individuals voice their wants, needs, and deep emotions (Step 5), and then partners are taught ways to express acceptance and compassion for the other person’s needs and emotions (Step 6).
In Step 7, partners continue to learn to express needs and emotions while also learning ways to discuss the issues that normally cause conflict.
Stage 3: Consolidation and integration
In the final steps (8 and 9), the therapist coaches the couple to utilize new communication styles to discuss old problems and create new solutions. The couple will practice the skills in therapy outside of the sessions and develop a plan to make new interaction patterns a consistent part of their life.
5 Foolproof EFT Techniques
In Emotion-Focused Therapy, a variety of therapeutic techniques are used to achieve specific goals based on where the individual or couple is. These techniques are also known as “therapeutic tasks,” which were discovered through a task analysis of psychotherapy session transcripts.
This analysis attempted to describe the process of a client’s cognitive and emotional change to provide therapists with a more reliable condition for therapy (Rice & Greenberg, 1984). These techniques or tasks are classified into five groups: empathy-based, relational, experiencing, reprocessing, and action (Elliott, 2012).
Empathy-based techniques use empathic exploration for problem-relevant experiences and empathic affirmation to move painful emotions to a place of self-affirmation. For example, identifying the feeling of vulnerability (a painful emotion related to self) moves to self-affirmation where the client feels understood, hopeful, and strong.
Relational techniques are those concerned with establishing the therapeutic alliance such as creating a productive working environment, exploring goals, and investing in therapy for greater self-understanding.
These techniques are typically used in the beginning stages of therapy but also extend to stages where the clients may experience difficulty or withdrawal. In these cases, the alliance needs to be repaired, and an opportunity for greater self-understanding and a deeper bond can be found.
Experiencing techniques include clearing space, focusing on experiences, and teaching the client to feel and express the emotion. Things like systematic evocative unfolding and chair work are used to help the clients learn to successfully express appropriate emotions.
Reprocessing tasks are both situational and perceptual. They include dealing with difficult or traumatic experiences through trauma retelling. Additionally, tasks may include creating and working through problematic reaction points, which are known as “meaning protests” (when a life event violates a cherished belief, such as having a baby out of wedlock, which would violate many religious belief systems).
Action tasks are just that: “action” oriented. They involve chair work such as two-chair dialogue and enactment to address self-evaluative split (self-criticism, “tornness”) and self-interruption split (blocked feelings and resignation).
Empty chair work helps with unfinished business like resentment and unforgiveness. And finally, compassionate self-soothing helps with stuck, deregulated anguish.
4 Useful Worksheets for Your Sessions
The Recognizing How We Think, Feel, and Behave worksheet allows clients to identify patterns in their reactions and behavior.
By recognizing opportunities to change unhelpful
beliefs, thoughts, and automatic psychological processes that impact emotions, there is a basis for growth, self-reflection, and change.
This Conflict Resolution Checklist is great for both couples and individuals. It can serve as a reminder between therapy sessions or after learning about de-escalation. Using an objective checklist can point out sticking points that are causing distress.
This Emotion Regulation Worksheet helps individuals identify their typical responses to situations and events and contrasts it with more appropriate or healthier response possibilities.
This worksheet helps clients understand how expressing their emotions affects others. By increasing awareness of the ‘footprint’ of expressing emotions, clients can learn new and appropriate responses to the emotions that they experience.
A List of EFT Interventions
In Emotionally Focused Therapy, there are specific interventions for the three stages of the process (Diener, Hilsenroth, & Weinburger, 2007).
- The first intervention is designed to create awareness through accessing emotional experiences and linking them to patterns. The intervention uses evocative questions that allow the client to respond, leading to an emerging experience. The therapist will also validate the client’s realities and emotional responses.
- A second intervention is de-escalating using “parts language” and an attachment perspective. This looks at conflicting attachment strategies such as anxiety and avoidance.
During de-escalation, the therapist will direct the enactment and dialogue between clients, explore the underlying needs/wants, and support a new experience of safety and empowerment. The goal is to integrate previous emotions, soften critical parts, and consolidate that integration or bond.
- The final intervention involves consolidation of the newly developed models of self and/or other. This allows internal and external positive interaction cycles. Positive narratives are contrasted with old ways of coping, thinking, and feeling. The goal is increased security (Diener et al., 2007).
Top 3 Activities and Interventions
The Emotional Mental Models exercise is a perfect activity for Emotionally Focused Therapy that can help clients develop emotional awareness through visualization.
It is designed to help individuals think about how they could use these emotional insights in the future.
This worksheet is a DBT exercise that you can use to help clients deal with intense negative emotions and experiences. It is a useful exercise to help them acknowledge that they cannot control every aspect of what they experience. In this way, they can start to move beyond the distress they are experiencing without trying to change or control situations.
In this exercise, clients can begin to identify the extent to which they struggle or accept their negative feelings and thoughts. By completing this exercise, they can start to think of helpful ways that they might cultivate a more well-balanced relationship with their emotions.
Couples and Family Counseling
The conflicting patterns of interaction between couples and family members is referred to as a “dance” in Johnson’s (1998) literature. EFT for couples includes the same nine-step model described previously. Johnson (2008) discusses leading the couple or family through these steps in a spiral fashion. One step leads to another.
The speed of moving through the steps and stages depends on the level of distress in the relationship or family (Johnson, 2008).
While working with couples and families, problems can often be traced to identify core concerns such as issues with self-worth or needs for validation. When this is the case, the individual and family can be best treated using therapeutic methods directed toward the self rather than interactions between family members (Goldman & Greenberg, 2015).
For example, if an individual’s core emotion is one of shame, soothing from a partner or family member may be helpful but will not ultimately solve the problem. In order for structural emotional change to take place, the individual must alter their own view of themself for improvement in the family dynamic to occur.
Strengths and Critiques of EFT
Emotionally Focused Therapy is collaborative in that it uses a combination of theoretical (attachment) and applicable (person-centered, meaning-making) approaches.
The strategies for change and specifically timed interventions are clearly outlined in the psychotherapy process with the use of nine steps within three stages.
Additionally, EFT has been validated by 30 years of research, which includes the change process and predictors of success. EFT is effective for helping with marital distress and has also successfully been applied to various problems among individuals and populations (Pascual-Leone, Greenberg, & Pascual-Leone, 2009).
One of the main criticisms of EFT is regarding its foundational premise that emotional regulation is a key aspect of therapeutic change and that it is critical to psychotherapeutic success. Ecker (2015) disagrees with this claim, arguing that the key ingredient to therapeutic change is the perceived mismatch between the expected and experienced patterns of behavior.
Problems occur when there is a perception that the world functions differently than one’s learned model (Ecker, 2015). The discrepancy is not based on emotion, but on learning and past experience.
Additionally, claims have been made that EFT would be strengthened by including additional factors that improve treatment for more serious mental health problems (Lane, Ryan, Nadel, & Greenberg, 2015). EFT does not account for the diversity that the concept of “psychopathology” encompasses.
It is also not designed to be used with violent couples, highly dysfunctional individuals, or those who have already decided to separate/divorce.
Top 4 Books and Workbooks
1. Hold Me Tight – Dr. Sue Johnson
Hold Me Tight presents Emotion-Focused Therapy in a nonclinical way that the general public can access.
It teaches couples how to save or enrich a relationship through safe connection and attachment bonds.
Find the book on Amazon.
2. Working with Emotions in Psychotherapy (The Practicing Professional) – Leslie S. Greenberg and Sandra C. Paivio
The book Working with Emotions in Psychotherapy is designed for professionals in the field of psychology.
It uses case studies and examples to help clinicians work with processes and techniques for specific emotions.
Find the book on Amazon.
3. Narrative Processes in Emotion-Focused Therapy for Trauma – Sandra C. Paivio and Lynne Angus
This richly illustrated book presents a new approach to treating trauma survivors.
Emotion-Focused Therapy for trauma is an evidenced-based approach that uses both narration and emotion.
Find the book on Amazon.
4. Emotion-Focused Workbook: A Guide to Compassionate Self-Reflection – Bridget Quebodeaux
This workbook was designed by therapist Bridget Quebodeaux to provide her clients with resources between sessions.
The emotion-focused videos, exercises, and worksheets help therapy clients continue their work between sessions.
Find the book on Amazon.
A Note on Training in EFT
There are numerous trainings designed to teach the steps, stages, and processes involved in Emotionally Focused Therapy.
The International Centre for Excellence in Emotion-Focused Therapy (ICEEFT) offers both training and certification in the evidence-based approach to helping individuals and couples. The certification includes core skills training and individual supervision for licensed practitioners.
According to the ICEEFT, the purpose of certification is to promote the excellence and maintenance of high standards to the EFT approach. More information and training can be found on their website.
The Emotional Intelligence Masterclass© is a perfect resource to tap into aspects of EFT with individuals, couples, and families.
The masterclass can help provide a solid foundation and framework for understanding and explaining emotions in Module 1. Modules 2 and 3 expand on emotional intelligence and emotional awareness, which are critical for working through the steps of EFT.
When clients can identify the beliefs they have about emotions, it can help them relate to the emotion–need connection and finally provide healthy ways to express these emotions in order to fulfill their needs.
17 Emotional Intelligence Exercises – If you’re looking for more science-based ways to help others develop emotional intelligence, this collection contains 17 validated EI tools for practitioners. Use them to help others understand and use their emotions to their advantage.
A Take-Home Message
The emotionally focused therapist is characterized as active, engaged, and flexible and provides a “hands on” clinical experience (Greenberg, 2004). They are often seen as a “choreographer” and collaborator who works with an individual or couple to discover amazing possibilities of change and growth.
Emotions are powerful, directly impacting physical, psychological, and social wellbeing. Based on the premise of EFT, emotions provide insight to personal identity, choice, and decision making. EFT is an approach that can improve emotional awareness and regulation to avoid distress and gain access to the important information emotions can provide.
We hope you enjoyed reading this article. Don’t forget to download our three Emotional Intelligence Exercises for free.
- American Psychological Association (2020). Psychological treatments. Division 12 of the American Psychological Association. Retrieved December 2020 from https://div12.org/treatments/
- Corey, G. (2013). The art of integrative counseling (3rd ed.). Cengage Learning.
- Diener, M. J., Hilsenroth, M. J., & Weinburger, J. (2007). Therapists affect focus and patient outcomes in psychodynamic psychotherapy: A meta-analysis. American Journal of Psychiatry, 164, 936–941.
- Dixon, T. (2003). From passions to emotions: The creation of secular psychological category. Cambridge Press.
- Ecker, B. (2015). Memory reconsolidation understood and misunderstood. International Journal of Neuropsychotherapy, 3(1), 2–46.
- Elliott, R. (2012). Emotion-focused therapy. In P. Sanders (Ed.). The tribes of the person-centered nation. An introduction to the schools of therapy related to the person-centered approach (2nd ed.). Ross Wye: PccS Books.
- Goldman, R., & Greenberg, L. (2015). Case formulation in emotion-focused therapy: Co-creating clinical maps for change. American Psychological Association.
- Greenberg, L. (2004). Emotion-focused therapy. Clinical Psychology and Psychotherapy, 11, 3–16.
- Greenberg, L. S., & Paivio, S. C. (2003). Working with emotions in psychotherapy (The practicing professional). Guilford Press.
- Johnson, S. (1998). Listening to the music: Emotion as a natural part of systems theory. Journal of Systemic Therapies, 17(2), 1–17.
- Johnson, S. (2008). Emotionally focused couple therapy. In A. S. Gurman (Ed.), Clinical handbook of couple therapy (pp. 107–137). Guilford Press.
- Johnson, S. (2014). Hold me tight (audiobook). Brilliance Audio.
- Johnson, S., & Brubacher, L. (2016). Emotionally focused couple therapy: Empiricism and art. In T. Sexton & J. Lebow (Eds.). Handbook of family therapy (2nd ed.) (pp. 326–348). Routledge Press.
- Johnson, S., & Greenberg, L. (1992). Emotionally focused therapy: Restructuring attachment. In S. Budman, M. Hoyt, & S. Friedman (Eds.). The first session in brief therapy (pp. 204–224). Guilford Press.
- Johnson, S., Hunsley, J., Greenberg, L., & Schindler, D. (1999). Emotionally focused couples therapy: Status and challenges. Clinical Psychology: Science and Practice, 6(1), 67–79.
- Lane, T., Ryan, L., Nadel, L., & Greenberg, L. (2015). Memory reconsolidation, emotional arousal and the process of change in psychotherapy: New insights from brain science. Behavioral and Brain Sciences, 38, 1–80.
- Paivio, S. C., & Angus, L. (2017). Narrative processes in emotion-focused therapy for trauma (Kindle ed.). American Psychological Association.
- Pascual-Leone, A., Greenberg, L., & Pascual-Leone, J. (2009). Developments in task analysis: New methods to study change. Psychotherapy Research, 21(3), 331–347.
- Quebodeaux, B. (2015). Emotion-focused workbook: A guide to compassionate self-reflection. Author.
- Rice, L. N., & Greenberg, L. S. (Eds.) (1984). Patterns of change: Intensive analysis of psychotherapy process. Guilford Press.
- Yalom, V. (2011). Sue Johnson on emotionally focused therapy. Psychotherapy.net. Retrieved November 28, 2020 from https://www.psychotherapy.net/interview/sue-johnson-interview