Strengths of Emotion Focused Therapy

• Emotion Foscused Therapy is considered one of the most well-substantiated therapies (even Baucom, the heavy-duty behaviorist agrees) with well designed studies backing it up as having isolated necessary and unique factors of change in therapy. Holly Blue is a therapist in Tacoma WA that has tremendous experience in using EFT to help her patients.
  • It’s been shown to be an effective couples counseling and family therapy for those facing sexual abuse histories, depression, grief, management of chronic illness, eating disorders, and PTSD. The only caution I’ll offer though is that it’s hard to tell from the studies I’ve read whether the bulk of the research has been based on married or cohabitating couples.
  • Meta-analysis of the best EFT studies (with randomized assignment and control groups) shows a Fail Safe n of 30-50, so the effect sizes obtained are pretty strong.
  • EFT is brief work (8-12 sessions) and leads to as good or better rates of improvement (less distress after therapy) and recovery (adjustment and satisfaction scores in the non-distressed range) as other therapies.
  • Several studies show slight increases in adjustment and functioning after therapy has ended. Cloutier et al. (2002) found 62% improved at termination, but 77% improved at the two year follow-up (an increase of 15%). She found 15% were recovered at termination, while 64% were recovered at the two year follow-up (an increase of 49%). The longer terms studies show about the same rate of improvement; some show over a 30% increase in recovery, but the follow-up for these studies is generally a few months.
  • In Cloutier’s study, in the EFT group 7% had divorced two years after the treatment, compared to 38% of the controls.
  • In fairness though, Johnson and Greenberg acknowledge that they have been involved in the majority of the research for EFT. Even though it’s been methodologically sound, other researchers need to get involved 1) to avoid allegiance bias, and 2) to make sure that conclusions from studies of EFT with expert therapists really do relate to how it’s done with real world therapists and cases.
  • Christensen reports that there have been nine solid studies of the effectiveness of EFT, prompting Baucom and colleagues (1998) and Gurman and Fraenkel (2002) to both rate EFT as one of the most research supported therapies for couples.
• Clients report that five things happened in therapy that made things better for them:
  • One partner expressed underlying feelings, and the other changing their perceptions of the partner after hearing this
  • Learning to understand underlying emotions
  • Learning to productively express emotional needs
  • Taking responsibility for emotional needs
  • Receiving validation for one’s needs
• Indicators for EFT are high negative emotional engagement, low sexual affection, older couples (especially for men over 35), and lower sense of emotional engagement or time together in the couple; interestingly, these are also predictors of failure in TBMT.
• EFT is culturally sensitive as universal emotions are examined, but placed in a personal cultural context. For example, shame is universal, but shame takes on an additional role in the Japanese culture. Anger is universal, but often takes different forms when men and women express it. Responsibility is universal, but what’s “a man’s responsibility” and “a woman’s responsibility” is determined but the culture’s views of marriage.
• EFT is humanistic based, and believes the couple can heal itself. Feminists appreciate that the therapy model:
  • Does not shows a patriarchal pathologization of connection and attachment (women’s ways of relating), and idealization of separation and individuation (men’s ways of relating).
  • Requires that the does not assume the position of power over the couple, but empowers the partners.
  • Views both partners as lacking in some skills; men need to expand their emotional repertoire and women need to feel powerful enough to express their needs.
  • Allows for the analysis of changing gender expectations that create a new kind of stress for couples to manage. Examples include dual careers, the freedom not to marry, and expectations of both parents to raise the children.
• EFT offers a theory of how to understand adult love, which has been lacking in the field of couples therapy:
  • EFT offers a way (based on attachment theory) to integrate disparate practices like gottman’s therapy, ibmt, and narrative approaches.
  • Counter-productive behaviors can also be seen as an insecurely attached partner’s efforts to provoke some kind of response, rather than as stable pathology.
  • Attachment theory also explains healthy development, as securely attached partners are open to reframes and different points of view, and able to tolerate ambiguity, to meta-communicate, to handle learning unflattering things about themselves, to feel and express regret for their past failures recognizing and meeting their partner’s needs, and to see their understanding of the world and others as working models.
  • Attachment theory also explains unhealthy development, as insecurely attached mourn lost attachments (think about someone who is legally married but has been emotionally divorced for a long time), engage in inconsistent attachment behaviors (think attack and defend, or pursue and distance patterns), suffer ongoing attachment injury (ongoing negative sentiment override), may experience attachment panic (maintain physical and emotional control over their partners), or maintain multiple attachments for fear of losing or being swallowed by one (who have affairs).
  • Attachment theory also makes building love maps and rituals of connection, halting the four horsemen and flooding, and engaging in behavioral exchanges all behaviors that can improve attachment. However, as johnson says, simple skill building and behavioral scripting is not sufficient for marital improvement; rather, the ability to “unlatch” from negative emotional and behavioral cycles is required.

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