Emotionally Focused Family Therapy

Restoring Connection and Promoting Resilience

James L. Furrow, Gail Palmer, Susan M. Johnson, George Faller, Lisa Palmer-Olsen

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781317364726
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Emotionally Focused Family Therapy is the definitive manual for applying the effectiveness of emotionally focused therapy (EFT) to the complexities of family life.

The book sets out a theoretical framework for mental health professionals to enhance their conceptualization of family dynamics, considering a broad range of presenting problems and family groups. The first section applies EFT theory and principles to the practice of family therapy. The second section explicates the process of EFT and examines the interventions associated with the EFT approach to families. In the final section, the authors provide case examples of emotionally focused family therapy (EFFT) practice, with chapters on traumatic loss, stepfamilies, externalizing disorders, and internalizing disorders.

Integrating up-to-date research with clinical transcripts and case examples throughout, Emotionally Focused Family Therapy is a must-read for therapists looking to promote the development and renewal of family relationships using the principles of EFT.

PART I

THEORY AND PRACTICE

ONE

Emotionally Focused Family Therapy

Emotion is at the heart of the relational life of a family. The building blocks of a family are emotional bonds and the confidence one has in the security of these bonds is a resource of resilience for an individual but also for the family as a whole. More than just sentiment, these emotions are a complex signaling system in the family that provides a rapid response system to threats to wellbeing and a resource for signaling meaning and importance. Emotions take precedence in defining what it means to belong, and what it means to be a family. As T. S. Eliot (1970) poignantly suggested, “Home is where one starts from.” Home is more than a geographical address, for when we describe being “at home” we are referring to an emotional state, and experience of belonging.

Home is a point of origin, an orientation, and a consistent longing extending from a basic human need for belonging. John Bowlby, the pioneer of attachment theory, recognized this intrinsic need as fundamental to human wellbeing throughout the whole of life. “All of us, from cradle to grave, are happiest when life is organized as a series of excursions, long or short, from the secure base provided by our attachment figure(s)” (Bowlby, 1988, p. 62). However, home and the emotional security it affords, is not guaranteed. Families are faced with navigating the changing demands of developmental transitions, daily life challenges, and unexpected crises each of which require families to find and sustain an emotional balance and coherence that govern what it means to promote both belonging and becoming.

Parents and children gain resilience through their confidence in the connections they share even though over time and development these relationships change. Facing these changes and life’s other challenges require families to continuously seek ways to invest and engage in the vital connections that affirm these basic family ties. Families who struggle to maintain these connections or lack opportunity and ability to retain these bonds fall into psychological and relationship distress.

Exploring Emotionally Focused Family Therapy

Emotionally focused family therapy (EFFT) engages the relationship resources families need most in times of disruption and distress. EFFT practices increase the emotional availability of family members and the effectiveness of these relational bonds (Johnson, 2004). Families gain greater “felt security” through corrective emotional experiences. These experiences enable parents and children with greater confidence in the availability of support and strength in the bonds of love that organize a family’s sense of connection and resiliency. The process of EFFT enables families to renew and rebuild these affective bonds that promote exploration, encourage growth, and sustain vital relationships across the lifespan.

Susan Johnson first proposed the application of emotionally focused therapy (EFT) to families in in her book The Practice of Emotionally Focused Therapy: Creating Connection (Johnson, 1996, 2004). Johnson highlighted the similarity in the EFT approach with couples and families suggesting that the key processes and goals of EFT were identical in principle. The EFT therapist targets the emotional experiences informing problematic interactional patterns that are typically focused on to problematic issues with a child (IP—Identified Person). These problems typically express underlying distress in the attachment dynamics of particular dyadic relationships (e.g., mother and son) but also impact the network of attachment relationships that undergird the wellbeing of the family as a whole (Sroufe & Fleeson, 1988). Rigid behavioral patterns result from negative absorbing emotional states that constrict a family’s ability to work together for their shared interest. These patterns are indicative of attachment-related distress typically present when family members lose a sense of safe connection with an attachment figure (Bowlby, 1973). Although most obvious in parent–child relationships these instances of distress are also found between sibling relationships.

EFFT treatment focuses on transforming these negative interaction cycles through engaging the emotional realities underlying these problematic patterns and their role in blocking a family’s ability to respond to a child or adolescent’s core attachment needs. Johnson (2004) summarized the key shifts that occur in working through a family pattern as including:

• Accessing the unacknowledged feelings underlying interactional positions.

• Reframing the problem in terms of underlying feelings, and interactional patterns.

• Promoting identification with disowned needs and aspects of self and integrating them into relationship interactions.

• Promoting the acceptance of others’ experience and new interactional responses.

• Facilitating the expression of needs and wants and creating emotional engagement. (p. 248)

The results of EFFT are seen most clearly in changes in the IP’s relationship to his or her family and in new responses that promote more open and flexible interactions characterized by the emotional responsiveness that is the core feature of secure bonding. The family is reorganized to respond to the attachment needs of the IP and heighten caregiving resources.

The EFT therapist takes the role of a process consultant to the family, whose goal is to provide parents and children a safe place to face the challenges and distress they experience in family relationships. Through empathic reflections and validation that the therapist provides an opportunity for families to engage new emotional experiences that transform negative patterns of interaction, typically focused on one family member. The therapist uses emotional experience through empathic reflection, evocative questions, and intensifying interventions to bring forward attachment-related emotions and translate these new experiences into new relationship encounters. As such, change in EFT is less likely to result from new insights and knowledge, or instruction in specific skills or parenting strategies. Instead, the EFT therapist provides a resource for families to together face and respond more effectively to emotional demands, unacknowledged experiences, and unmet attachment needs and find new abilities to solve problems together.

Emotionally Focused Therapy—Overview of Principles and Practices

The practice of EFFT is based upon the principles and interventions used in emotionally focused couple therapy—EFCT. EFCT is supported by three decades of research spanning efficacy trials and process research studies. Reviews of these studies include a meta-analysis (Johnson, Hunsley, Greenberg, & Schindler, 1999) that demonstrated a 70–73 percent recovery rate from relationship distress based on four randomized clinical trials. Other clinical trials have shown EFT to be effective in treating depression, chronic illness, and post-traumatic stress (Weibe & Johnson, 2016). A series of studies demonstrate EFT’s effectiveness in resolving attachment injuries including couples facing betrayals of trust and affairs (Halchuk, Makinen, & Johnson, 2010; Makinen & Johnson, 2006; Zuccarini, Johnson, Dagleish, & Makinen, 2013). These researchers demonstrated EFT’s successful impact enabling couples to resolve injuries and forgive their partner’s offenses. Couples who repaired these injuries demonstrated continued improvement in their relationship satisfaction three years post treatment. Recent findings highlight the ongoing positive effects of EFT on relationship satisfaction following treatment and support for reduction in markers of insecure attachment and gains in secure base behaviors (Wiebe, Johnson, Lafontaine, Burgess Moser, Dalgleish, & Tascam, 2016). EFT process research findings highlight the importance of the depth of emotional experience and the shaping of successful enactments between partners focused on expressing attachment-related emotions and needs (Greenman & Johnson, 2013). Results from these studies highlight the importance of sharing vulnerability in a way that leads to new levels of emotional engagement and evokes empathy and compassion (Burgess Moser, Dalgleish, Johnson, Weibe, & Tasca, 2017; Johnson & Greenberg, 1988; Weibe et al., 2016).

EFT Principles

Five foundational EFT principles underscore the pivotal role of attachment theory in this systemic and experiential approach to couple distress and its treatment. Johnson (2004) used these principles to summarize the integral relationship of emotion to attachment and how the EFT therapist draws on both to transform relational bonds. The following examples illustrates each principle with a couple relationship.

Affectional Bond

First, a couple’s intimate relationship is understood as an emotional bond, where each partner has attachment significance. Partners in close relationships provide a level of comfort and security that each rely on in ways that mirror the security a child finds in an attachment relationship with a parent (Hazan & Shaver, 1987). These reciprocal bonds are mutual in their influence in couple therapy where each partner has a shared role in caregiving. However, parent–child bonds are more hierarchical. As parents are the architects of security in the family, they hold a unique role and responsibility for providing care that is not dependent on their child. More than effective communication practice or a positive balance trust and positive experiences, EFT focuses on the many ways romantic partners rely on each other for care and comfort, particularly in a time of need (Johnson, 1986).

Sierra and Steve sought therapy after Sierra’s recent miscarriage. Both describe the distance in their relationship as a “deafening silence” that has grown over the years. Sierra found herself frozen in grief over the loss of the pregnancy, and Steve’s attempts to reach her in these moments left him feeling alone and ineffective. In her words, “you haven’t been there for me for years, why would I now suddenly believe that you really care about me or what this is like for me.”

Emotional Precedence

Guided by attachment theory, the EFT therapist recognizes the underlying logic of a couple’s distress and the ways that their emotions take control precedence in moments of insecurity. Emotions and their expression organize partners’ actions and interactions when attachment needs are at stake. Whether partners react with surface emotions defensively responding to a perceived threat or in moments of safety express deeper vulnerable sentiment, emotions are the signaling system for attachment. The EFT therapist provides a safe relational space fit to explore the emotions that organize the actions and experience of self, other, and their relationship. In EFT, emotion is both the target and the agent of change. The therapist focuses on each partner’s emotion as a resource for transforming rigid insecure patterns through active engagement, processing, and sharing of emotion and the attachment messages these emotions hold.

Sierra’s cold distance toward Steve defined the protective distance she sought from the pain and loss she knew in her relationship. Her words were sharp with criticism, highlighting how Steve had failed to see what she needed, and appeared indifferent when she confronted him directly. Her critical stance was in its own way a protest to his absence. The intensity and negativity were signals of her underlying pain and fear that he was in fact uncaring. Steve’s caution in response, made his attempts to console weak and dispassionate. His fear of losing Sierra fed his tentative efforts to work around her anger in hopes of finding a safer approach. Underlying Steve’s caution was his care and his own fear of losing Sierra, taking her anger as a sign of rejection.

Rigid Patterns

The third EFT principle highlights the rigid and patterned behavior found in distressed relationships. Negative emotional states become absorbing and couples sink into predictable patterns that govern and deepen the insecurity in their relationships. Couple distress is mutually determined and reinforced by repeated enactments of reactive response fueled by efforts to shift the relationship toward care and comfort without directly engaging the underlying attachment needs and emotions running behind the scenes. Couples’ attempts to cope with this distress only reinforce feelings of fear and futility that intensify the negative state of their relationship.

Steve’s caution and Sierra’s defensiveness frame the typical positions and actions taken when important or sensitive topics are discussed. The predictable sequence of confrontation and caution has played out over the history of their relationship but its impact on their ability now to connect has left both feeling defeated. Although each can find fault with the other’s actions and reactions, the EFT therapist connects each partner’s actions and emotions in the interactional sequence driving their distress. This helps partners shift from seeing their partner as the problem to identifying this rigid pattern as the problem.

Attachment Needs

A fourth principle highlights how viewing a couple’s reactive pattern through the lens of attachment theory enables the therapist to connect these emotions to each partner’s underlying attachment needs. The rigid positions that take hold reflect the primary importance of each partner’s need which become distorted through the negativity taking hold in their relationship. The EFT therapist uses these deeper emotions and needs to shift partners from their rigid positions defined by their pattern of distress. As partners are able to engage these emotions, they are better able to see their partner and themselves through a new lens of hope and security.

Steve kept his distance from Sierra’s painful criticism. His actions over the years had become a reflex. He withdrew without thinking most of the time and he also lost awareness of his own feelings. Steve was a problem solver and often sought to fix a problem before he had to face Sierra’s disappointment and anger. Ultimately, Steve’s withdrawal was fed by his fear of failure and Sierra’s likely rejection of him. He never shared these fears and found it difficult to allow himself to be vulnerable enough to feel them with the therapist’s help. Similarly, Sierra confronted a similar risk letting Steve into her pain and the hurt she endured from someone she loved and still needed. She feared letting go of the protection of her critical anger but also longed for his care and comfort.

Transforming Experience

The final principle highlights the work of emotion to transform a couple’s rigid pattern. The blocks to attachment security are worked through accessing, processing, and engaging each partner’s underlying emotions and attachment needs. The EFT therapist choreographs and conducts a corrective emotional experience though eliciting and engaging attachment-related emotions and needs in a new context of emotional acceptance, availability, and confidence in the love each partner seeks.

For Steve and Sierra these shifts required Steve to acknowledge his fear of losing Sierra and risk his need for reassurance while also acknowledging his own failings and disengagement. The therapist helps Steve assemble his emotional experience so that he can share vulnerably his deeper feelings and needs with congruence and coherence. Sierra a similar risk in facing her fears of rejections and need for Steve’s comfort. In similar fashion, the therapist provides a secure base to explore her own needs and risk reaching for Steve for comfort. Through the therapist’s active and attuned alliance and deliberate direction the couple finds a resource to explore and engage their affectional bond from a new experience of felt security.

EFT Practices

Emotionally focused therapy as a brief systemic approach incorporates an interpersonal focus on negative interaction patterns with an intrapsychic focus on individuals’ attachment-related experience. Theoretically, EFT draws on a synthesis of humanistic/experiential and systemic assumptions (e.g., Minuchin & Fishman, 1981; Rogers, 1951) each evident in EFT’s dynamic use of emotion to engage partners in new more adaptive relational patterns. From inception, EFT assumed an essential focus on strengthening a couple’s emotional ties and that of family members through increased accessibility and responsiveness. EFT treatment follows a nine-step change process which unfolds over three stages of change: Stabilization and De-escalation; Restructuring Interactional Positions; and Consolidation.

Stabilization and De-escalation

In the initial stage the therapist is focused on stabilizing and de-e...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the Authors
• Introduction
• PART I: Theory and Practice
• PART II: Following the Stages and Steps
• PART III: Exploring Clinical Realities
• Epilogue
• Appendix—Annotated Stages and Steps
• Index