1. EFT Gottman

2. EFT Approach
Leslie Greenberg and Sue Johnson

3. Emotion Focused Couples Therapy
“views marital distress as being maintained by the manner in which people organize and process their emotional experience, and the patterns of interaction they engage in, which take on a life of their own and become self-reinforcing”
(Johnson, 2004, p. 41).

4. Experiential Humanistic Viewpoint: Looking Within (intrapersonally)
A focus on corrective emotional experience
A focus on process
A focus on the necessity for a safe, collaborative therapeutic alliance
“The name [EFT] was therefore both an attempt to stress a crucial element that was missing from other interventions, and a statement about the value and significance of emotions” (Johnson, 2015, p. 98).
A focus on health
A focus on emotion
Change does not come from insight alone but from a new and improved emotional experience.
Primary
Secondary
Instrumental
(Johnson, 2004)
A focus on process: what was the client’s experience of the event.
A focus on the necessity for a safe, collaborative therapeutic alliance: important to look at the individual in the context of their relationships with others.
A focus on health: nonpathologizing views of the individual as individuals are naturally oriented toward growth.
A focus on emotion: emotions serve as communication.
Emotions play a significant role:
Primary: here and now, direct responses
Secondary: reactions to and attempts to cope with
Instrumental: used to manipulate the responses of others
“The name was therefore both an attempt to stress a crucial element that was missing from other interventions, and a statement about the value and significance of emotions” (Johnson, 2015, p. 98).
A focus on corrective emotional experience: Change does not come from insight alone but from a new and improved emotional experience. (Johnson, 2004)

5. Systems Theory Viewpoint: Looking Between (Interpersonally)
Look at the context as a whole
Process over content.
The elements of a system interact in a predictable way.
Counselor’s task is to help alter the negative and rigid interactional cycle.
Level-one change (first order) vs. level-two change (second order)
Help foster and allow the partners a sense of belonging as well as autonomy
Behavior is circular.
To do so, Minuchin and Fishman’s(1981) work is incorporated.
Look at the context as a whole.
Important to consider patterns and interaction cycles.
The elements of a system interact in a predictable way.
Level-one change (first order) vs. level-two change (second order)
Behavior is circular.
It is important to look at how each individual mutually influences, interacts with, and creates the cycle.
Process over content.
It is important to consider how things are said, not necessarily what is said.
Counselor’s task is to help alter the negative and rigid interactional cycle.
Help foster flexibility and allow the partners a sense of belonging as well as autonomy.
When there is a secure base, differences are enlivening, not threatening. (Johnson, 2004)
“The hallmark of all family systems therapies
is that they attempt to interrupt repetitive cycles of interaction
that include problematic or symptomatic behavior”
(Johnson, 2004, p. 47).

6. Attachment Theory Viewpoints:
Attachment is an innate motivating force.
Fear and uncertainty activate attachment needs.
The process of separation distress is predictable.
Secure dependence complements autonomy.
A finite number of insecure forms of engagement can be identified.
Attachment offers an essential safe haven.
Attachment involves working models of self and other.
Attachment offers a secure base.
Emotional Accessibility and responsiveness builds bonds.
Isolation and loss are inherently traumatizing (pg )
“The focus here is always on attachment concerns; on safety, trust, and contact; and on the obstacles to the above” (Johnson, 2004, pg. 12.) (All quotes below from this citation)
Johnson (2004) articulates the ten tenets of attachment theory (originally created by Bowlby and then applied to adults by Shaver) as:
Attachment is an innate motivating force.
“Dependency, which has been pathologized in our culture, is an innate part of being human rather than a childhood trait we outgrow” (p. 25).
“It reminds us that when the wind blows, it stings the eyes of all. The fear of isolation and loss is found in every human heart” (p. 25).
Secure dependence complements autonomy.
No such thing as complete independence of overdependency, only effective or ineffective dependency
“Secure dependence fosters autonomy and self-confidence. Secure dependence and autonomy are then two sides of the same coin, rather than dichotomies” (p. 25).
Attachment offers an essential safe haven.
“It is the natural antidote to the inevitable anxieties and vulnerabilities of life. For people of all ages, positive attachments create a safe haven that offers a buffer against the effects of stress and uncertainty” (p. 26).
Attachment offers a secure base.
“…from which individuals can explore their universe and most adaptively respond to their environment. […] encourages exploration […] promotes confidence necessary to risk, learn, and continually update models of self, others, and the world so that adjustment to new contexts is facilitated” (p. 26).
“The need for a secure emotional connection with a partner, a connection that offers a safe haven and secure base, is the central theme of couple distress and the process of effective relationship repair” (p. 26).
Emotional Accessibility and responsiveness builds bonds.
“It is emotional engagement that is crucial and the trust that this engagement will be there when needed […] in attachment terms, any response (even anger) is better than none. If there is no engagement, no emotional responsiveness, the message from the attachment figure reads as ‘Your signals do not matter, and there is no connection between us.’ […] Attachment relationships are where our strongest emotions arise and where they seem to have most impact” (p ).
Fear and uncertainty activate attachment needs.
“When the individual is threated […] attachment behaviors, such as proximity seeking are then activated. A sense of connection with a loved one is a primary inbuilt emotional regulation device” (p. 27).
The process of separation distress is predictable.
“If attachment behaviors fail to evoke comforting responsiveness and contact from attachment figures, a prototypical process of angry protest, clinging, depression, and despair occurs, culminating eventually in detachment. Depression is a natural response to loss of connection. […] distinguished between the anger of hope and the anger of despair, which becomes desperate and coercive. In secure relationships, protest at inaccessibility is recognized and accepted […] basic dramas of distress such as demand-withdraw, as variations on the theme of separation distress”” (p. 27).
A finite number of insecure forms of engagement can be identified.
“There are only so many ways of coping with a negative response to the question ‘Can I depend on you when I need you?’ Attachment responses seemed to be organized along two dimensions, anxiety and avoidance […] anxious preoccupied clinging and detached avoidance, fearful avoidant […] These insecure habitual forms of engagement can eb modified by new relationships, but they can also mold current relationships and so can become self-perpetuating […] reality regulating and reality creating, not just reality reflecting” (p. 31).
Attachment involves working models of self and other.
“We define ourselves in the context of our most intimate relationships. […] Securely attached people, who believe others will be responsive when needed, also tend to have working models of others as dependable and worthy of trust. These models of self and other, distilled out of a thousand interactions, become expectations and biases that are carried forward into new relationships. […] Working models are formed, elaborated, maintained, and most important for the couple and family therapist, changed through emotional communication” (p. 31).
Isolation and loss are inherently traumatizing (pg )
It is important to recognize that attachment is essentially a theory of trauma. […] As a theory of trauma, attachment theory specifically helps us understand the weight behind emotional hurts such as rejection or perceived abandonment by a loved one. […] The trauma perspective, with its focus on the power of helplessness and fear, helps the couple therapist tune in to the reality of distressed partners and deal with that reality constructively” (p. 32).
Additional Notes on Attachment:
Differences than children-adult attachment
It is more representational
More sexual
More reciprocal
“This anxiety and protest shows up in the couple therapist’s office as a ‘communication difficulty’ or lack of closeness” (p. 35).
The Components of Attachment Theory:
There are four key components of attachment:
Safe Haven: When the child feels threatened or afraid, he or she can return to the caregiver for comfort and soothing.
Secure Base: The caregiver provides a secure and dependable base for the child to explore the world.
Proximity Maintenance: The child strives to stay near the caregiver, thus keeping the child safe.
Separation Distress: When separated from the caregiver, the child will become upset and distressed.
“The need for a secure emotional connection with a partner, a connection that offers a safe haven and secure base, is the central theme of couple distress and the process of effective relationship repair” (Johnson, 2004, p. 26).

7. Role of the Counselor Collaborative partner Process consultant
Choreographer
  “In general, the EFT therapist turns and turns the experience and interaction to hold them up to the light. The therapist constantly frames emotions as the music of the couple’s dance and the dance as creating the music. The therapist turns both to the light so as to make the following shifts:
The role of the Counselor is seen as:
Collaborative partner
Process consultant
Choreographer (Johnson, 2004)
“In general, the EFT therapist turns and turns the experience and interaction to hold them up to the light. The therapist constantly frames emotions as the music of the couple’s dance and the dance as creating the music. The therapist turns both to the light so as to make the following shifts:
From vague to vivid
Obscure to tangible
General to specific
Then to now-immediate
Global to personal
Passive to active
Abstract to concrete” (p. 111).
From vague to vivid
Global to personal
Obscure to tangible
Passive to active
General to specific
Abstract to concrete”
Then to now-immediate
(Johnson, 2004, p. 111).

8. Emotion Focused Couples Therapy
Building the alliance.
Empathetic attunement
Acceptance
Genuineness
Continuous monitoring of the alliance
Joining the system
“The focus is, ‘What is it like to be this client in this context and what is the essence of this person’s experience?’” (Johnson, 2004, p. 60).
Empathetic Attunement
Connect on a personal level […] empathy reduces a client’s anxiety and allows for a more complete engagement in ongoing experience. […] The focus is, ‘What is it like to be this client in this context and what is the essence of this person’s experience?’” (Johnson, 2004, p. 60).
Acceptance
“A nonjudgmental stance is essential in the creation of a powerful alliance. […] The experiential approach to therapy has emphasized the need for the therapist to honor and prize clients as they are, and to be able to tolerate ambiguity and aspects of clients that even they themselves do not prize or accept” (Johnson, 2004, p. 61).
Genuineness
“how real and present he or she is able to be […] the therapist is accessible and responsive to the client in a way that the client can trust. The therapist can then admit mistakes, and allow clients to teach him or her about their experience. […] real human encounter, which the therapist takes on with integrity” (Johnson, 2004, p. 62).
Continuous Monitoring of the Alliance
“The therapist must take an active, deliberate role in monitoring, probing, and if necessary, restoring this alliance. If the therapist has any hint that there may be a rupture in the alliance, the mending of this alliance becomes an immediate priority” (Johnson, 2004, p. 62).
Joining the System (Johnson, 2004)
“The couple therapist engages not inly each partner but also the relationship system. The therapist sees and accepts the relationship as it is structured at the beginning of therapy. […] The most common of these patterns is demand/criticize/pursue followed by defend/distance/stonewall” (Johnson, 2004, p. 62).

9. When emotional risk may be present, utilize RISSC:
“When the therapist wishes clients to contact and engage with difficult emotions, the following RISSSC acronym is useful. In EFT training, we offer the scaffold below to increase awareness of nonverbals, especially when emotional risk (hence the acronym) is present:”
Repeat
Image
Simple
Slow
Soft
Client’s Words
(Johnson, 2004, p. 109).
As we move through as see how the skills and interventions are applied, it is important to note that one of the noticeable things about how Sue works, is almost in using a sing-song type of voice. This can also be seen as her utilizing “RISSSC”
When emotional risk may be present, utilize RISSC:
“When the therapist wishes clients to contact and engage with difficult emotions, the following RISSSC acronym is useful. In EFT training, we offer the scaffold below to increase awareness of nonverbals, especially when emotional risk (hence the acronym) is present:” (Johnson, 2004, p. 109).
Repeat: “It is important to repeat key words and phrases a number of times” (p. 109).
Image: “Images capture and hold emotion in a way that abstract words cannot ” (p. 109).
Simple: “It is essential to keep words and phrases simple and concise” (p. 109).
Slow: “Emotional experience unfolds in a session; a slow pace enables this process” (p. 109).
Soft: “A soft voice soothes and encourages deeper experiencing and risk taking” (p. 109).
Client’s Words: “The EFT therapist notes and adopts the client’s words and phrases in a collaborative and validating way” (Johnson, 2004, p. 109).

10. Skills and Interventions
Reflection:
“So, help me understand, Ellen, what you are saying to Peter is, I don’t see that you want me and miss me. What I see and hear is that I am never enough. I disappoint you. I am analyzed and found wanting. I feel put down and defeated, is that it?” (Johnson, 2004, p. 79)
Validation:
“You feel so alarmed that you can’t even focus. When we’re that afraid, we can’t even concentrate. Is that it?” (Johnson, 2015, p. 111)
Evocative Responding:
“When you say that, Sam, there is a catch in your voice, like it hurts you to even put it into words, that you may not be what Mary needs” (Johnson, 2004, p. 81)
“The therapist might summarize it from one person’s perspective” (Johnson, 2015, p. 110) [Gurman Chapter]
Skills and Interventions (all below quotes from Johnson, 2004):
Reflection
“is not simply echoing and paraphrasing the client’s words. It requires intense concentration from the therapist and an empathetic absorption in the client’s experience. […] If such reflection is skillfully done, the client feels seen and acknowledged. […] a good reflection is the first step in making a client’s experience vivid, tangible, concrete, specific, and active (versus something that happens to you).” (Johnson, 2004, p. 79).
Validation
“The therapist takes the stance that there is nothing wrong, irrational, deficient, shameful, or strange about their responses” (Johnson, 2004, p. 79).
Evocative Responding: Reflections and Questions
“These responses focus upon the tentative, unclear, or emerging aspects of a partner’s experience and encourage exploration and engagement. […] These reflections are offered tentatively, for the client to taste, try on, correct, reshape, or take on, not as an expert synthesis of his or her responses” (p. 80).

11. Skills and Interventions continued…
Heightening
“So can you say that again, Jim, I just can’t open up and let myself commit to her” (Johnson, 2004, p. 83)
Empathetic conjecture/interpretation:
“You don’t believe it’s possible that anyone could see this part of you and still accept you. Is that right? So you have no choice but to hide?” (Johnson, 2015, p. 111)
Self-Disclosure
“Hm, well I know I find it hard to really take in anything when I’m scared. Being scared tends to take up so much space” (Johnson, 2004, p. 89).
Page 111 in Gurman if you want to follow along!
Skills and Interventions continued…
Heightening
“highlight and intensify particular responses and interactions […] repeating a phrase, intensifying the experience by how something is said, using clear poignant images or metaphors, turning intrapsychic experience into interpersonal messages, maintain specific and sometimes relentless focus” (p. 83).
Empathetic conjecture/Interpretation
“Here the EFT therapist infers the client’s current state and experience from nonverbal, interactional, and contextual cues to help the client give color, shape, and form to his or her experience and take this experience one step further. […] these interpretations not be in any way imposed upon the client by the therapist so impede the client’s discovery of his or her own awareness” (p. 85).
Self-Disclosure
“not a large part of the EFT therapist’s repertoire […] limited and used for a specific purpose, such as to build an alliance and intensify validation of client’s responses, or as a form of joining with clients to help them identify elements of their own experience” (p. 90).

12. Stages of Change
“The term choreograph is used deliberately in that, like a choreographer, the therapist has an overview of the dance and gives step-by-step direction and structure, but the dance is also the dancers’ own creation and a vehicle for the expression of self”
(Johnson, 2004, 101).
Stage 1: The De-escalation of Negative Cycles of Interaction (Johnson, 2004):
[At the end of stage one there should be a de-escalation of the negative cycle of interaction.]
Step 1. Creating an alliance and delineating conflict issues in the core attachment struggle.
A description of the conflict issues are explored.
Step 2: Identifying the negative interactional cycle where these issues are expressed.
The negative interaction cycle that holds the couple in distress is identified.
Step 3: Accessing the unacknowledged emotions underlying interactional positions.
Assess and identify primary emotions for each individual.
Step 4: “Reframing the problem in terms of the negative cycle, underlying emotions, and attachment needs. The cycle is framed as the common enemy and the source of the partners’ emotional deprivation” (Johnson, 2004, pg. 18.)
Stage 2: Changing Interactional Positions:
[At the end of stage two the withdrawer should begin engaging. Blamer softening should also be occurring.]
Step 5: Promoting identification with disowned attachment emotions, needs, and aspects of self and integrating these into relationship interactions.
Supporting identification of unknown attachment needs and aspects of self and incorporating these into the relationship.
Step 6: Promoting acceptance of the partner’s experience and new interactional responses.
Encouraging the other partner to be responsive to their partner’s vulnerabilities and incorporate this into their view of the partner.
Step 7: Facilitating the expression of needs and wants and creating emotional engagement and boding events that redefine the attachment between partners.
The individual defines the relationship for her/himself rather than reacting to their partner.
Stage 3: Consolidation and Integration:
[At the end of stage three there should be consolidation and integration of what has been learned and experienced.]
Step 8: Facilitating the emergence of new solutions to old relationship problems.
Problem solving.
Step 9: Consolidating new positions and new cycles of attachment behaviors.
Supporting healthy and constructive patterns for the couple. Incorporating the changes made in counseling into everyday life.

13. EFT video
work/

14. References
Johnson, S. M. (2015) Emotionally Focused Couple Therapy. In Clinical Handbook of Couple Therapy (5th ed, pp ). New York, NY: The Guilford Press.
Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. (2nd ed.). Taylor & Francis Group, LLC.