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Made to Measure: Adapting Emotionally Focused Couple Therapy to Partners' Attachment Styles

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Made to Measure: Adapting Emotionally Focused Couple Therapy to Partners' Attachment Styles Made to Measure: Adapting Emotionally Focused Couple Therapy to Partners' Attachment Styles Susan M. Johnson and Valerie E. Whiffen University of Ottawa This article summarizes the theory, practice, and empir- ment (Bartholomew & Perlman, 1994); EFT has been ical findings on emotionally focused couple therapy empirically validated, and a recent meta-analysis found a (Em, now one of the best documented and validated considerable effect size for marital adjustment after 10-12 approaches to repairing close relationships. EFT is sessions (Johnson, Hunsley, Greenberg, & Schlinder, based on an attachment perspective of adult intimacy. 1999); there is research on the change process and pre- The article then considers how individual differences in dictors of success in this approach; finally, EFT has been applied to different kinds of problems and populations, attachment style have an impact on affect regulation, such as the parents of chronically ill children (Walker, information processing, and communication in close re- Johnson, Manion, & Clothier, 1996), depressed women lationships and how the practice of EFT is influenced (Dessaulles, 1991; Whiffen &Johnson, 1998), and couples by these differences. dealing with posttraumatic stress disorder (Johnson & Key words: couple therapy, emotionally focused Williams-Keeler, 1998). This approach is also used with couple therapy, individual dhrences in couple ther- families (Johnson, 1996; Johnson, Maddeaux, & Blouin, apy, adult attachment. [Clin Psycho1 Sci Prac 6:366- 1998). 381, 19991 The psychotherapy literature emphasizes that once general effectiveness has been established, the next chal- Emotionally focused therapy for couples (EFT) is now lenge is to consider individual differences and specify how one of the best delineated and empirically validated inter- a treatment approach can be tailored to individual cou- ventions in the field of couple therapy (Baucom, Shoham, ples. There is as yet only one study that predicts success Mueser, Daiuto, & Stickle,1998). The strengths of EFT, in EFT from initial client variables (Johnson & Talitman, which first appeared in the literature in 1985 (Johnson & 1997). This article wdl attempt to summarize the empiri- Greenberg, 1985), are as follows: change strategies and cal and theoretical underpinnings of EFT and then move interventions are specified and applied in nine clearly on to consider how the clinical practice of EFT can be delineated steps (Greenberg & Johnson, 1988; Johnson, tailored to different kinds of partners at particular points 1996); the theoretical base of EFT is explicit, in terms of in therapy. the conceptualization of adult love and of marital distress, EFT focuses on reshaping a distressed couples struc- and these conceptualizations are supported by research on tured, repetitive interaction patterns, and the emotional the nature of marital distress (Gottman, 1994; Gottman, responses that evoke these patterns and fostering the Coan, Carrere, & Swanson, 1998) and on adult attach- development of a secure emotional bond (Johnson, 1996, 1999). For example, in the process of therapy a repetitive Address correspondence to Susan M. Johnson, C.P.S., Vanier demand-withdraw pattern that is accompanied by anger Building, School of Psychology, University of Ottawa, 11 Mane and frustration, or a withdraw-withdraw pattern charac- Curie, Ottawa, Ontario, Canada, K1N 6N5. Electronic mail terized by numbing and polarization, will expand into a may be sent to [email protected]. more flexible pattern of expressing needs and vulnerabili- Q 1999 AMERICAN PSYCHOLOGICAL ASSOCIATION D12 366 ties and responding to such needs in the partner. As a tress, the number of session may increase. The therapist is result, the partners are able to comfort, reassure, and sup- seen as providing a secure base (Bowlby, 1969) and as 3 port each other, creating a safe haven, which empowers process consultant, working with partners to construct each of them and maximizes their personal growth and new experiences and new dialogues that redefine their development. So “You are impossible to get close to” fol- relationship. Throughout the therapy process, the thera- lowed by “You are too angry. I don’t want to get close, ” pist focuses upon two tasks, the accessing arid reformulat- may become “I need you to hold me” followed by “I want ing of emotional responses and the shaping of new to comfort you. I feel so good when you turn to me.” interactions based on these responses. In the first task, the The key assumptions of the emotionally focused therapist focuses on the emotion that is most poignant and model, which have been discussed in detail elsewhere salient in terms of attachment needs and fears and that (Johnson, 1996; Johnson & Greenberg, 1995). can be plays a central role in patterns ofnegative interaction. The summarized as follows: therapist stays close to the emerging or “leading edge” of the client’s experience (Wile, 1995) and uses esperiential Emotion is primary in organizing attachment behav- interventions (Greenberg, Rice, 61 Elliott, 1993; Perk, iors and how self and other are experienced in an intimate 1973; Rogers, 1951) to expand and reorganize that expe- relationship. Emotion guides and gives meaning to per- rience. These include reflection, evocative questions, vali- ception, motivates and cues behavior, and when dation, heightening, and empathic interpretation. expressed, communicates to others. It is a powerful link Reactive responses such as anger tend to evolve into more between intrapsychic and social realities. primary emotions such as a sense of grief or fear. In the The needs and desires of partners are essentially second task, the therapist tracks and reflects the patterns healthy and adaptive. It is the way such needs are enacted of interaction, identifying the negative cycle that con- in a context of perceived insecurity that creates problems. strains and narrows the responses of the partners to each Problems are maintained by the way interactions are other. The therapist uses structural techniques (Minu- organized and by the dominant emotional experience of chin & Fishman, 1981) such as reffaming and choreo- each partner in the relationship. Mect and interaction graphs new relationship events. Problems are reframed in form a reciprocally determining feedback loop. terms of cycles and patterns and in terms of attachment Change occurs not through insight, catharsis, or needs and fears. So the therapist will ask a partner to share negotiation but through new emotional experience in the specific fears with his or her partner, thus creating a new context of attachment-salient interactions. kind of dialogue that fosters secure attachment. These In couple therapy the client is the relationship be- tasks and interventions are outlined in detail elsewhere tween partners. The attachment perspective on adult love together with transcripts of therapy sessions (Johnson 8i offers a map to the essential elements ofsuch relationships. Greenberg 1995; Johnson, 1996, 1998). Problems are viewed in terms ofadult insecurity and sepa- ration distress. THE PROCESS OF CHANGE IN EFT The process of change in EFT has been delineated into The emphasis given to affect and to self-reinforcing inter- nine treatment steps. The first four steps involve assess- actional patterns in EFT is supported by research on the ment and the deescalation of problematic interactional nature of marital distress (Gottman, 1994), and the per- cycles. The middle three steps emphasize the creation of spective on adult intimacy needs is supported by research specific change events where interactional positions shift on adult attachment (Bartholomew & Perlman, 1994; and new bonding events occur. The last two steps ofther- Cassidy & Shaver, 1999). apy address the consolidation of change and the integra- tion of these changes into the everyday life of the couple. THE THERAPEUTIC TASKS OF EFT The therapist leads the couple through these steps in a EFT is a relatively brief intervention. Empirical studies spiral fashion, as one step incorporates and leads into the have employed 8-12 sessions. In clinical practice, where other. In nlildly distressed couples, partners usually work couples may have other problems as well as marital Is- quickly through the steps at a parallel rate. In more dis- EFT & ATTACHMENT STYLE JOHNSON 6 WHIFFEN 367 tressed couples, the more passive or withdrawn partner is (Johnson & Greenberg, 1988). When both partners have usually invited to go through the steps slightly ahead of completed Step 7, a new form of emotional engagement the other. The increased emotional engagement of this is possible and bonding events can occur. These events are partner then helps the other, often more critical and active usually fostered by the therapist in the session, but also partner, shift to a more trusting stance. occur at home. Partners are then able to confide and seek The nine steps of EFT are as follows: comfort from each other, becoming mutually accessible and responsive. Accessibility and responsiveness have been Cycle Deescalation identified as the two key elements that define a relation- Step 1. Assessment: creating an alliance and explicating ship as a secure bond (Bowlby, 1988). At this stage ofther- the core issues in the couple’s conflict using an attach- apy, for example, a withdrawn spouse might access his ment perspective. deep distrust of others, his own longings to be close, and Step 2. Identifying the problematic interactional cycle his fear-driven need to stay “numb.”
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