Question 1

How can emotionally focused therapy help couples with sex difficulties?

Sue Johnson · Accepted Answer

Yes. Securely attached people tend to have more and more satisfying sex and sexual satisfaction improved for the clients in our recent attachment study showing that insecure relationally distressed partners could repair their relationship and move into secure connection.

Question 2

How much does this therapy examine childhood experiences?

Sue Johnson · Accepted Answer

Childhood experiences are the ground adult attachment strategies are built on and we do take an attachment history, but EFT focuses on the PRESENT and how past sensitivities emerge in the present and are either confirmed or disconfirmed in key ongoing emotional events.

Question 3

Can I go alone to EFT sessions if my spouse refuses to come with me?

Sue Johnson · Accepted Answer

If you go alone, you are engaging in EFIT – individual therapy. This may help you understand your experience in your relationship better, but to repair a relationship really requires couple interventions.

Question 4

If one partner has issues with addiction, should they seek intervention for this before engaging in couples EFT?

Sue Johnson · Accepted Answer

Yes. Addiction most often blocks the repair of relationships and active addiction is then a contraindication for EFT for couples. Addiction in attachment terms is a substitute for the secure connection with others that allows us to deal effectively with our vulnerability.

Question 5

Hi Dr Johnson, in your experience how often is it necessary for couples therapy to be supplemented by individual treatment for one or both parties?

Sue Johnson · Accepted Answer

If one partner has chronic depression, core anxiety problems, PTSD or addiction then we usually recommend individual therapy as well as couple interventions.

Question 6

How does trauma affect relationships?

Sue Johnson · Accepted Answer

A core problem in trauma is overwhelming negative emotion, heightened sensitivity and vigilance for threat coupled with numbing and avoidance. It is easy to see how these factors would begin to destroy a relationship. The more distressed the relationship becomes the more alone the person is with their trauma and the more overwhelmed they become. Attachment insecurities and disconnection increase trauma symptoms and these symptoms further undermine relationships. We call this the trauma trap. When we know how to heal relationships we create relationships that heal – the most natural healing place for trauma is in the arms of the person you love.

Question 7

How does EFIT compare to CBT for clinical presentations such as generalised anxiety disorder or major depressive disorder?

Sue Johnson · Accepted Answer

EFIT sees these disorders in the context of attachment relationships and the models of self and other that are shaped by interaction patterns in these relationships. It also intervenes differently taking people into and through difficult emotions rather than teaching people how to cope with them. CBT often teaches coping skills. EFT offers corrective emotional experiences so that the nature of the depression or anxiety changes. These experiences shape more emotional balance and expand client’s ways of thinking and behavioral repertoires but in a different way than CBT.

Question 8

Can principles of EFT and attachment science be integrated with other approaches such as CBT?

Sue Johnson · Accepted Answer

There are general principles that underlie all effective therapies – for example most use some form of gradated exposure to negative stimuli that shapes new responses. However the mind set and specifics of intervention are very different in EFT and CBT.

That being said we do use David Barlow’s UP model of emotional disorders to outline  the nature of depression and anxiety problems in EFIT, as laid out in the book Attachment Theory in Practice (2019).

Question 9

What kind of interventions or change strategies are used in Emotionally Focused Therapy?

Sue Johnson · Accepted Answer

EFT uses a structured sequence of macro interventions called the EFT Tango across modalities of therapy, to move clients into core emotions and corrective emotional experiences that expand the sense of self and engagement with others. Micro interventions from Rogerian models of therapy, such as asking evocative questions, and from systemic interventions such as shaping new positive enactments between intimates are also used. Change occurs through corrective emotional experiences that speak to client’s deepest needs, longings and existential dilemmas.

Question 10

Does EFIT take a transdiagnostic approach to mood and anxiety disorders or are there disorder-specific protocols?

Sue Johnson · Accepted Answer

EFIT uses the Unified Protocol outlined by David Barlow, a transdiagnostic approach to emotional disorders, to focus on the organizing features of depression and anxiety and views them both as problems of emotion regulation. Co-morbidity rates for anxiety and depression are high and treatments for one seems to produce significant improvements in the other. Both are characterized by a sense of uncontrollability and a heightened sense of perceived danger and helplessness. EFT stresses the impact of a felt sense of emotional isolation from others in the triggering and perpetuation of this emotional disorder process.

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