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Emotionally Focused Therapy: A Family Counseling Approach
Cynthia Carodine
Department of Counselor Education and Family Studies, Liberty University
Author Note
Cynthia Carodine
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Cynthia Carodine
Email: ccarodine1@liberty.edu
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Abstract
Engaging in lifelong partnerships can be a difficult and challenging endeavor. Sue
Johnson and Les Greenberg, the creators of EFT, established the treatment to meet attachment
needs and develop emotionally secure bonds. The structure of the paper is such that the first half
will be a more formal and direct literature review that will include an annotated history, tenets,
and concepts of EFT as well as current research on the approach. EFT will be compared to other
family counseling approaches to identify similarities and differences from the family counseling
framework. There will be a Christian Worldview Statement included that weaves the author’s
beliefs into the paper that will help to illustrate how the lens of Scripture and biblical knowledge
of God’s heart for love, forgiveness, and connection informs both the material and final
application. The second half of the paper will be a personal reflection with a particular focus on
the SYMBIS report. In this portion, I will demonstrate the connection between the formal
review, theoretical framework, and personal experiences in order to highlight the applicability of
the material to life.
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Part I: Emotionally Focused Therapy
Introduction
Emotionally Focused Therapy, or EFT, is an empirically validated approach that has
quickly grown in popularity as one of the most effective methods of family and couple
counseling (Dalgleish & Power, 2015). Focused on the development of emotionally sensitive,
and inclusive therapy, EFT has consistently proven its effectiveness in treating a wide variety of
mental health issues, with a large emphasis on problems with emotional detachment and insecure
attachment. Created by Dr. Sue Johnson and Dr. Les Greenberg in the 1980’s, EFT is based on
attachment theory and focuses on emotional health within relationships (Greenberg & Johnson,
1988). Attachment-based EFT focuses on feelings and emotions as the primary basis for change,
with primary attention on the creation of emotional security (Greenman, Klobucar, & Johnson,
2017) . In order to do this, Johnson and Greenberg created an approach to relationship therapy
which puts focus on discovering and verbalizing previously unexpressed emotions, in order to
gain better understanding, create connection, and promote growth and communication in
relationships. The approach has since spread and gained recognition, and is now used in the
treatment of family and individual issues.
EFT is based on the idea that the creation of emotional bonds and the development of
these attachments is the single most effective predictor of relationship success (Johnson, 2019).
EFT has helped hundreds of couples in their relationship through the development of a set of
guidelines that focus on the expansion of emotional awareness and the redefinition of
relationships in healthier ways. Focused on strengthening attachment bonds and creating a set of
interaction patterns which promote greater trust and secure attachment, EFT is ideal for couples
who feel the need to improve their communication, feel conflict or negative emotions on a
frequent basis, or report feelings of disconnection or disinterest in one another.
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Johnson and Greenberg created EFT as an approach which would attempt to standardize
effective treatment, and couple it with the growing awareness and effectiveness of focusing on
emotional well-being in order to facilitate change. Focused on both attachment as well as
emotional processing, EFT was built as a system which would emphasize emotional responses
within relationships, and change the “interaction cycles” within relationships in a way which
created more emotional awareness, as well as promoted responsive interaction, rather than
maladaptive interaction which serves to increase negative feelings and blame (Johnson,2008).
The approach has since spread, and is not only used for couples, but with families and
individuals as well. EFT has gained a significant following over the past few decades, and has
been widely supported by evidence from all around the world, with research validating the
method’s effectiveness in improving client relationships with one another, and even across a
wide variety of cultures. In addition to being incredibly effective, it is a systemic approach which
integrates more micro or “single-level” theories, such as experiential interventions, into a more
global, family-based approach to mental health (Johnson & Lebow, 2021).
Leading Figures
EFT was originally co-developed by Dr. Sue Johnson and Dr. Les Greenberg in the 1980s
(Greenberg & Johnson, 1988). Sue Johnson, a leading researcher in the field of adult attachment,
was responsible for the clinical refinement and popularization of the model in the years that
followed. Her subsequent research and clinical work on the model in the areas of marital distress
and relationship repair were central to the empirical evidence-base that has been built up over
time. Sue Johnson’s book Hold Me Tight became a popular guide for therapists and couples and
helped to disseminate the model beyond research and clinical circles (Johnson, 2008). Les
Greenberg was a key figure in the early development of the EFT model, and his work in this field
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was fundamental to the model’s emphasis on emotional processing and experiential techniques.
He later moved on to focus more on the development of Emotion-Focused Therapy (EFT, a
model applied to individual therapy), but his early work in this area helped to lay the foundations
for EFT’s integration of emotion and systemic thinking. The collaboration of Johnson and
Greenberg led to a model that was able to effectively integrate cognitive-behavioral, systemic,
and humanistic approaches, and EFT has become one of the most respected and empirically
supported interventions for relationship therapy.
Development of the Theory/Historical Events
Emotionally Focused Therapy began in the 1980s as a therapy model for couples that
both responded to and filled the gaps in the current models of couples counseling that
predominated the time. At the time, many of the approaches in wide use such as behavioral and
cognitive-behavioral models and systems-based therapies largely concentrated on the observable
or cognitive elements of a relationship such as behaviors, communication skills, or problem
solving strategies. While these approaches have been very useful and effective at treating many
forms of distress, Sue Johnson and Les Greenberg were working with clients who were coming
to therapy to talk about the ways they were arguing or not being able to connect emotionally but
ended up talking about their underlying emotions and the ways these contributed to their
experience of their problems and conflict. It seemed to Johnson and Greenberg that a complete
model of couples counseling would need to incorporate a focus on emotion.
The attachment theory work of John Bowlby, which describes how individuals form an
internal working model of relationships, how to interpret and predict the behaviors of others, and
how to respond in relationships based on these models, also emphasized the critical role of
emotion and emotional experiences (Dalgleish & Power, 2015). Attachment theory has
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influenced many, if not most, modern models of couple and family therapy by describing how
individuals connect to others. By describing adult love relationships as emotional attachment
bonds, EFT then began to be informed by clinical trials and outcome research that both defined
its process and shape. In particular, Johnson and her colleagues conducted randomized controlled
trials to investigate the long-term effectiveness of the model in reducing marital distress and
promoting emotional closeness.
Basic Assumptions and Key Philosophy
EFT is based on the idea that the security of emotional attachment is central to
relationship health (Johnson & Lebow, 2021). Emotional pain is often related to unsatisfied
attachment needs and interactional cycles that leave partners or family members feeling unsafe,
unheard, or emotionally disconnected. Negative cycles of protest, withdrawal, or defensiveness
damage trust. EFT aims to expose the positive intentions of each partner and restructure
interactions to restore trust and promote safety. The therapist helps clients express their
underlying attachment needs and reform their emotional interactions to be more responsive to
each other. Focusing on emotional needs and strengthening emotional safety are what set EFT
apart.
Key Concepts
Attachment bonds: These are the emotional ties that make us feel safe and secure with others in
relationships (Greenberg et al., 2017).
Emotional Responsiveness: This is the ability to understand, accept, and respond to a partner’s
emotional needs in a supportive manner.
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Primary and Secondary Emotions: EFT differentiates between primary emotions (often more
vulnerable emotions such as fear, sadness, or hurt) and secondary emotions (such as anger or
defensiveness) that may obscure or be a reaction to more basic needs.
Negative Interaction Cycles: These are patterns of behavior and emotional responses that
maintain and exacerbate distance and miscommunication. EFT aims to break these cycles and
establish new, more emotionally connected interactions (Greenberg et al., 2017).
Techniques
The three phases of EFT are de-escalation, restructuring interactions, and consolidation.
During de-escalation, a therapist will guide clients in identifying negative interaction patterns
and understanding the emotional needs underneath (Worthington, 2005). During the restructuring
phase, partners are encouraged to express primary emotions and respond to each other with
empathy and vulnerability, forming new cycles of connection. During the consolidation phase,
the couple takes stock of their progress and practices new patterns with day-to-day challenges.
Key EFT interventions include enactments, where clients communicate directly with one another
in session; empathic reflection, where the therapist focuses on echoing emotional content; and
tracking, which follows and clarifies patterns as they emerge in the moment. These techniques
require the therapist to be highly attuned, validating, and directive in guiding new interactional
sequences.
Similarities and Dissimilarities
Emotionally Focused Therapy has humanistic underpinnings in common with
Person-Centered Therapy, including an emphasis on empathy, authenticity, and the therapeutic
relationship. EFT also shares an interdependent, systemic view of relationships with Bowenian
Family Systems Therapy (Nichols & Davis, 2020). However, EFT is distinct from Bowenian
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models in its focus on the present moment, emotional experience, and accessibility rather than
multigenerational patterns and differentiation. EFT is also distinct from Behavioral Family
Therapy, as the former prioritizes emotions and attachment rather than observable external
behaviors and change through reinforcement (Koski & Shillam, 2020). EFT’s emphasis on
emotional transformation as the primary agent of change is also key to what makes this approach
distinct from other methods.
New Knowledge Acquired
One of the two main points I will remember from Emotionally Focused Therapy is the
importance of attachment in adult love relationships. Another significant takeaway is that I
learned how to use a highly structured, yet still emotion-focused model, which has broadened my
perspective on how change can happen in therapy. Furthermore, a counselor should be able to
access vulnerable emotions for relationships to change. It has made me want to be a more
empathic, patient, and purposeful counselor. Emotionally Focused Therapy has taught me that
emotional safety is not just a goal of therapy but a precondition for healing, growth, and
connection. Additionally, recent research found that EFT assists individuals ability to restructure
their responses or reactions to conflict and stress by activating neurological parts of the brain
connected to affective processing and attachment (Johnson, 2019).
Part II: Faith Integration and Personal Perspective
Christian counseling is described by Hawkins (2015) as a type of discipleship that assists
individuals in discovering God's will and becoming closer to Christ. As a Christian, I believe that
the principles of EFT are in harmony with biblical teachings on love, empathy, and restoration.
The Bible emphasizes emotional closeness and forgiveness, as seen in verses like Peter 1:22 and
Colossians 3:13 (1 Peter 1:22 and Colossians 3:!3, New International Version). Just as God
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desires a secure relationship with His children, EFT helps couples establish safe and nurturing
emotional connections. Jesus exemplified empathy and emotional attunement, and as an EFT
therapist, I strive to bring that same level of compassion and understanding to my work. I
integrate prayer, Scripture, and spiritual sensitivity into my practice, recognizing that EFT can be
a powerful tool that aligns with and supports God’s design for marriage and family. I've
discovered how important and complex a function a Christian counselor plays in a client's
development. Counselors need to be able to remain composed during the most trying times, and
Scripture is essential for finding words of support or direction for their clients (Hawkins &
Clinton).. A spiritual link I will keep with me throughout this journey is the realization that God
has selected counselors with a crucial gift to assist people in trusting God. As Christian
counselors, God has faith in us, and his people have faith in us with their minds, souls, victories,
losses, and wounds.
Part III: SYMBIS Report Reflection
The SYMBIS assessment revealed to me that I had a "Romantic" idealist attitude about
love. I agreed with this. I am a person who views love as sacred and lasting. However, I also
recognize that, although this is a healthy way to look at love, I must balance it with hard work,
humility and realistic expectations.
Five Key Relationship Issues
• Love: I learned to value both emotional intimacy and intentionality.
• Attitude: My growth area is maintaining resilience during stress.
• Communication: I am reflective while my partner is direct—requiring balance.
• Gender Differences: I prefer shared time, my partner prefers emotional affirmations.
• Conflict: I need to slow down and engage more patiently in tense situations.
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Walking Together with God
Three ways we plan to honor God in marriage are: Praying together regularly,
participating in ministry together and studying Scripture as a couple. Praying together can be a
routine created based on everyday life or when we are faced with a challenge. Praying together
will not only strengthen our faith with God but increase our trust and closeness with each other.
Participating in ministry will give us an opportunity to share our testimony with others and
receive wisdom from our faith based group. Lastly, studying Scripture together will help us
understand the desires God has for us and allow us to interpret those wants as a couple instead of
individuals. Keeping these three things as a priority in our relationship will assist us in building a
stronger relationship with each other through God.
Theory and Spiritual Integration
SYMBIS and EFT go hand-in-hand in the ways that they encourage emotional security
and a deeper level of relating to one another. SYMBIS provides couples a reliable assessment of
their partnership dynamics, emphasizing strengths and weaknesses (SYMBIS, 2024). By
revealing rooted issues such as conflict styles, expectations and communication disparities,
SYMBIS enhances EFT’s beliefs on psychological behaviors. For Christian couples, EFT
provides a platform to uphold Christian principles such as love, sacrifice, and covenant.
SYMBIS is also inline with EFT’s goal of increasing martial safety and emotional awareness, by
having couples revisit their emotions, past experiences and beliefs (Worthington, 2015). Through
the guidance of Scripture and prayer, EFT can be a holistic tool for healing and growth.
Faith-based relationships are built on a foundation of shared ideas, values, and
expectations, including spiritual and religious convictions, which SYMBIS encourages couples
to examine and make clear. By stressing marriage as a holy covenant rather than merely a
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contract, it supports couples in viewing their relationship through a faith-centered lens and is
consistent with many spiritual traditions. Discussing spirituality, worship, faith aspirations, and
how to incorporate them into daily life and marriage is made easier by the examination. The
topics covered by SYMBIS, like commitment, forgiveness, and conflict, are highly relevant to
religious teachings on grace, mercy, and reconciliation. Intentional development and shared
spiritual journeys are encouraged by SYMBIS, which assists couples in establishing spiritual
goals and comprehending the influence of their faith on their relationship.
Conclusion
In conclusion, the SYMBIS exam and Emotionally Focused Therapy (EFT) provide a
strong, evidence-based framework for developing safe, secure, and spiritually based
relationships. Couples can create strong emotional bonds and end destructive patterns by using
EFT's emphasis on attachment, emotional accessibility, and responsiveness (Worthington, 2015).
Couples that integrate SYMBIS are able to learn a great deal about their relationship dynamics,
including expectations, communication styles, and religious beliefs. This integration helps
couples create marriages that respect both psychological well-being and spiritual commitment by
fortifying emotional ties and adhering to Christian values of covenant, forgiveness, and grace. By
taking a comprehensive approach, counselors and therapists may help couples grow and heal
their relationships in a way that is based on love, empathy, and faith. EFT is an evidence-based
and spiritually compatible approach to family counseling (Dalgleish & Power, 2015). EFT's
attachment-based model is rooted in both psychological theory and Christian principles.
Integrating EFT with faith promotes holistic healing and honors God in the process of
strengthening families.
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focused couple therapy: Conceptualization, assessment, and treatment. Journal of Marital
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Hawkins, R., & Clinton, T. (2015). The new Christian counselor: A fresh Biblical &
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