Spotlight: Couple's Therapy
Why do couples come to therapy?
Partners may choose to begin couple therapy for a variety of reasons. The most obvious issues that typically come to mind are frequent misunderstandings or recurring conflicts, physical intimacy issues such as no longer have sex or infidelity, and bitter arguments that may escalate into full-blown fights in which one or both partners experience feelings of resentment toward the other. Additional relationship problems that may bring couples into therapy are communication difficulties; inability to effectively resolve conflict; emotional distance or a sense of growing apart; no longer seeming to share similar values, goals, or interests; and adjustment difficulties following major life transitions such as the birth of a child, a death in the family, and professional or career changes. Finally, the daily tasks and general responsibilities of living – work/life balance, financial issues, parenting, caregiving for older parents or loved ones, trying to preserve individual quality time for themselves, trying to preserve quality time as a couple – are all factors that may contribute to interpersonal conflict within a committed relationship.
However, in the simplest terms, couples often seek therapy because something has been lost within their relationship. It may be a palpable sense of closeness and connection, the desire and ability to express themselves openly and honestly, the desire and ability to be empathic and supportive of the other, or the sense of stability and security they had in each other and their union. There may be a loss of intimacy at any if not all levels including emotional, physical, intellectual, and spiritual. One or both individuals may find themselves not only avoiding potential conflictual topics with the other but avoiding their partner altogether. This may involve working late into the evenings or on weekends, spending more time in solo parenting endeavors, increasing individual social and recreational outings, or becoming immersed in personal hobbies or interests – all as a means of limiting time and contact with their partner. Couples often note feeling as if they have transitioned from being romantic partners to living as roommates or simply co-existing under the same roof with as limited interaction as possible. Such a loss or change in the relationship often results in discomfort and distress for each person as well as the relationship itself.
Why should couples consider coming to therapy?
Research indicates that couple distress remains a significant issue in the United States with 40-50% of first marriages ending in divorce. The likelihood of divorce increases with each subsequent marriage with 60-70% of second marriages ending in divorce. The average length of a marriage that ends in divorce is eight years. Couples therapy research tells us that most couples experience approximately seven years of relationship distress before entering couple therapy.
Why should partners consider couple therapy?
Partners with a desire to resolve their problematic issues and remain together should not only consider but actively engage in couple therapy because there is simply no reason to live with the negative, unwanted consequences of relationship distress when effective therapy is available and accessible.
How do we know if a couple therapy is effective?
A term you may encounter when investigating couple therapy options is “evidence-based” or “empirically supported.”
When we refer to “evidence” that a specific psychotherapy is effective, this does not mean the individual or couple participating in that treatment simply reports feeling “better,” thus we know the treatment works. In treatment outcome research, the goal is to determine if a given psychotherapy is effectively addressing the condition or symptoms for which it was created. If the individual or couple receiving that treatment report decreased symptoms and/or improved functioning, this serves as evidence that the specific psychotherapy is effectively addressing the very issue it was designed to treat.
Therefore, evidence-based psychotherapy refers to treatment that backed by science. Extensive research studies have been conducted to determine if the treatment is effective. The effectiveness of the treatment is objectively evaluated to reduce any prejudice or bias. And, these studies are often published in peer-reviewed scientific journals, meaning a group of experts in the field “kick the tires” on the study to ensure it was well-designed, correctly implemented, and the results are reliable and valid prior to distributing those results to the field through publication.
If you are considering psychotherapy for any given issue, simply type “evidence-based psychotherapy for X” in the Google search box and see what specific therapies are cited. If you conduct such a search for evidence-based couple therapy, you will see Emotionally Focused Couples Therapy as the top contender.
Introduction to Emotionally Focused Couples Therapy (EFCT)
Emotionally Focused Couples Therapy (EFCT) is one of a handful of evidence-based couple therapies. It is the most researched and has the most empirical evidence of such therapies. EFCT was developed in the 1980’s and is firmly based on attachment science. Sue Johnson, a key developer of EFCT, suggested that it was created in response to the various behavioral treatment models that were heavily influencing the field of couples therapy at that time.
Emotionally Focused Couples Therapy is a time-limited, structured approach based on the theory that our emotional experiences are essential to our relationships. An individual’s emotional experience is not simply composed of one’s feelings, but the meaning one makes from a given experience, thus embodying the person’s feelings, thoughts, behaviors, and interactions with others. EFCT helps each person in the relationship more fully understand their own emotional experiences as well as their partner’s emotional experiences. This improved understanding results in enhanced emotional connection with themselves and with their partner.
Before discussing the theoretical underpinnings of EFCT, it is important to understand the purpose of theory in a treatment model. The theory upon which a given psychotherapy is based serves three primary purposes. First, it provides an explanation of the development, maintenance of, and recovery from the specific condition or symptoms treated. It is this explanation or description of the specific issue addressed in therapy that helps both the therapist and client understand how this issue came about and why this issue has continued despite the distress or discomfort it is causing, and the couples’ attempts to correct it on their own. Most importantly, theory provides an explanation of how to intervene and address this issue that has served as a barrier and kept the couple stuck in their symptoms and distress.
Second, theory provides a framework for the therapist of how to practice within the boundaries of the psychotherapy protocol. This is especially important in evidence-based treatment. Psychotherapy is most certainly not a one-size-fits-all model, even when participating in a structured therapy such as EFCT. Each individual person is unique and each relationship between two people is unique, thus an effective therapy must be able to account for and adapt to these distinctive differences, even when that therapy is targeting the common issue of relationship distress. A well-trained and skilled therapist with a solid understanding of the underlying theory will be able to modify the treatment within the parameters of its theoretical model, thus creating flexibility while maintaining fidelity to the treatment model.
Third, the theory upon which a psychotherapy approach is based provides guidance for trouble-shooting challenges that may arise during the therapy process. Just as each individual person or couple is unique, each therapy process is unique as well. Humans are complex, as are relationships. Even in an evidence-based protocol with established efficacy, struggles or setbacks often occur along the way, which is normal in psychotherapy. The essence of therapy is creating change. Change is not typically something that happens instantaneously. It usually requires the person trying on for size this new way of being or relating to determine how well it fits. And, in most cases, determining that unique fit embodies a period of adjustment. Moreover, life does not stop because one begins therapy. Life goes on and may get in the way of therapy from time to time. Theory is our roadmap for therapy. It helps us navigate this process of change, considering individual differences and potential obstacles, while remaining true to the underlying treatment model deemed effective based on empirical evidence.
Although the theoretical underpinnings of EFCT originate from various sources, this couple therapy relies most heavily on attachment theory, which has an extensive amount of research supporting it from decades and decades of scientific investigation of attachment across the lifespan. Attachment theory tells us that human beings are inherently designed for emotional connection and security. These are basic human needs that each person possesses from birth throughout their lifespan. While most people associate attachment theory with parent-child relationships, adult attachment science indicates that although these early attachments impact our adult relationships, we never outgrow the need to bond and feel safe with another. People need people, always. Emerging research in the neurobiology of attachment indicates that our nervous system is built to distinguish emotional connection versus emotional disconnection with a loved one. When the latter occurs, our brain interprets this break in or lack of emotional connection as a threat to our safety, which subsequently results in the person feeling confused, disoriented, fearful, or even panicked.
It is through this lens of attachment theory that the EFCT model views relationship distress between two individuals. Namely, the conflict and pain each partner experiences are in response to their emotional disconnection from each other. This relationship distress may portray itself in a variety of ways ranging from escalating emotions and anger to withdrawal and emotionally shutting down. Each person in the relationship typically misunderstands or misinterprets their partner’s response to this breach of emotional connection. The individual on the receiving end of intense emotion and anger may feel that they have harmed or failed their partner, thus they respond by withdrawing or shutting down to avoid further conflict and damage. The other person then experiences that person’s retreat as indicative of the partner not recognizing or caring about their distress. Thus, the person attempts to gain their partner’s attention by becoming more emotionally upset, hoping to convince that person they are hurting so the partner will engage and respond to them.
This cycle of misconstruing each other’s behaviors and intentions often results in an established, repetitive, negative pattern of relating to the other. Thus, the emotional connection and sense of safety each person had in the other continues to erode, leading to more instances of emotional disconnection and relationship distress in response to this attachment threat. Over time, each person’s basic attachment need for connection and safety is not adequately met by the other person in the relationship. Instead of having a felt sense of emotional connection and safety with their partner, each individual experiences a sense of insecure connection or bond.
EFCT not only acknowledges but prioritizes human emotions as central to human experiences and human relationships. Our emotions play a fundamental role in influencing our thoughts, behaviors, and interpersonal interactions. Thus, this evidence-base treatment model views each person’s emotional experience as the transformative component of successful couple therapy. EFCT seeks to assist each person in accessing and expressing their own emotions in a way their partner can hear as well as respond to them. This process of identifying, processing, and sharing their more vulnerable emotions with each other often promotes enhanced understanding and empathy between the partners.
Moreover, EFCT views each couple as a system within themselves. In this regard, one person’s emotions and actions influence those of the other. This therapy focuses on the underlying patterns within each person as well as the patterns of interaction between the two partners. One of the primary roles of an EFCT therapist is to identify and interrupt the couples’ negative cycle of interaction, thus assisting the couple in recognizing that the major source of distress in their relationship is their unhealthy cycle of interaction, not their partner or the relationship itself. Therapy then seeks to help the couple restructure these unhealthy cycles of interaction into more positive cycles of connection, safety, and intimacy.
The Science Behind EFCT
As previously noted, Emotionally Focused Couples Therapy is the leading, evidence-based couple therapy currently available. Empirical findings support not only its effectiveness in decreasing relationship distress but the stability of these results over time. This couple therapy has been utilized in a range of treatment settings including private practice, hospital clinics, and university training centers. Couples from diverse cultural backgrounds and with varying educational levels have successfully completed EFCT with positive treatment outcomes. EFCT has been implemented in North and South America, Europe, Australia, Asia, Africa, and New Zealand. It had been used with heterosexual and same-sex couples. Research tells us that approximately 75% of couples report significantly decreased relationship distress and 90% of couples who complete EFCT report improved relations. Research indicates that couples have successfully completed EFCT related to a range of issues including communication problems, infidelity, depression, anxiety, PTSD and trauma reactions, significant medical illness, and challenges related to forgiveness.
The EFCT Process: What happens in therapy?
Emotionally Focused Couples Therapy is a short-term, structured psychotherapy that consists of weekly 45-minute sessions over the course of eight to twenty weeks. The primary goals of EFCT are three-fold:
- To access, expand, and re-structure each person’s key emotional responses within themselves as well as between the two partners in the relationship.
- To create a more healthy, positive cycle of interaction and patterns of relating between the two partners in the relationship.
- To cultivate and enhance the secure bond between both partners, namely a felt sense of connection and safety with the other in the relationship.
Therapy itself is composed of three stages:
1. Stage One:
Stage One focuses on de-escalation. During this interval, both partners work together along with their therapist to identify and understand their negative, cyclic pattern of interacting with each other that relates to their underlying attachment issues. The therapist assists each person in accessing and expressing their deeper, underlying emotions that are at the center of their conflicts. This process allows each person to better understand and accept their own emotional experiences as well as those of their partner. At the end of Stage One, the couple can comprehend their unhealthy cycle of interaction including the role each person plays in it as well as the triggers that set the cycle in motion.
2. Stage Two:
Stage Two centers on reshaping the unhealthy cycles of interaction between the two partners in the relationship. This step includes each person acknowledging their own attachment needs (e.g., connection, reassurance) while also learning about and developing empathy and compassion for their partner’s attachment needs. The therapist supports each person in expressing their own needs to their partner. At the end of Stage Two, once each person is able to recognize the unhealthy cycle when it is triggered, adequately express their own emotions and needs, and display empathy for their partner’s needs, the couple now has the ability to restructure their negative cycle, which they were unable to do before.
3. Stage Three:
Stage Three involves the couple creating a new, healthy cycle of interacting and relating to each other. The two partners are equipped to navigate conflict more easily and effectively. The previous unhealthy cycle may emerge on occasion, but the couple can now interrupt this cycle and replace it with a healthier pattern of interaction. At the end of Stage Three, each person is more skilled in managing their negative emotions and underlying needs as well as sharing their vulnerabilities with their partner. The couple experiences an enhanced capacity for understanding and supporting each other.
How can we benefit from EFCT?
As outlined above, couples benefit from EFCT in a myriad of ways including increased emotional connection, resulting in a secure bond between partners. Couples experience enhanced communication, understanding, and empathy for each other. In addition, research indicates couples report more long-term fulfillment and stability in their relationship upon completing EFCT. Moreover, it is important to consider that couples therapy is not simply helpful for couples who are experiencing intolerable relationship distress. As previously mentioned, a variety of issues bring couples into therapy. EFCT can be helpful in strengthening your bond with your partner in addition to helping you better understand and navigate routine conflicts.
Each and every person needs a felt sense of connection and security with their loved in a relationship.
Each and every couple is the system addressed in EFCT.
Each and every system has negative cyclic patterns that vary in severity over time.
There is no need to wait until your unhealthy cycle of interaction surpasses your or your partner’s threshold.
Couples therapy is a commitment to as well as an investment in yourself, your partner, and your relationship. If you and your partner are going to make this commitment and investment, it is worth seriously considering doing so with an empirically driven couple therapy. Choosing to engage in EFCT is not simply taking your first step towards improving your relationship. Choosing to engage in EFCT is taking best, most purposeful step you can take for improving your relationship.
Why should we consider EFCT at Upward Behavioral Health?
Research indicates that although EFCT is the leading, evidence-based couple therapy, it is not readily available through most community providers. Treatment outcome studies suggest that a therapist’s competence and fidelity to the psychotherapy protocol play a primary role in their client’s positive treatment outcomes. Moreover, implementation studies of EFCT indicate therapist who receive formal training in EFCT have better treatment fidelity and client treatment outcomes.
Dr. Megan Keyes has completed EFCT trainings with the International Centre for Emotionally Focused Therapy and is a therapist listed on their EFCT roster. Upward Behavioral Health offers measurement-based caring, which means each week you and your partner will complete brief self-report measures to assess your symptoms of relationship distress. We will monitor how well EFCT is working for you and if we are not seeing the results we would hope, we will determine together what potential barriers are present and how best to navigate them.
Although Upward Behavioral Health is an out-of-network practice and does not accept insurance, we will provide you with a superbill so that you may apply for some level of reimbursement with your health insurance carrier.
How do we get started?
If you and your partner are interested in Emotionally Focused Couples Therapy, please schedule a free consultation call with Dr. Megan Keyes. You can do this through our website, by calling our office at (205) 983-4063, or by emailing us at info@upwardbehavioralhealth.com.