What Is Emotionally Focused Therapy?

Emotionally focused therapy (EFT) is a type of short-term therapy that is used to improve attachment and bonding in adult relationships. This approach to couples therapy was developed by doctors Sue Johnson and Les Greenberg in the 1980s and is rooted in research on love as an attachment bond.

While often used for couples, it has also been adapted for use with families. This treatment can help couples and family members form a more secure emotional bond, which can result in stronger relationships and improved communication.

Techniques

The change process through EFT has been mapped into a clearly defined system consisting of nine steps across three stages that help guide the therapist and track progress. The three stages of EFT are:

De-Escalation

This step is focused on identifying negative interaction patterns that contribute to conflict, identifying negative emotions related to attachment issues, and reframing these issues. This process helps couples better see how insecurities and fears may be hurting their relationship.

Partners begin to view undesirable behaviors (i.e., shutting down or angry escalations) as “protests of disconnection.” Couples learn to be emotionally available, empathetic, and engaged with each other, strengthening the attachment bond and safe haven between them. 

Restructuring

During this stage, each partner learns to share their emotions and show acceptance and compassion for each other. This step helps each partner become more responsive to their partner’s needs.

The process attempts to reduce a couple’s conflict while creating a more secure emotional bond. Couples learn to express deep, underlying emotions from a place of vulnerability and ask for their needs to be met.

Consolidation

During the final step, a therapist helps the couple work on new communication strategies and practicing skills when interacting with each other. This process can help couples see how they have been able to change and how new interaction patterns prevent conflict.

New sequences of bonding interactions occur and replace old, negative patterns such as “pursue-withdraw” or “criticize-defend.”2 These new, positive cycles then become self-reinforcing and create permanent change. The relationship becomes a haven and a healing environment for both partners.

What EFT Can Help With

Emotionally focused therapy can benefit couples who are struggling with conflict, distress, and poor communication. While often used in couples therapy, EFT can also be helpful in individual therapy and family therapy.

With individuals, this approach can help people improve emotion-related problems. It can also help family members form more secure bonds with one another. 

The couples who may benefit from EFT include those where one or both partners have:

• Addiction
• Depression
• Chronic illness
• Post-Traumatic Stress Disorder

EFT has also proven to be a powerful approach for couples dealing with infidelity or other more traumatic incidents, both recent and past. Neuroscience intersects with attachment and EFT. More recently produced MRI studies demonstrate the significance of secure attachment.3 Our attachments are potent, and our brains code them as “safety.”

EFT is being used with many different kinds of couples in private practice, university training centers, and hospital clinics. It is also quite useful with various cultural groups throughout the world.

Benefits of Emotionally Focused Therapy

There are a number of benefits that couples and families can gain from EFT. Some of these include:

• Better emotional functioning: EFT provides a language for healthy dependency between partners and looks at key moves and moments that define an adult love relationship. The primary goal of the model is to expand and re-organize the emotional responses of the couple.
• Stronger bonds: EFT is based on attachment theory, which suggests that attachments between people typically provide a safe haven—a retreat from the world and a way to obtain comfort, security, and a buffer against stress.4
• Improved interpersonal understanding: EFT helps people become more aware of their partner’s needs. Because of this awareness, they are also able to listen and discuss problems from a place of empathy instead of a place of defensiveness or anger.

Emotionally focused therapy can unwind automatic, counter-productive reactions that threaten relationships.

Effectiveness

EFT has many strengths as a therapeutic model. First, it is supported by extensive research. Second, it is collaborative and respectful of clients. It shifts blame for the couples’ problems to the negative patterns between them, instead of the couples or individual partners themselves.

There is a substantial body of research outlining the effectiveness of this treatment. It is now considered one of the most (if not the most) empirically validated forms of couples therapy.

Emotionally focused therapy can be an effective way for couples to form stronger bonds and build better relationships. Research has found that EFT can improve interactions between partners and reduce the amount of stress that people experience in their relationships.5

Things to Consider

Because emotionally focused therapy involves exploring the negative emotions and patterns that contribute to conflicts in relationships, it can be challenging. The therapy process itself may lead to difficult or intense emotions.

It is also important for each individual to participate in the process. EFT may be less effective if one person is less willing to participate.

Due to insecure attachment, any perceived distance or separation in our close relationships is interpreted as danger.7 Losing the connection to a loved one threatens our sense of security.

Because of this, people go into a self-preservation mode and rely on the things they did to “survive” or cope in childhood. This is the reason people are triggered as adults in romantic relationships to repeat unhealthy patterns from their formative years. While the process can be difficult at times, the goal of EFT is to help change these patterns and replace them with more helpful ones.

How to Get Started

During an EFT session, a therapist observes the dynamics between a couple and then acts as a collaborator to coach and direct new ways of interacting. Unlike some other forms of therapy where the therapist is more of a passive listener, EFT therapists take an active role in guiding the conversation. The therapeutic approach also focuses on addressing emotions and interactions within the session rather than focusing on things like worksheets and homework.

Therapists are empathetic and help couples recognize their emotions as valid. They help couples and individuals recognize behaviors and patterns that they may not even be aware of and see how these actions contribute to conflict in a relationship.

If you think this form of therapy would improve your relationship, you can find an EFT Trained Therapist through The International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) website.

• Factors that may impact what type of treatment is used include cost-effectiveness, availability, patient preferences, and the severity of the symptoms the person is experiencing. While cognitive-behavioral therapy (CBT) is a popular and effective approach, evidence suggests that psychodynamic therapy can be just as effective for many conditions.

What is Psychodynamic Therapy

Psychodynamic therapy is an approach that involves facilitation a deeper understanding of one’s emotions and other mental processes. It works to help people gain greater insight into how they feel and think.

By improving this understanding, people can then make better choices about their lives. They can also work on improving their relationships with other people and work toward achieving the goals that will bring them greater happiness and satisfaction.

Psychodynamic therapy is rooted in psychoanalytic theory but is often a less intensive and lengthy process than traditional psychoanalysis. While psychoanalysis tends to focus a great deal on the patient and therapist relationship, psychodynamic therapy also places a great deal of emphasis on a patient’s relationships with other people in the outside world.

What Is Psychodynamic Therapy?

Psychodynamic therapy is a form of talk therapy. It is based on the idea that talking to a professional about problems people are facing can help them find relief and reach solutions. 

Through working with a psychodynamic therapist, people are able to better understand the thoughts, feelings, and conflicts that contribute to their behaviors. This approach to therapy also works to help people better understand some of the unconscious motivations that sometimes influence how people think, feel, and act.

By better understanding your emotional patterns and their roots, you are better equipped to manage your problems and develop coping techniques that will help you both now and in the future.

Uses

While it is similar to psychoanalysis in many respects, it is often less frequent and shorter in duration. Like other forms of therapy, it can be used to treat a variety of mental health problems.

• Anxiety
• Depression
• Eating disorders
• Interpersonal problems
• Personality disorders
• Psychological distress
• Post-traumatic stress disorder
• Social anxiety disorder2
• Substance Use Disorders    

Factors that may impact what type of treatment is used include cost-effectiveness, availability, patient preferences, and the severity of the symptoms the person is experiencing. While cognitive-behavioral therapy (CBT) is a popular and effective approach, evidence suggests that psychodynamic therapy can be just as effective for many conditions.

Online therapy is another option that you might consider. Some research also suggests that online psychodynamic therapy may be as effective as online CBT.3

How It Works

Psychodynamic therapy helps people recognize repressed emotions and unconscious influences that may be affecting their current behavior. Sometimes people act in certain ways or respond to others for reasons that they don’t really understand. 

Psychodynamic therapy helps people learn to acknowledge, bear, and put into perspective their emotional lives. It also helps people learn how to express their emotions in more adaptive and healthier ways.

Important Characteristics

Some important aspects of psychodynamic therapy include:

• Identifying patterns: Psychodynamic therapy helps people learn to recognize patterns in behavior and relationships. People often develop characteristic ways of responding to problems without really being aware of these tendencies. Learning to spot them, however, can help people find new approaches to coping with problems.
• Understanding emotions: Research has found that psychodynamic therapy is useful for exploring and understanding emotions. Through gaining insight into emotional experiences, people are better able to recognize patterns that have contributed to dysfunction and then make changes more readily.
• Improving relationships: Relationships with others are a key focus of psychodynamic therapy. In working with a therapist, people are able to understand how they often respond to others.

The therapeutic relationship itself can serve as a way to look into the relationships a person has with other people through a process known as transference. This gives people an immediate “in vivo” way to explore and then change their pattern of responses in order to improve their relationships.

How Effective Is It?

How effective is psychodynamic therapy and how does it compare to other forms of treatment?

Assessing the efficacy of psychodynamic therapy presents some challenges, but research does suggest that it can be useful in the treatment of a variety of psychological problems.

While it is relatively easy to measure changes in specific acute symptoms, it is much more difficult to measure underlying personality changes, noted researcher Jonathan Shedler in a press release by the American Psychological Association (APA).4

Despite this difficulty, research supports the efficacy and use of psychodynamic therapy to treat a variety of conditions.

• One notable review published in the journal American Psychologist concluded that the evidence supports the efficacy of psychodynamic therapy.5
• Another study found that psychodynamic therapy could be at least as effective as cognitive-behavioral therapy (CBT).6
• A 2017 review published in the American Journal of Psychiatry concluded that psychodynamic therapy was as effective as other established treatments. However, the authors of the study suggested that further research was needed to determine who benefited the most from this type of treatment.7

What You Can Expect

If you decide to try psychodynamic therapy, you may meet with your therapist weekly to a few time each week. Each session typically lasts for around 45 minutes and you will continue to see your therapist for several months. In some cases, you may keep having sessions for a year or longer.

During psychodynamic therapy, people are often encouraged to talk about anything that might be on their minds. This might include things they are currently experiencing or memories of things that have happened in the past. 

One form of psychodynamic therapy known as brief psychodynamic therapy is designed to produce results more rapidly, often in 25 to 30 sessions. In this shorter-term form of treatment, people may initially determine a particularly emotional area where they want to focus on.8

What is Behavioral Therapy?

Behavioral therapy is a term that describes a broad range of techniques used to change maladaptive behaviors. The goal is to reinforce desirable behaviors and eliminate unwanted ones.

Behavioral therapy is rooted in the principles of behaviorism, a school of thought focused on the idea that we learn from our environment. This approach emerged during the early part of the 20th-century and became a dominant force in the field for many years. Edward Thorndike was one of the first to refer to the idea of modifying behavior.

Unlike the types of therapy that are rooted in insight (such as psychoanalytic therapy and humanistic therapies), behavioral therapy is action-based. Because of this, behavioral therapy tends to be highly focused. The behavior itself is the problem and the goal is to teach people new behaviors to minimize or eliminate the issue.1

Types of Behavioral Therapy

There are a number of different types of behavioral therapy. The type of therapy used can depend on a variety of factors, including the condition being treated and the severity of the person’s symptoms.

• Applied behavior analysis uses operant conditioning to shape and modify problematic behaviors.
• Cognitive behavioral therapy (CBT) relies on behavioral techniques, but adds a cognitive element, focusing on the problematic thoughts behind behaviors.
• Cognitive behavioral play therapy utilizes play to assess, prevent, or treat psychosocial challenges. The therapist may use play to help a child learn how to think and behave differently.
• Dialectical behavioral therapy (DBT) is a form of CBT that utilizes both behavioral and cognitive techniques to help people learn to manage their emotions, cope with distress, and improve interpersonal relationships.
• Exposure therapy utilizes behavioral techniques to help people overcome their fears of situations or objects. This approach incorporates techniques that expose people to the source of their fears while practicing relaxation strategies. It is useful for treating specific phobias and other forms of anxiety.
• Rational emotive behavior therapy (REBT) focuses on identifying negative or destructive thoughts and feelings. People then actively challenge those thoughts and replace them with more rational, realistic ones.

• Social learning theory centers on how people learn through observation. Observing others being rewarded or punished for their actions can lead to learning and behavior change.2

Techniques

In order to understand how behavioral therapy works, it is important to know more about the basic principles that contribute to behavioral therapy. The techniques used in this type of treatment are based on the theories of classical conditioning and operant conditioning.

Classical Conditioning

Classical conditioning involves forming associations between stimuli. Previously neutral stimuli are paired with a stimulus that naturally and automatically evokes a response. After repeated pairings, an association is formed and the previously neutral stimulus will come to evoke the response on its own.

Classical conditioning is one way to alter behavior. Several different techniques and strategies are used in this approach to therapy.

• Aversion therapy: This process involves pairing an undesirable behavior with an aversive stimulus in the hope that the unwanted behavior will eventually be reduced. For example, someone with an alcohol use disorder might take Antabuse (disulfiram), a drug that causes severe symptoms (such as headaches, nausea, anxiety, and vomiting) when combined with alcohol.3
• Flooding: This process involves exposing people to fear-invoking objects or situations intensely and rapidly. It is often used to treat phobias. During the process, the individual is prevented from escaping or avoiding the situation.
• Systematic desensitization: In this technique, people make a list of fears and then learn to relax while concentrating on these fears. Starting with the least fear-inducing item and working their way to the most fear-inducing item, people systematically confront these fears under the guidance of a therapist. Systematic desensitization is often used to treat phobias and other anxiety disorders.2

Operant Conditioning

Operant conditioning focuses on how reinforcement and punishment can be utilized to either increase or decrease the frequency of a behavior. Behaviors followed by desirable consequences are more likely to occur again in the future, while those followed by negative consequences become less likely to occur.

Behavioral therapy techniques use reinforcement, punishment, shaping, modeling, and related techniques to alter behavior. These methods have the benefit of being highly focused, which means they can produce fast and effective results.

• Contingency management: This approach uses a formal written contract between a client and a therapist (or parent or teacher) that outlines behavior-change goals, reinforcements, rewards, and penalties. Contingency contracts can be very effective in producing behavior changes since the rules are spelled out clearly, preventing both parties from backing down on their promises.
• Extinction: Another way to produce behavior change is to stop reinforcing behavior in order to eliminate the response. Time-outs are a perfect example of the extinction process. During a time-out, a person is removed from a situation that provides reinforcement. By taking away what the person found rewarding, unwanted behavior is eventually extinguished.
• Behavior modeling: This technique involves learning through observation and modeling the behavior of others. Rather than relying simply on reinforcement or punishment, modeling allows individuals to learn new skills or acceptable behaviors by watching someone else perform those desired skills.

• Token economies: This strategy relies on reinforcement to modify behavior. Parents and teachers often use token economies, allowing kids to earn tokens for engaging in preferred behaviors and lose tokens for undesirable behaviors. These tokens can then be traded for rewards such as candy, toys, or extra time playing with a favorite toy.4

What Behavioral Therapy Can Help With

Behavioral therapy can be utilized to treat a wide range of psychological conditions and disorders, including:

• Bipolar disorder5
• Alcohol and substance use disorders
• Anxiety
• Attention-deficit/hyperactivity disorder (ADHD)
• Autism spectrum disorders
• Borderline personality disorder (BPD)
• Depression
• Eating disorders
• Panic disorder
• Phobias
• Obsessive-compulsive disorder (OCD)6

Behavioral therapy is problem-focused and action-oriented. For this reason, it can also be useful for addressing specific psychological concerns such as anger management and stress management.7

Benefits of Behavioral Therapy

Behavioral therapy is widely used and has been shown to be effective in treating a number of different conditions. Cognitive behavioral therapy, in particular, is often considered the “gold standard” in the treatment of many disorders,8 and cognitive behavioral play therapy, specifically, can be effective for children where other types of therapy aren’t.9

CBT is often more affordable than other types of therapy and results are often seen in five to 20 sessions.10 Research has shown that CBT is most effective for the treatment of:

• Anger issues
• Anxiety
• Bulimia
• Depression
• Somatic symptom disorder
• Stress
• Substance abuse and relapse prevention11

In addition, behavioral therapy has been found to help people with the following:

• Communication
• Coping strategies
• Healthier thought patterns
• Self-esteem12

Effectiveness

How well behavioral therapy works depends on factors such as the specific type of treatment used as well as the condition that is being treated.

This does not mean that CBT or other behavioral approaches are the only types of therapy that can treat mental illness. It also doesn’t mean that behavior therapy is the right choice for every situation.

Anxiety disorders, including post-traumatic stress disorder (PTSD), panic disorder, obsessive-compulsive disorder (OCD), and phobias, for example, often respond well to behavioral treatments.14 However, researchers found that the effectiveness of behavioral therapy, specifically CBT, in the treatment of substance use disorders can vary depending on the substance being misused.15

CBT was also shown to have beneficial effects on some symptoms of schizophrenia but showed no benefits on relapse and hospital admission when compared to other forms of treatment.15

Things to Consider

Behavioral therapy has a number of advantages. However, behavioral approaches are not always the best solution.

It’s Not Enough for Complex Mental Health Conditions

When treating certain psychiatric disorders such as severe depression and schizophrenia, behavioral therapy often must be used in conjunction with other medical and therapeutic treatments. Behavioral therapy can help clients manage or cope with certain aspects of these psychiatric conditions, but should not be used alone.2

It May Not Account for Underlying Problems

Behavioral treatments tend to focus on current problems with functioning and may not fully appreciate or address the underlying factors that are contributing to a mental health problem.2

It May Not Address the Whole Picture

Behavioral approaches are centered on the individual working to change their behaviors. Some of these approaches, however, often don’t address how situations and interpersonal relationships might be contributing to a person’s problems.2

How to Get Started

If you are interested in behavioral therapy, there are some things that you can do to get the most out of your treatment.

• Find a behavioral therapist. Some mental health professionals who can provide behavioral therapy include counselors, psychologists, psychiatrists, and social workers.
• Ask for recommendations. If you aren’t sure where to begin your search, it can be helpful to ask your primary care physician for a referral.
• Contact your health insurance. Find out if your plan covers behavioral therapy and, if so, how many sessions.
• Set goals. Once you begin treatment, discuss your goals. Knowing what you hope to accomplish can help you and your therapist create an effective treatment plan.
• Be an active participant. In order for behavioral therapy to be effective, you need to be committed to participating in the process.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a type of psychotherapeutic treatment that helps people learn how to identify and change the destructive or disturbing thought patterns that have a negative influence on their behavior and emotions.1

Through CBT, faulty thoughts are identified, challenged, and replaced with more objective, realistic thoughts.