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How and Why Does Emotionally Focused Family Therapy Work?

A brief summary of EFFT, supporting research, and how it can help your family.

Key points

  • EFFT can help children of any age feel emotionally safer with their parents.
  • When children can turn to their parents safely and vulnerably, it builds their health and resilience.
  • In EFFT, parents are expected to change before children because of the hierarchical nature of parent-child relationships.
  • In EFFT, children need to be able to turn vulnerably to parents but not vice versa.

The central tenet of EFFT is that families are not in conflict because of communication problems, parenting failures, or child/parent psychopathology, (although they may be there); they are in distress because they are struggling with attachment and relational challenges like the felt sense of connection, safety, and security in their family bonds. EFFT thus is meant to help restore trust, connection, and family bonds so that each member, especially parents and children, can rekindle their connection to each other.

As you probably know, family discord can become deeply distressing to the point where it feels like your life is in serious danger. Our need for emotional safety in our family relationships, and the powerful emotions accompanying this need, tend to arise sharply and suddenly. Focusing on the content of arguments (i.e why you need to remind your teen five times to do his homework) "misses the forest for the trees" from an EFFT perspective; it's merely symbolic of attachment dilemmas in the parent-child bond. EFFT therapists build an understanding of the dilemmas underlying the content struggling families bring to therapy.

In EFFT, what fights are really about is the child's emotional safety with their parent(s), each child's subjective sense of their parent(s) caring for them (or being there for them), and fear they will not measure up or get hurt in relationship with their parent(s). A child's hard-wired need to pursue and bond with their parental figures and a parent's capacity for their child's emotional accessibility, responsiveness, and engagement, especially in trying times (like a pandemic or financial stress), are essential to the quality of not only family life but also to our individual, social, emotional welfare. Children who know they can turn to parents develop healthier self-esteem and resilience.

In this sense, the EFFT solution is parents' emotional accessibility and responsiveness, and the therapist actively collaborates with parents to rebuild accessibility and responsiveness for their children. In doing so, emotions (the music of the dance of connection in families) are the targets and vehicles of change. This is a crucial difference to couple therapy; with couples, partners' needs are seen as equal, whereas with families, childrens' needs/feelings are usually prioritized. Emotions are fundamental in orienting our perception, creating internal models of self, i.e., as a loved, worthy person, and viewed as responses that help us predict, interpret, and respond in family relationships.

Children need parental (or caregiver) connection to mature, regulate their emotions, grow and develop, and launch their own personal and professional lives; parents need connection with their children to grow as well. In an unpredictable and chaotic world, family is one of our few safe havens. The EFFT therapist reinforces a family’s strengths and works collaboratively to build and strengthen family rituals that promote and encourage family connection and emotional support.

Because attachment needs are naturally healthy and adaptive, parents often seek family therapy because their interactive patterns with their children leave them feeling stuck and disconnected. Children, especially adult children may seek family therapy for similar reasons, but this is less common. In EFFT, these patterns are demarcated as a family's "negative cycles," in which parents, children, and the therapist thus ally to combat as a team. To an EFFT therapist, your child's "bad behavior" is less viewed as a form of oppositional pathology (how you may currently see it if you're a parent), but as grappling with both developmentally crucial needs; independence/autonomy and strong emotional connection to their parental figures.

Effectiveness of EFT and how it was created

EFT (first with only couples, which is why there's only one F in this acronym) was formulated in the mid-1980s by Sue Johnson and Les Greenberg. It developed in tandem with the science of intimate relationships. It views human beings as innately relational, social, and wired for intimate bonding with others. This is why EFT prioritizes emotion as the key organizing agent in individual experience and key relationship interactions.

EFT is best known not only as a highly effective relationship intervention but also for individual depression in a child, teen, or adult, anxiety, post-traumatic stress, and other mental health issues. In the late 1990s, EFT therapists began expanding similar tenets to family therapy, hence the birth of EFFT, starting with families in which children were grappling with eating disorders. To date, three and a half decades of ample research shows it works quickly and effectively. It has consistently helped 73-90% of relationships, even the majority that tolerated up to 7 years of distress before trying therapy (Johnson, 2019).

Conclusion

Family therapy is thus an opportunity to create new emotionally bonding experiences of vulnerability and closeness between parents and children, instead of the stuckness from their negative family cycles. In this sense, the problem families come to therapy with is the pattern of responses they get stuck in when children feel their attachment bond with their parent(s) is threatened. Thus, family relationships break down not because of increased conflict, but lack of connection, decreasing affection, and reduced emotional responsiveness from partners’ stuck responses in their "negative cycles" with their children.

To find a therapist, please visit the Psychology Today Therapy Directory.

References

Palmer, G., & Efron, D. (2007). Emotionally focused family therapy: Developing the model. Journal of Systemic Therapies, 26(4), 17-24.

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