Relationships with parents, siblings, and other family members pass through certain passages and obstacles as they progress through the life cycle. Resilient families reorganize their relationships to respond to changing demands and stress factors within the family system. Those who fail find themselves in recurring patterns marked by conflict and distress, often resulting in the need to seek treatment.
Emotionally Focused Family Therapy (EFFT), based on attachment theory, is a pragmatic, short-term treatment approach designed to alleviate distress in family functions. This article provides an overview of the EFFT process, its theoretical underpinnings, and the strategies EFT family therapists use to promote positive outcomes.
Over the past 20 years, research studies have shown the effectiveness of emotionally focused couple therapy (EFT) in helping couples repair their troubled relationships. The natural extension and broader application of EFT couple therapy can be particularly valuable and effective when working in a family system. The basic principles of Emotionally Focused Couple Therapy are based on attachment and attachment theories that aim to help individuals gain greater awareness of their emotions and provide them with strategies to effectively cope, regulate and transform their emotions.
It is a short-term, evidence-based approach that allows the therapist to set goals, target basic processes, and identify and eliminate emotional blocks that prevent healthy functioning of couples, and provides alternative approaches that serve this. It increases the bonding and belonging levels of attention, empathy, and emotions.
According to Johnson, EFFT is similar to emotionally focused therapy for couples, with the only difference being that the purpose of families is to “change family relationships towards increased accessibility and responsiveness so that the family builds a secure foundation for the growth and separation of children.” Working within a larger family system can be particularly daunting when therapists try to navigate the landscape of broad family dynamics that encompass multiple, complex interpersonal processes between members, particularly the strong bonds that exist between parent and child, which are often strong when weak and disconnected and may be the root of the dysfunction. The essence of a family’s human experience lies in its ability to create supportive bonds that sustain it during turbulent and stressful times in its life cycle.
EFFT Steps and Stages
The EFFT process is divided into three stages and nine treatment stages. In the first four treatment steps, the therapist carefully focuses on evaluating the family’s interactive styles and works logically to mitigate any conflict that arises. During the middle stages of treatment (steps five, six, and seven), the therapist and family work together to find new ways to establish safer family relationships. In the last two stages of treatment, the therapist emphasizes and confirms new patterns of positive interaction.
More importantly, the therapist strengthens family members’ confidence to deal with future conflicts and problems as they are now armed with greater empathy and understanding for each other. The stages and steps of EFFT are summarized and discussed below. The process steps are generally as follows;
• Step 1: Building an alliance and family assessment.
• Step 2: Identify patterns of negative interaction that continue to be insecure.
• Step 3: Access to basic emotions that inform about positions of interaction / relational blocks.
• Step 4: Reframing the problem in light of relational blocks and negative interaction patterns.
• Step 5: Accessing and deepening denied aspects of a child’s self and attachment needs.
• Step 6: Encourage the child’s new experience and acceptance of attachment needs.
• Step 7: Reconfiguring family interactions, focusing on sharing attachment needs and supportive caregiving responses.
• Step 8: Discovering new solutions to past problems from more secure locations.
• 9 Steps: Reinforcing new positions and strengthening positive patterns.
The explanation of the first main three steps is as follows;
In phase one, the primary focus is on identifying and tracking behaviors and secondary emotions that fuel attachment insecurities. The therapist guides the family to develop a more careful awareness of what underlies the difficulties they express, without focusing on the content of their current conflicts. The therapist accomplishes this task by tracking familial behaviors caused by intense emotions. As therapists understand, in times of distress, family members often deal with their emotions and interpersonal behavior in unproductive ways.
Some may retract, discuss, obey, explain, or engage in other behaviors designed to minimize their emotional pain and distract them. During this phase, the Therapist pays close attention to the family’s interactive behaviors and reframes the maladaptive or secondary emotional responses in their efforts to become aware of the negative interaction cycle. The negative cycle is defined as a predictable model of interaction that repeats and organizes the family around insecurity rather than vulnerability.
Tracking the cycle disrupts the behavior and for the first time shows the family their true underlying emotions and how their current behavior serves as protective mechanisms to avoid discomfort and pain. Access to primary emotions such as fear, hurt, and sadness creates empathy among family members, facilitates sensitivity, and helps the family calm down (rather than vulnerability.) Negative cycles are tiring and destructive for family functioning.
At this stage of treatment, the therapist often returns to using follow-up interventions to reaffirm the importance of understanding and coping with family discontent to improve family stability and healthy functioning.
In the second phase, the focus is on deepening and expanding primary emotions and unmet attachment needs to reshape bonding bonds between family members who are more secure and connected. The change event in the second stage involves the therapist accessing needs embedded in the new expanded primary emotions that drive the negative family cycle; and helping family members learn to identify and demand basic attachment needs not previously expressed.
The therapist deliberately configures interventions known as reenactments that function to reconstruct bonding ties between family members. Typically, these demands are for direct care, contact, or comfort, and the transition is based on parents’ ability to respond to their child’s vulnerability. It is very common at this stage to observe that parents have a desire to react to their children in a more emotionally connected way, but their empathy may be restricted. In such cases, the EFFT therapist will work with parents to develop their responsiveness and abilities to replace negative and harmful interaction cycles by shifting family relationships into more secure bonds.
This phase is the consolidation phase. Finally, in the third phase of EFFT, positive attachment cycles are reinforced and integrated into the family’s life. At the end of this phase, the family can best integrate new ways to participate in discussions and invest in more security. Discussions are characterized by greater openness, responsiveness, and participation among family members. It is imperative that the family learn how to repair attempts to connect outside of failed sessions. The therapist acknowledges that before it ends, the family can now deal with problems and conflicts by examining and resolving them in new and more effective ways. The therapist also focuses on strengthening the family’s vision, including positive impact, vulnerable access, and increased attention to connection.
Treating families in distress is extremely difficult for family therapists. Professionals working with families, particularly novices, often feel insecure and discouraged when trying to navigate an environment of broad family dynamics that encompass multiple, complex interpersonal processes between members. As a result, family therapists find themselves negotiating or presenting solutions rather than focusing on the underlying problems of the dysfunction.
Unfortunately, they soon realize that the techniques used are not effective, and soon family members are back where they started. This makes the therapists feel incompetent and ineffective and may therefore be reluctant to do family chores.
Access to a practical, organized and effective model for working with families is essential if practitioners are to make meaningful differences in the lives of the people they serve. EFFT emerged from the realization that the principles of change used in EFT can be applied to family relationships and thus the loops of interaction can be changed. EFFT is a powerful and efficient way to evaluate and create positive change within the family system. In essence, EFFT sees family distress as a result of insecurity of attachment when family members cannot meet their attachment needs.
Such families do not have the skills to express their attachment needs, and by protecting themselves by defending, they initiate a negative cycle of interactions that hinders healthy family functioning and stability. Accessing the underlying attachment-related feelings and the needs associated with these feelings opens the family to address needs in new ways. Corrective emotional experiences create security that alters family relationships and most likely affects future generations. It is powerful to take advantage of parents’ unconditional love; It gives great hope to families and offers tremendous hope in revitalizing the field of family therapy.
Author: Ozlem Guvenc Agaoglu