The Practice of Emotionally Focused Couple Therapy: Creating Connection

by Sue Johnson

Since its original publication in 1996, this volume has been a helpful guide to therapists in the practice of emotionally focused therapy. This second edition addresses the many changes in the field of couples therapy, including updated research results linked to clinical intervention and new information on using EFT to address depression and PTSD. A new section covers the growth of couples therapy as a field and its overall relevance to the mental health field, accompanied by coverage of how recent research into the nature of marital distress is consonant with EFT. Other new features are a section on EFT and feminism, as well as a section on cultural competence for the EFT therapist.

Written by a leading authority on emotionally focused couples and marital therapy, this second edition is an up-to-date reference on all aspects of EFT and its uses for mental health professionals.

Genres: Psychology, Relationships, Counselling, Marriage, Nonfiction, Mental Health, Professional Development

361 pages, Paperback

First published August 1, 1996

About the author

Dr. Sue Johnson is a leading innovator in the fields of couple therapy and adult attachment; she is the primary developer of Emotionally Focused Couple and Family Therapy (EFT). Sue’s received numerous awards acknowledging her development of EFT, including the American Psychological Association’s “Family Psychologist of the Year'' and the Order of Canada, both in 2016.

Her best-selling book Hold Me Tight (2008) - with 1 million copies sold as of 2021 - has taught countless couples how to enhance and repair their relationships and has since been developed into a relationship enhancement program called Hold Me Tight Online.

As the founding director of the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT), Sue trains counselors in EFT worldwide and provides guidance to 80 affiliated centers. You can find out more about Sue and her work at drsuejohnson.com.

Reviews

[Morgan Blackledge · Rating 4 out of 5]

Emotion-Focused Therapy (EFT) is a therapeutic modality, grounded in attachment theory. EFT assumes that emotions are fundamental to identity and relationship, and that a lack of emotional awareness or avoidance of emotions (difficult or otherwise) can lead to problems.

All kinds of problems.

EFT seeks to improve the emotional bond between partners in relationship. And most importantly, to mellow OUT on the (approach - withdrawal) and (criticize - defend) dynamics that can MURDER even strong relationships.

I’m a therapist.

I see A LOT of couples.

It can be VERY demanding work.

EFT is very helpful.

Although EFT is mostly known as a couple therapy.

I also use it A LOT with individuals.

It’s a wonderful dimension of therapy to work in.

I highly recommend becoming familiar with it.

As far as therapy manuals go.

This one is pretty good.

Although it’s painful in sections.

It’s good enough.

4/5 stars ⭐️

[K · Rating 3 out of 5]

Rating this book fairly was a challenge for me, and I finally decided on the good old 3-star fallback simply because I didn't want to rate it overly high or overly low. This book took me forever to finish, but I can't decide whether that's attributable to a flaw in the book or whether it's just circumstantial that I'm not seeing any clients right now who seem right for this approach. The book is informative and clearly lays out a way of doing therapy with couples; unfortunately, the session scripts seemed so hokey that I couldn't see myself applying the concepts or imagine any of my clients embracing these interventions so readily and pouring forth with insight and emotion the way the ones in the book do.

A typical example (I just opened the book randomly and got this):

Therapist: So can you ask her, please, "I want you to start to get out of your tank. I want to be close."

Martin (to the therapist): Yes, I do want that. After all, then everything would be better -- and the problems with her family would be...

Therapist: Martin, can I interrupt you? Can you look at your wife and tell her that please -- that you want her to get out of her tank and let you in?

Martin (turns to his wife and looks at her): Yes, I want that -- for you to let me in, and I'm not going anywhere. I want to be beside you, not in the next yard. I want some tenderness, and I want to give it back.

Therapist: How does it feel to say that, Martin?

Martin: It feels good, like it's real, and I feel taller for saying it. (Therapist nods and smiles)

Therapist: What is it like for you to hear that, Susan?

Susan: It's a bit scary, but, well, I think I like it, and (to her partner) I really like that you wanted to say it enough to risk it; it's different. It's more like when we were first together.

As an aside, I started reading a different one of these case illustrations to my husband and he stopped me after two lines with, "Please, you're making me want to puke." But in all seriousness, I don't know whether it's just that I'm an inexperienced therapist, but I can't imagine the above dialogue taking place with any of my clients; they are SO not at that place. Maybe the book felt it would be a waste of time to include dialogue from the earlier sessions where the clients are screaming at each other and it's all the therapist can do to simply contain them, but it might have been helpful for me to see more dialogues where the session wasn't going so well, the hostility was high and the insight was low, and to see how the emotionally focused therapist deals with a couple who isn't smoothly going along with the process. I also couldn't help wondering, if they were that emotionally in-tune and insightful, why would they need me? Is it my goal to get my clients to sound like they're in some touchy-feely film like "Stepmom?" And is that at all realistic?

[Scott · Rating 4 out of 5]

What I like most about the EFT approach is that it incorporates attachment concepts into couples therapy. The romantic relationship is an attachment relationship, and is affected by previous attachment relationships, especially the one with your caregivers in your early childhood experiences. Those are enduring and affect you throughout your life as an attachment style that you carry with you. Fortunately, attachment styles can change--if the early experiences were ones that fostered insecurity, greater attachment security can be gained, most notably through positive attachment experiences in a couple relationship. The EFT approach aims at repairing the couple relationship by attending to attachment needs, and to change patterns of interaction in the couple relationship that are triggering maladaptive attachment responses.

[Don · Rating 3 out of 5]

I think that emotionally focused therapy (EFT) is a wonderfully insightful and life-changing couples therapy, and I also think that this book, though containing excellent information and great examples, can at times be repetitive and sluggish. If you’re looking for an introduction to EFT, I would recommend Lorrie Brubacher’s Stepping into Emotionally Focused Couple Therapy, which is more concise and enjoyable to read.

[Yasaman Riahi · Rating 5 out of 5]

سو جانسون عزیزم، تو نابغه‌ای!
بالاخره یک راه سیستمی، واقعی، انسانی، علمی، عمیق، منطقی و «احساسی» برای کمک به رابطه‌های در گِل مانده و آدم‌های درمانده

[Kelsey Ravindran · Rating 4 out of 5]

So far the reviews I've seen for this text tell me other clinicians in the field aren't the brightest bulbs in the bunch or they're just missing the point. For a text book, this read was very straight forward and easy to follow. Plus attachment theory is just brilliant to know well. This model is proven to be effective and the statistics are undeniable.

[Caryl Brent · Rating 5 out of 5]

I will be forever grateful to Sue Johnson for the best book on psychotherapy I have ever read. Her theory and practice make so much sense to me and more importantly they work.

I just returned from a 4 day workshop in Toronto with
Sue Johnson and Gail Palmer. I learned so much about relationships that will help anyone in a relationship.

[Sarah Ryburn · Rating 4 out of 5]

Definitely written for psychotherapists and probably too clinical for the casual reader.

Johnson's anticipation of current neurobiology research and discovery is impressive, particularly considering that she worked from an exclusively phenomenological base.

[Tess Fragoulis · Rating 3 out of 5]

A tad repetive. The workbook is organized in a much clearer fashion, gives better examples, and is more straight forward.

[Joshua · Rating 5 out of 5]

Practical and compelling. I now have a goal of becoming certified in EFT.

[Paul · Rating 5 out of 5]

I read the new 3rd edition and this is fantastic stuff. I use this every day in my practice and would recommend it to anyone who works with couples and families.

[Shannon · Rating 4 out of 5]

Listed to this via audiobook.

This was a pretty helpful manual for a modality that I'm finding myself increasingly leaning towards in my therapy work. I think it's a softer, more vague approach to psychoanalysis in that it seeks to bring disowned emotions to the forefront, in a manner that reminds me a lot of how older therapies put much stock into exploring the "unconscious." Turns out, the therapist doesn't need to wildly speculate on how various anecdotes, turns of phrases, and dreams can be manufactured and contorted into metaphors that fit within the therapists purview of interpretation. EFT can be quite broadly accomplish what most people need out of therapy, particularly couples therapy, by the therapist merely disarming couples by enumerating the emotions that they can't bring themselves to acknowledge at home. Emotions aren't usually subconscious, they are more often just ignored and misinterpreted. What attracts me to EFT over psychoanalysis is that I think they both necessitate the therapist having to make assumptions so as to create a new, softer, kinder narrative for the clients to facilitate a smoother life. But the assumptions made about emotions are much safer to make (and safer to fuck up) than the assumptions Freud would make about inner thought processes, and subsequently applying his esoteric (and frequently misinformed and occasionally deranged) fixed classification analysis upon his unwitting clients.

EFT as a contrast is far less presumptuous and more straightforward. I found the interventions in this book had a surprising effect directly when used with a couple I had been going in circles with for some time.

I found this book fascinating until about halfway through. There did come a point where I think I more just got burnt out on consuming therapy content than anything else, and it took me a lot longer to finish the second half. But it didn't help that there is an element of EFT that I find to be just a bit painfully sappy and sincere. What I love about the Gottman's is that their work is so rigorously scientifically validated, that their assertations can be made that allow for both of their wry sense of humor and occasional sarcasm to show through. Therapeutic manuals, much like therapists, are better off for having that personality. Sue Johnson isn't so much a phoney as she is relentlessly drippy. I respect her work and I'll use EFT, because I can see where her approach can so thoroughly disarm a client so as to completely redirect their affective interaction with a spouse. But I don't think I'll ever be able to achieve the ideal EFT therapist persona. Because sometimes anger really is the primary emotion, and sometimes merely acknowledging a spouses emotional experience does nothing to increase empathy. It's in those moments that I prefer more of a Gottman or perhaps a Terry Real approach - a bit of a kick in the ass.

[Evan Micheals · Rating 3 out of 5]

I read this as I am increasingly being asked to see couples. I am previously familiar of the work of Sue Johnson and felt the need to brush up on my knowledge of Emotionally Focused Therapy as it relates to working with couples. It reminded me of the circular argument and behavioural cycles that are a feature of how we argue as couples. These are arguments that cause; trigger; effect; then repeat, repeat, repeat, into a negative spiral. Johnson also identifies the: The blame – withdrawal cycle and the withdrawal – withdrawal cycle. Johnson reminds us “The goal of therapy is not to push clients into particular choices but to help them see the choices they already unwittingly make and the choices that are open to them” (p 169). AKA not telling people what to do, but helping them be aware of all the options open to them so they can make their own choice.

This book would be better ‘learned’ in combination with lectures and role plays that support the theory of the book. As just a book the concepts I found the concepts a bit abstract. The book concluded with a number of transcripts drawn from Johnson practice where she applied the concepts described. I found ‘The Peanut Butter Incident’ so familiar of arguments I have had in my relationship where connection has broken down. I suspect a lot of us fall into the same patterns. Easy to see from the outside, not so much when you are in it. If you work at it you may develop the observers mind with your partner of the patterns your engage in.

[Evan Micheals · Rating 3 out of 5]

I read this as I am increasingly being asked to see couples. I am previously familiar of the work of Sue Johnson and felt the need to brush up on my knowledge of Emotionally Focused Therapy as it relates to working with couples. It reminded me of the circular argument and behavioural cycles that are a feature of how we argue as couples. These are arguments that cause; trigger; effect; then repeat, repeat, repeat, into a negative spiral. Johnson also identifies the: The blame – withdrawal cycle and the withdrawal – withdrawal cycle. Johnson reminds us “The goal of therapy is not to push clients into particular choices but to help them see the choices they already unwittingly make and the choices that are open to them” (p 169). AKA not telling people what to do, but helping them be aware of all the options open to them so they can make their own choice.

This book would be better ‘learned’ in combination with lectures and role plays that support the theory of the book. As just a book the concepts I found the concepts a bit abstract. The book concluded with a number of transcripts drawn from Johnson practice where she applied the concepts described. I found ‘The Peanut Butter Incident’ so familiar of arguments I have had in my relationship where connection has broken down. I suspect a lot of us fall into the same patterns. Easy to see from the outside, not so much when you are in it. If you work at it you may develop the observers mind with your partner of the patterns your engage in.

[heidi · Rating 5 out of 5]

I want to swim in the crystal clear waters of this gorgeous theory. It is a profoundly beautiful way of seeing our universal vulnerabilities, of learning how we can better love and be loved.

The philosophy behind EFT is simple, sound, and deeply compassionate. I adore how it can be consistently applied to tap into the soft cores of couple and families stuck in vicious cycles of disconnection. Its experiential style demands an intense presence and patience from the therapist, which holds the potential to fundamentally reshape how someone experiences their sense of self in relationship.

”Movement comes here not as a result of trying to do something different, but as a result of experiencing fully what it is that one does when threatened in the relationship, as well as how compelling and legitimate one’s responses are.”

Thank you, Sue (and Virginia), for all the lives you have touched through your craft. I hope to learn from you and spread your wisdom through my practice.

[Vicky]

I love this book and the theories discussed throughout. It has been so helpful in my work as an early-career psychologist. The concepts are explained in a way that is simple and helpful. It is a great accompaniment to supervision and work with couples. I highly recommend it to others in my position!

I am leaving this book unrated because I ran out of energy and time to read it all the way through. I know that I will pick it back up as soon as my Ph.D. work calms down, but right now I don't have the time to sleep, let alone read!

[Μαρία · Rating 5 out of 5]

Η ανάγκη για σύνδεση είναι έμφυτη, βιολογικά εγγεγραμμένη μέσα μας όπως η πείνα και η δίψα και καμία δεν το περιγράφει πιο σθεναρά, πιο λαμπρά και ευήκοα όσο η Dr. Sue Johnson. Μεταγενέστερη του John Bowlby, μας δίνει άλλο ένα εξαιρετικό απόσταγμα σοφίας, τρυφερότητας και αγάπης ως υπέροχη θεραπεύτρια ζεύγους που είναι. Βασικό εγχειρίδιο για κάθε θεραπευτή ζεύγους ώστε να κατανοήσει και να εφαρμόσει τον τρόπο που θα συμβάλει στο να (επανα)αποκτήσει το ζευγάρι που έχει μπροστά του έναν ασφαλή δεσμό. Διότι, εν αρχή και τέλος, όλα γύρω από αυτό περιστρέφονται πάντα και παντού.

[Panos Chronis · Rating 5 out of 5]

Possibly one of the few complete manuals for practising EFT. The book introduces us to the concepts of attachment theory (Bowlby & Ainsworth) and how it can affect the way we relate, systemic thinking and therapy and the work of Salvador Minuchin as well as the psychological aspects of emotion and embodiment. It continues with very useful clinical examples, where the EFT practices are applied. As a couples therapist, I am very happy that this book exists, as it is a well-written example of a therapists' aid.

[Tamara M · Rating 4 out of 5]

Good book for anyone who is interested in being trained in Emotionally Focused Couple Therapy (EFT). For me it was a required reading for my graduate course - and I definitely learned a lot from it. As any book wrote by someone who is primarely a clinician and not an author, sometimes it might look like it is all over the place, but all in all by the end of it you'll be familiar with the EFT approach, its language and its practices.

[CRTNEAN Licensed Marriage & Family Therapist; MS Clinical · Rating 4 out of 5]

This book does an amazing job of providing an in-depth discussion of the theory of EFT and does a great job of breaking down each stage of EFT into digestible chunks, along with examples and questions to facilitate treatment with couples in therapy. I would highly recommend to any clinician who works with couples in therapy.

[Megan · Rating 5 out of 5]

CNSL 580
Emotionally Focused therapy

[Cass · Rating 1 out of 5]

One of the most repetitive and boring books I've ever read. It's so dry. Information could have been delivered better.

[Nicholas Poveda · Rating 5 out of 5]

Really influential and informative book for those who are interested in EFT. As I’m looking for this theory to be my specialty/modality of therapy, this is a really helpful book.

[Le Shepard - TherapyBooks · Rating 5 out of 5]

Everyone who works with couples should read this book.

[Coosje Van Zwol · Rating 3 out of 5]

Geweldige methode , EFS voor relatieproblemen. Gaat naar de oorzaak en pakt dit aan. Vraagt wel veel van de therapeut. Na lezen ook zeker flinke scholing nodig om dit echt effectief te kunnen doen

[Leandra · Rating 3 out of 5]

One of the best, most clear set of reasons and reflections I’ve ever read. Everything he writes is brilliant.

[Kitty · Rating 2 out of 5]

Full disclosure: I have picked this up sporadically, read different parts out of sequence, and mostly did a lot of skipping of things I already knew.

Two bits of advice: If you are not a therapist, read Hold Me Tight instead. If you are a clinician, take one of Sue Johnson's trainings instead.

Oh, wait-- third piece of advice, specifically for clinicians: She says this approach works for all types of couples. While I appreciate her attempts at being inclusive, just saying something is inclusive of diverse populations doesn't make it so. If you're going to work with LGBTQQIA2S, poly, fetish scene, and/or clients of non-dominant cultures, religions, and ethnic backgrounds, work from that point first before trying to do EFT. This was a modality designed with white, middle class, heterosexual clients in mind. Doesn't mean it doesn't work with all couples; just means you need to be more culturally competent than the average schmo before incorporating EFT.

[Adrienne · Rating 4 out of 5]

This book I believe is a wonderful tool for therapists who are interested in EFT. It took me some time to read through it, however I think it's one of those books that you should take time with and reread sections. I am fortunate enough to be learning under a therapist who has a lot of experience working in this modality and he really brings it to life. I think if I had not had that experience, it would have made the book more difficult to get into. However, if you're a therapist interested in EFT, I highly suggest this book as a foundation block for your learning.

[Elizabeth]

I don't know what they are actually teaching yet. Mostly I know what they are claiming to be teaching but no teaching yet.

[Lindsey · Rating 5 out of 5]

I must read for those interested in couple therapy!