Emotionally Focused Therapy (EFT)

Love Sense (Sue Johnson)

We live in an age of emotional isolation with more of us now living away from our families and supportive communities. We've asked our romantic partners to fill this voice. Since the 1980s the number of Americans saying they only have their partners to confide in has increased by 50 percent.

Some conclusions from our the most current research findings about love:

• Our primary instinct is "to seek contact and comforting connection." "Bowlby proposed that we are designed to love a few precious others who will hold and protect us through the squalls and storms of life." Our drive to bond arose because human babies cannot survive on their own and require years of nurturing. Natural selection thus wired into our brains "an automatic call-and-response system that keeps child and parent emotionally attached to each other."
• Adult romantic love is an attachment bond just like the one between a mother and child. We never lose the need "to depend on one precious other" and transfer this need from our primary caregiver to our mother. 
• Secure attachment leads to good sex, not the other way around. Monogamy is our natural state. (??)
• Emotional dependency is not pathological but is actually a sign of mental health. Look at the studies of institutionalized children deprived of love and touch who suffered from brain abnormalities and died young. Or look at how prisoners in solitary confinement suffer. Study after study shows that married people live longer and healthier lives than singles. 

Past approaches to couple counseling. (1) Analytical: let's dig into your childhood experiences to understand why you act the way you do. (2) Practical: let's teach you how to communicate more effectively, how to negotiate and compromise, how to do things to spice up your sex life, etc. "Ultimately, these remedies are ineffectual because they don't address the source of relationship distress: the fear that emotional connection -- the font of all comfort and respite -- is vanishing." The best way to help couples is to strengthen their emotional connection. This is what Emotionally Focused Therapy (EFT) does.

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University of Amsterdamn study. Two groups of low-income mothers: only one given six hour class on recognizing baby's signals and providing prolonged soothing activities. In follow-up, the infants in the first group "matched normal babies in their ability to turn to their mothers for comfort when they were upset and to calm down when soothed by them." In second group, only 28 percent of infants were securely attached.

Bowlby/Ainsworth found four elements of attachment:

• We seek out, monitor, and try to maintain emotional and physical connection with our loved ones. Throughout life, we rely on them to be emotionally accessible, responsive, and engaged with us.
• We reach out for our loved ones particularly when we are uncertain, threatened, anxious, or upset. Contact with them gives us a sense of having a safe haven, where we will find comfort and emotional support; this sense of safety teaches us how to regulate our own emotions and how to connect with and trust others. 
• We miss our loved ones and become extremely upset when they are physically or emotionally remote; this separateion anxiety can become intense and incapacitating. Isolation is inherently traumatizing for human beings. 
• We depend on our loved oones to support us emotionally and be a secure base as we venture into the world and learn and explore. The more we sense that we are effectively connected, the more autonomous and separate we can be. 

The Strange Situation. Almost all babies cried and protested when their mothers left. Those with warm and response mothers: "calm themselves quickly, easily reconnect with their moms, and resume exploratory play." Those with emotionally inconsistent mothers, mothers who are sometimes warm and sometimes cold: "stay upset and nervous and turn hostile, demanding, and clingy when their moms return." Those with cold and dismissive mothers: "evince no pleasure, distress, or anger and remain distant and detached from their mothers."

A lover is not just a friend plus sex. "No matter how close, friends cannot offer the degree of caring, commitment, trust, and safety that true lovers do. They are not our irreplaceable others."

(1) Securely attached people "see themselves as generally competent and worthy of love, and they see others as trustworthy and reliable. They tend to view their relationships as workable and are open to learning about love and loving." (2) Anxious people "tend to idealize others but have strong doubts as to their own value and their basic acceptability as partners. As a result, they obsessively seek approval and the reassurance that they are indeed lovable and not about to be rejected." (3) Avoidant people supress any doubts that they are not worthy of love. "They have a negative view of others as inherently unreliable and untrustworthy."

Jeff Simpson studied attachment by observing couples. Just as Bowlby predicted, Simpson found that secure and anxiously attached people "tend to reach for those they love for comfort while avoidant people tend to withdraw." Surprisingly, Simpson found that this result is only true when a threat comes from outside the relationship but not when it comes from within the relationship. When discussing a problem within the relationship, both secure and avoidant people can remain emotionally calm and on-topic (although secure people are warmer and better at discussing solutions), while anxious people do not reach out but instead "catastrophize, bring in irrelevent issues, and become angry and confrontational, even when their partner refrains from being reciprocally hostile."

When a relationship is ending, anxious people tend to go through love and hate -- longing for the partner, desiring the partner, and reacting with extreme hotility and even violence -- while avoidant people cope by further withdrawing from their partner. 

Primal panic results when we lose or fear we're losing an attachment figure. Stages of separation distress: (1) anger and protest, (2) clinging and seeking, (3) depression and despair, (4) detachment (i.e., accepting that the relationship is over and deciding to let it die). EFT aims to halt this sequence of events, teaching couples to "turn toward each other and reveal our fears and longings." 

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Paul Ekman's six innate and universal emotions: fear, anger, happiness, sadness, surprise, shame. Affect labeling: naming our own feelings can calm the intensity of those feelings, and we can use this strategy when having conflict with our spouses -- e.g., "I notice that Paul is feeling sad, and that makes me feel anxious." 

Reappraising a tough emotional situation is more helpful than suppressing or stifling your emotions. Stanford's James Gross had people watch a disturbing scene (e.g., someone vomiting): half the people were asked to suppress their emotional reactions (e.g., "keep face still") or reappraise the scene and view it from the perspective of a medical practitioner. The first group showed more activity in the amygdala and had a greater emotional reaction as it took great energy holding back their reactions, while the second group had reduced emotional reactions and showed greater activity in the prefrontal cortex. If we have difficult emotions with our partners, we should share them, not bottle them up. Confiding "helps us reorganize our thoughts and responses, get clear about our priorities, receive new information and feedback, and feel comforted and calm." 

Mario Mikulincer: securely attached people have the least fear of death. "Anxiously attached people's fears center around not mattering to anyone anymore and leaving others. Avoidant people's fears focus on the unknown nature of death."

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Thomas Boyce and Bruce Ellis: dandelion children will thrive in all environments, whole orchid children will only thrive if they receive high quality parenting. Danielle Dick studied 400 children with a gene (CHRM2) implicated in alcoholism, antisocial behavior, and depression. Dick found that children who had the gene but more distant parents tended to exhibit bad behavior, while those children with involved parents did much better.

Oxytocin: "the cuddle hormone," "the monogamy molecule." Being close to a loved one or even just thinking about them can trigger a dose of oxytocin. Anna Buchheim: study showed that a whiff of oxytocin "increases our tendency to trust and engage with others in a less defensive, more empathetic way." Oxytocin decreases the strength of the amygdala. Researchers believe that oxytocin increases dopamine levels, allowing us to feel a high when around a loved one. Oxytocin also reduce stress, further allowing couples to bond.

We're innately empathic. Tania Singer: sat two women side-by-side; when first woman received an electric shock, the second woman (who had not received a shock) reacted as though she had and the same region of her brain lit up (the same pain circuit being activated). So why then do couples sometimes not respond to one another with empathy? (a) Autism. (b) Stress or depression may have exhausted our mental resources. (c) We're simply distracted -- e.g., our fear of upsetting or losing a couple prevents us from focusing on their anguish. We're thus better able to love our better when we manage our own emotions well. Also, as Omri Gillath found, when we're securely attached, we're better able to manage our emotions.

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Avoidant people have "sealed-off sex" -- it is "self-centered and self-affirming, a performance aimed at achieving climax and confirming one's own sexual skill," no cuddling afterward. Anxious people have "solace sex" -- it is used as "proof of how much they are loved."

"A secure bond is characterized by emotional openness and responsiveness in the bedroom as well as out. That leads to better communication and engaged, focused attention, which in turn leads to greater arousal, pleasure, and satisfaction." Secure partners "are able to express their needs and preferences." Because they feel safe, they have "the freedom to explore and be sexually adventurous." Secure lovers "tend to confident about their physical attractiveness, sexual desirability, and skill." Secure people state that "they prefer to have sex in a committed relationship and that affection and expressions of love are key parts of their sexual experience."

Bad sex doesn't ruin a relationship; rather, bad sex is a bellwether that the emotional bond has weakened and the relationship is in trouble. "For more secure people, good sex can help overcome minor misattunements and even more serious difficulties."

Monogamy "tends to be the rule in [mammals] who must invest time and effort to ensure survival of their offspring and the species as a whole." For example, humans as well as the California mouse, pygmy marmoset, beaver, and gray wolf "are all biologically wired to attach to those who depend on them and to those upon whom they depend." All of these mammals produce oxytocin, both parent-to-child and partner-to-partner.

Rene Hurlemann administered an oxytocin nasal spray to men, and those men in committed relationships kept more physical distance between an attractive, unfamiliar female.

"The truth is that we stray and have affairs not because we are all naturally inclined to have multiple mates but because our bond with our partner is either inherently weak or has deteriorated so far that we are unbearably lonely." Some say that it's impossible to sustain passion. "This is true -- if we do not know how to invest in the security of our bond or if we only know how to have sealed-off, avoidant sex. More and more novelty is necessary to sustain attention if sensation and performance alone are the focus of intercourse. Then familiarity becomes the death knell of exciting sex. For secure partners, however, rigorous studies and surveys show that the thrill can last indefinitely." University of Chicago survey showed that "sexual satisfaction and excitement for both men and women increases with emotional commitment and sexual exclusivity."

Omri Gillath and Melanie Canterberry: showed men and women arousing pictures; both of their brains lit up, but only in women did the prefrontal cortex and other parts of the brain associated with decision-making light up. Conclusion: women are concerned with safety, and they can only lust if they feel safe. Rosemary Basson: women need more than touch to get turned on; they also need to feel satisfied in the relationship and emotionally intimate.

Women with lower libidos need "more sensual, teasing foreplay to cement their sense of security and move into the awareness of desire and arousal." "For men, that means overhauling their view of female sexuality and adjusting their verbal and physical approaches to make it apparent that there is desire for the person, not just for orgasm."

"Porn addiction is a perfect example of the consequences of cutting off sex from attachment and connection with others. Sex and attachment are meant to go together. Most addictions are, at base, desperate attempts to find a substitute for secure attachment to others. But such substitutions cannot satisfy, and they are destructive to healthy, happiness, and even, ultimately, to sexual functioning. As men become accustomed to porn's high-octane stimulation, they become desensitized to the pleasures and the physiological highs of regular sex. When they are with a real partner, they find themselves unable to become aroused. Urologist Carlo Foresta, professor at the University of Padua, has found from his surveys that 70 percent of the young men seeking help for sexual performance problems admit to routinely using porn. He suggests that a numbed-out sexual response system resulting from obsessive use of porn, not performance anxiety, is now one of the main causes of erectile dysfunction (ED). Clinicians are finding that if men can abstain from porn for a period of time, their physiology eventually recalibrates, their sexual performance improves, and their libido rekindles."

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Different periods of a relationship, each containing shifts that are actually "potential bonding crises in which our need for connection and the nature of our bond is the core issue." (1) The Spellbound Phase, (2) Formal Bonding, (3) Parenthood, (4) Mature Love.

(1) The Spellbound Phase. Paul Eastwick: passion is sexual connection + attachment bonding. "The process of feeling anxious and vulnerable and finding that another can and will respond is the basic building block of love." One way to strengthen our attachment bond is to receive someone's comfort when we're feeling vulnerable.

(2) Formal Bonding. Marriage "allows full emotional commitment" by (a) formally transfering attachment from one's parents to one's partner and (b) allaying "anxiety about attachment" and laying "the groundwork for a long-term bond to grow." Ted Huston: the biggest predictor of a marriage's dissolution is a couple's lack of emotional responsiveness.

(3) Parenthood. Becoming parents can be stressful and cause depression. The best response is to strengthen the bond between spouses.

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Unraveling Bonds. Emotional erosion begins with the loss of connection. Lauri Pasch and Thomas Bradbury: partners said that "unsupportive behavior -- minimizing the scope of the problem, discouraging the expression of feelings, offering offhand or unhelpful advice, insisting that their partner follow recommendations -- was especially predictive of relationship distress." Ted Huston: "the chief predictive factor in partners who split was not how often they fought as newlyweds but how much affection and emotional responsiveness they had shown each other."

Criticism can be devastating; the affects of criticism are much stronger than those of praise. "Criticism from loved ones rings the survival alarm bell in our brain; it sets off the deep-seated fear that we will be rejected and abandoned." Criticism from a loved one can be overwhelming, causing "so much hurt and panic" that we find ourselves withdrawing.

Withdrawing (or stonewalling) becomes toxic "when it becomes the customary response to a partner's perceived blaming." A relationship is a dance: "If there is a stumble, you pause to get your balance and then resume moving. But if you wait too long, your partner gets the feeling you don't want to continue the dance."

The sudden snap. Relationship wounds. E.g., infidelity. Most affairs are not about sex but about "the hunger for connection and not knowing how to satisfy this hunger with one's partner." Failures of empathy, not being there when our partner needs us, can result in serious wounds. 

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Love relationships require couples to continually readjust their level of emotional engagement. Even the best couples regularly become attuned to one another and need to readjust. Ed Tronick: monitored interactions between mothers and their children and found that "even happily bonded mothers and infants miss each other's signals fully 70 percent of the time. Adults miss their partner's cues most of the time, too! We all send unclear signals and misread cues. We become distracted, we suddenly shift our level of emotional intensity and leave our partner behind, or we simply overload each other with too many signals and messages." "What matters is if we can repair tiny moments of misattunement and come back into harmony." John Gottman: master couples fight but show "the ability to repair routine disconnections."

What partners must do to move from antagonism to harmony (i.e., having a Hold Me Tight conversation):

• Tune in to and stay with their own softer emotions and hold on to the hope of potential connection with the loved one.
• Regulate their emotions so they can look out at the other person with some openness and curiosity and show willingness to listen to incoming cues. They are not flooded or trying to shut down and stay numb.
• Turn their emotions into clear, specific signals. Messages are not conflicted or garbled. Clear communication flows from a clear inner sense of feared danger and longed-for safety. 
• Tolerate fears of the other's response enough to stay engaged and give the other a chance to respond. 
• Explicitly state needs. To do this they have to recognize and accept their attachment needs.
• Hear and accept the needs of the other. Respond to these needs with empathy and honesty. 
• React to the other's response, even if it is not what is hoped for, in a way that is relatively balanced and, especially if it is what is hoped for, with increased trust and positive emotion. 
• Explore and take into account the partner's reality and make sense of, rather than dismiss, his or her response. 

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Love in the 21st Century.

• Against plastic surgery. "Yes, these procedures can make us look younger, but so often they leave faces immobile and blank, wiped of laugh lines, furrowed brows, and all the other little signposts of emotion."
• We need to make more time for love -- not be such workaholics, need to give new parents more time off (they have one year in Canada).
• People are too disconnected in cities, people live in the same apartment complex without knowing one another. 
• Technology. 
• Roots of Empathy (ROE) program for children. 
• Leadership. Michael Kraus: the biggest predictor of which team would win the 2008-09 NBA finals was "the number of times team members reached for and touched each other in the first game." Mario Mikulincer: IDF troops most wanted to nominate soldiers for leadership positions who had secure attachment styles. Mikulincer: avoidant leaders "demoralize followers, reducing enthusiasm for group tasks," while anxious leaders "doubt their own abilities and communicate uncertainty to subordinates, and that makes the team hesitant to act and lowers productivity." 
• Secure individuals are more self-actualized, showing "fewer discrepancies between their stated actual and ideal traits." 
• Since secure people "live in what they perceive as a safe world, they are less self-absorbed and less preoccupied with threats than are anxious or avoidant people. This enable them to focus on, empathize with, and be tolerant of others." Mikulincer: after attachment-priming, subjects felt more compassionate for others. 
• AmericCorps promotes community-building.