DIAGNOSIS: Relationship Distress With Spouse or Intimate Partner
TREATMENT: Emotionally Focused Couples Therapy

2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Strength of Research Support

Empirical Review Status
2015 Criteria
(Tolin et al. Recommendation)
Very Strong
Insufficient Evidence
Treatment pending re-evaluation
1998 Criteria
(Chambless et al. EST)

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Brief Summary

  • Basic premise: Emotionally Focused Therapy for Couples (EFT) is attachment based and conceptualizes the negative, rigid interaction patterns and absorbing negative affect that typify distress in couple relationships in terms of emotional disconnection and insecure attachment. Change in EFT is presumed to occur, not from insight, catharsis, or improved skills per se, but from the formulation and expression of new emotional experience that transforms the nature of the interactional drama, particularly as it pertains to attachment needs and emotions.
  • Essence of therapy:  EFT draws on humanistic and systemic principles to help create a more secure attachment bond in a relationship. This model integrates the intrapsychic perspective afforded by experiential approaches with an interpersonal systemic perspective to help distressed partners shape emotional accessibility, responsiveness, and engagement—the key elements of attachment security.  The process of EFT involves three stages. The first stage, cycle de-escalation, helps the couple understand how their negative interactions drive a self-reinforcing cycle of distress. At the end of this stage, the couple has internalized that the problem is their self-reinforcing cycle associated with attachment disruptions leading to reframing the problem as their negative cycle. The second stage, restructuring interactions, involves the shaping of new core emotional experiences, and new interactions that lead to a more secure connection. Partners are encouraged to explore and share their attachment vulnerabilities and needs with their partner in session, in focused, structured enactments. These events create new constructive cycles of contact and caring, fostering secure attachment. The third stage of EFT, consolidation, involves helping couples use their more secure attachment bond and improved relationship functioning to solve problems in their everyday lives and create a story of resilience and mastery in their relationship. EFT couples therapy also uses the same 5-step process as EFT individual and family therapies to foster change.
  • Length: EFT is a brief short-term therapy that typically takes between 8 to 20 sessions to move a couple through the three stages. As a rule of thumb the first stage, de-escalation, generally requires 75% of the total number of sessions for a couple to de-escalate their emotional distress when triggered and reliably create emotional safety outside of the therapy office. Once that occurs, the second stage, deeply connecting/bonding, utilizes all but a few of the remaining sessions set aside for the final stage – consolidating gains. A variety of confounding variables can increase the number of sessions needed.

Treatment Resources

Editors:Robert Alan, PhD; Don Zeidlhack, PsyD

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals
Books Available for Purchase Through External Sites

Training Materials and Workshops

Measures, Handouts and Worksheets

Self-help Books

Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.

Video Demonstrations

  • Professionally developed training videos demonstrating all aspects of Emotionally Focused Couples Therapy are available by following the link to the International Center For Emotionally Focused Therapy and looking under the “Therapist Resources” section. A sampling of the titles to be find there include:
    • Emotionally Focused Therapy Step by Step: a complete online course
    • Shaping Secure Connection: Stages 1 & 2 of Emotionally Focused Couple Therapy
    • Facing The Dragon Together. EFT with Traumatized Couples

Video Descriptions

Clinical Trials

Meta-analyses and Systematic Reviews

Other Treatment Resources